Here’s what emergency medicine physicians from across the U.S. have been seeing lately.
- The U.S. is currently in the throes of a “tripledemic,” seeing rising cases of RSV, flu, and COVID.
- Hospital emergency departments often see a large number of patients with respiratory viruses.
- We asked five ER doctors to share what they’ve seen so far, during the surge in respiratory illnesses.
As 2022 comes to a close, the United States is in the throes of respiratory virus season, with RSV and flu peaking at unexpectedly high levels in late November, and COVID cases now starting to tick back up.123
A patchwork of vaccination statuses, prevalence of prevention measures, and other factors across the U.S. has meant that the respiratory virus season looks different depending on where a person lives.
That also means that emergency departments—which often diagnose, treat, and monitor people with severe cases of RSV, COVID, or flu—have had different experiences managing the surge in recent weeks.
We asked five emergency medicine physicians from across the U.S.—Florida, New York, Washington, Michigan, and North Carolina—to share more about what it’s been like dealing with the respiratory virus season this year, how they’ve been handling the influx of patients, and what they’re expecting to see in the next few weeks.
- Chris Griggs, MD, is an assistant professor of emergency medicine at Atrium Health Carolinas Medical Center.
- Brad Uren, MD, is a clinical associate professor of emergency medicine at the University of Michigan Medical School.
- Christopher McStay, MD, MBA, is vice chair of clinical operations in the department of emergency medicine at NewYork-Presbyterian Columbia University Irving Medical Center.
- Carolyn Holland, MD, is an associate professor of emergency medicine and medical director of the pediatric emergency department at the University of Florida Health Shands Hospital.
- Arvin Akhavan, MD, is assistant medical director for operations at the Harborview Emergency Department at the University of Washington Medicine.
Have you seen high numbers of RSV, flu, and COVID in your emergency department in recent weeks?
Dr. Griggs: Yes, I have seen high numbers of viral illness over the past couple of months. We definitely saw RSV spiking probably a month ago—that has been dropping significantly. The flu had been very high over the past few weeks and maybe ticked down a little bit, but it’s still pretty high. And COVID had been in kind of a lull—I hadn’t seen it be as high as the spikes we’ve had in the past, like with Omicron, but it’s certainly starting to tick back up. We’re consistently checking for all those, but there’s also just numerous other viruses.
Dr. Uren: It is busy. And I would say the respiratory illness burden is adding to that strain—it’s not necessarily the entirety of it, but it is one more thing that is making it even busier and even more challenging to do our jobs. We’re seeing a fair amount of COVID still, we’re seeing flu, we’re seeing RSV. We’re having confirmed positive cases of all of those things that are bringing people to the hospital. Not everyone with those diagnoses requires admission to the hospital, but a lot of times they require treatment, and that is consuming those resources and making the ER even busier.
Dr. McStay: Now, what we’re looking at is a viral and flu season that’s probably a little bit worse than usual. So we’re seeing a higher number of flu cases, we’re seeing a larger number of RSV cases—which predominantly impact children—and now, all of that with a background of COVID mixed in. So I would say that it feels a little bit busier than normal. There are a lot of alarmist headlines out there around a lot of organizations in facilities that are struggling. I would say in general, the trends are higher. But we’re coping and managing.
Aside from COVID, flu, and RSV, have you noticed higher case numbers for any other illnesses?
Dr. Griggs: Rhinovirus [is] considered the typical cold virus, but certainly in susceptible patients, it can cause—like in kids—a bronchiolitis, just like RSV can. So we’ve seen kids needing to get admitted to the hospital that had rhinovirus. The names are as long as a sheet—there’s lots of different viruses and lots of different names out there. But just in general, respiratory viruses or ones that cause diarrhea is what I’m seeing the most of. People come in with body aches, runny noses, sore throats, coughs, nausea, vomiting, diarrhea—that could be the flu, that could be COVID, or that could be any of these other viruses, just depending on how the virus interacts with your body.
Dr. Uren: Certainly for COVID or for flu, where we have some specific treatments that we can use for those infections, it does make sense to test people for those specific illnesses. Beyond that, there’s often little value to knowing specifically which virus a person has, because if you don’t have a specific treatment, you are simply treating that patient’s symptoms. So patients with other viruses—rhino[virus], entero[virus] or adeno[virus], or other types of coronaviruses—all of these things present like the common cold. If someone is tested for the flu and tested for COVID and those tests are negative, further testing may not be helpful.
Generally speaking, are you seeing more unvaccinated patients in your emergency department?
Dr. Holland: Just anecdotally—this is not a scientific study—but it seems to me that the majority of [people] that ended up coming to the emergency department for care were unvaccinated. That, I think, just reflects the fact that the [flu] vaccine this year was a good guess by the people who designed the vaccines […] and those people who have gotten sick that are vaccinated have had a very short illness—a couple of days—as opposed to the unvaccinated folks [who] have had their typical longer course of seven to 14 days of illness from influenza.
Dr. Uren: We are seeing people that are both vaccinated and unvaccinated for flu and for COVID that have come in with these infections. A lot of times we’ll see people that are probably feeling the effects more strongly when they are unvaccinated, because usually we’ll get the history of vaccination—particularly for COVID in the history—if someone has come [in] presenting with those symptoms. I don’t know that I could tell you with any certainty that we’re seeing a lot more. It seems like it’s hard to differentiate. It sort of seems even in my experience.
Has the uptick in respiratory illnesses put a strain on your emergency department?
Dr. Holland: This year, I believe we’ll have had more patients in our pediatric emergency department than any other year previously, since we opened. We’re one of the few hospitals in North Central Florida that takes pediatric inpatients to be admitted to the hospital. We have had such high censuses, both in the emergency department and on the floors that we’ve had boarders meaning patients who are admitted to the hospital, but there’s no space for them upstairs, which is extremely rare in our pediatric emergency department.4 We’ve also had to decline transfers from [other] hospitals because we don’t have the capacity to take care of those patients.
Dr. Griggs: Yes, I would say that our emergency department volumes and our inpatient bed capacity has been strained at different times over the past couple of months. I don’t think we’ve quite seen something that will break us here in Charlotte, but certainly there’s been reports in other areas of the country where they’re at more crisis levels.
Dr. Akhavan: I think that, in general, hospital systems, particularly in Washington state, but around the country [are] pretty strained from a capacity standpoint all the time. So anytime we have any uptick of any type of case—whether it be COVID or influenza and RSV this season—it does strain the system. Every time we have a slight uptick in the number of patients, it slows everything down. Especially with patients with infectious diseases like this, we can’t just put them in a room with everybody else—we want to keep other patients safe, keep other patients from getting influenza, COVID-19, and RSV.
Dr. McStay: The reality is a lot of this is predictable. During this time of year, emergency departments nationally see an uptick in the number of viral illnesses in pediatric and adult and elderly populations, and most emergency departments expect it and plan for it. So organizations may be required to stand up or create areas where we care for these individuals in sort of different ways. It’s entirely predictable. And importantly, a lot of the people that get the flu or RSV or any sort of these upper respiratory and viral illnesses, many of them are do just fine. My point is that hospitals and emergency departments set up systems to care for this type of patient population, and generally we do it quite well.
How are you feeling, personally, during this surge of illnesses?
Dr. Holland: I’m constantly looking at the lobby while still taking care of all the patients in the rooms and trying to identify, [if there is] somebody out there that needs attention right now, because it might be hours before I have a space for them to come back and see me. And so I think that stress for all of us in pediatrics, you know, we go into pediatrics because we want to take care of kids. […] That’s been a bit of a disheartening feeling for all of us.
Dr. Akhavan: I think medicine right now is a pretty tough place to work, especially in the post-pandemic time. It’s a hard question to answer. I feel like we’re doing a great job of it here. I’m really proud of everybody that works here and how they’re handling everything. But it definitely gets difficult […] We have to take extra measures to protect ourselves so that we can protect our other patients. And so it does become difficult, but we’re handling it here.
Are you concerned that the situation may get worse after the holidays?
Dr. Holland: Actually, just in the last few days since the holiday break from school, there’s been a decrease in our volumes. And I’m hoping that that’s related to the fact that kids are at home and parents are at home, and there’s less spreading of the germs amongst the small people.
Dr. McStay: As sort of a joke, I got out of the prediction game when it comes to viral illnesses and COVID—there’s such an unpredictable nature to it. Certainly after Thanksgiving, it seems like nationally we saw an uptick in viral illness, based on case numbers, etc. Is that directly related to Thanksgiving travel and people congregating? Or is that not related? It’s so hard to know. As we think about going into this holiday season, people traveling for Christmas, etc., it doesn’t necessarily concern me. We’re seeing rates of RSV drop, we’re seeing rates of flu go up. But these numbers and these trends are very specific to cities and localities. And so it’s hard to make national predictions or to engage in really meaningful predictions.
Dr. Uren: I would say I’m optimistic that we’re seeing a little bit of a plateau in the numbers right now that we’re seeing in the emergency departments. However, I’ve done this enough years to understand that if people get together for the holidays—and we expect to see colder weather moving into the winter and people are going to be driven inside and together more often—I believe we’re not done with this.
Is there anything that people can do to stay safe, or even help remedy the situation?
Dr. McStay: I get questions all the time like, ‘Should I travel, should I go home to see my family, what do I do?’ And I think it still comes down to a lot of those basic things: If you’re sick, stay home. If you’re in riskier environments—New York, and other major cities—[there are] recommendations to think about wearing a mask again, because there’s just high prevalence of viral illness that’s out there. And then, if there’s a vaccine for disease […] you should think about pursuing it.
Dr. Griggs: If you’re a person who has a complicated medical history and you have high risk features, like asthma, or you’re elderly, or you’re less than two years old, trying to get in to see your doctor earlier on in the course of an illness is helpful because there’s treatments that you can use earlier on that are more effective. So definitely, if you’re part of that high risk population, get seen early.
Dr. Akhavan: Get vaccinated, wear masks in public places. I think especially travel—airplanes, stuff like that—are good places to kind of protect yourself as much as possible, particularly if you’re seeing your family and seeing a bunch of people. Probably the most important one: If you’re sick, try to not be around other people, just so that you don’t get other people sick. I know it’s hard because post-pandemic everyone’s excited to be with their families and celebrate things. But just the normal precautions that we would take in any other time, keep taking them and being considerate [of] other people.