With winter comes a trio of respiratory illnesses, sometimes referred to as a “triple-demic”: influenza, COVID-19, and respiratory syncytial virus, or RSV. You may be exposed to one or more of these viruses as cold, dry weather drives people indoors, travel increases and loved ones gather.
In Florida, flu and COVID-19 numbers have been relatively low this year, while RSV – an illness that typically affects children – is spreading among adults in the South at an unprecedented rate, said clinician Frederick Southwick, M.D., a member of the University of Florida Emerging Pathogens Institute and a professor in the UF College of Medicine. Healthcare experts are unsure what’s driving the high incidence of RSV, Southwick said.
“Florida is in the middle of a big outbreak of RSV, and that’s accelerating,” Southwick said. “Meanwhile, influenza and COVID-19 look to be flat or decreasing.”
Because all three viruses can spread through the air, people should avoid being in closed spaces with others who are coughing. Surgical masks, when properly worn, can help curb the spread of RSV and the flu, but only N95 masks protect against COVID-19. When visiting loved ones this holiday season, keep in mind that RSV, the flu and COVID-19 pose a particular risk to the elderly.
“If a child has any upper respiratory infections this time of year, they probably shouldn’t see Grandma and Grandpa, or if they do, everybody better wear a mask or be outside,” Southwick said.
Safe, effective vaccines are available for RSV, flu and COVID-19. While these vaccines do not completely prevent infection, they prepare your immune system to fight the virus, lowering your chance of severe illness, hospitalization or death.
If you do get sick, healthcare providers can administer a respiratory PCR test to determine whether you have RSV, flu, COVID-19, or another viral or bacterial infection that often goes undetected, such as chlamydia and mycoplasma, Southwick said.
In between treating patients, Southwick shared more details on winter illness trends in Florida and expert advice on how you and your loved ones can reduce your risk of respiratory disease this season.
RSV is increasing in Florida adults
Respiratory syncytial virus, or RSV, is a highly contagious virus that infects the lungs and breathing passages. RSV typically causes mild, cold-like symptoms in healthy adults and older children. The virus, however, can be severe and even life-threatening in small children, the elderly, and people with compromised immune systems.
RSV – also known as croup – causes the passageways in the lungs to spasm, causing wheezing and upper airway restriction. The virus spreads primarily through coughing but can also be transmitted via contaminated surfaces. In children younger than three months, RSV can cause very severe respiratory illness that leads to hospitalization, Southwick said.
“RSV is dreaded by parents and pediatricians,” he said. “It can make it so difficult for young children to get oxygen into their lungs. Sometimes small children have to be intubated.”
The virus can also cause severe illness in people over 65. Southwick said he has seen a recent dramatic increase in RSV in adults. While the timing is not unusual – RSV season in Florida typically runs from late fall through early winter – “the incidence is much higher,” he said.
Southwick recently examined an elderly patient with RSV, a rarity in his experience. “The tip-off for me was that when you listen to the patient, you hear all kinds of wheezing. RSV can mimic an asthma attack,” he said.
An RSV vaccine, released in 2023, is safe and effective for children, pregnant women, the elderly, and the immunocompromised. As you plan winter shots, Southwick strongly urged that Floridians vulnerable to RSV prioritize getting vaccinated for this virus.
“The RSV vaccine is very cost-effective and reduces the risk of hospitalization considerably,” he said.
Flu rates could still peak in Florida
Influenza is a viral illness that can cause aches, fever, chills, a runny nose and coughing. Anyone can get the flu, but infections can be more severe in children younger than 2, people over 65, those with underlying health conditions and those who are pregnant. Like RSV, the flu can spread through droplets in the air and via contaminated surfaces.
In Florida, flu cases normally increase in October, but recent rates have been low. “Most of the time, Florida is going to have a milder rise in influenza cases than the Northeast, where it’s cold and dry and people are clustered inside because of the weather,” Southwick said.
However, the Sunshine State could still see a peak later this winter. Flu in Florida often ramps up during the travel season as people return home with the virus.
Florida’s current low flu rates should not prompt people to skip getting a shot, Southwick said. The body needs about two to four weeks post-jab to build up immunity. He recommended all adults and children get a flu vaccine. “Now is the time to do it,” he said. “Then when it does peak, you’ll be protected.”
COVID-19 is less severe but more infectious
COVID-19, also a viral respiratory disease, is far more contagious than RSV and the flu, Southwick said. The virus spreads through tiny infectious particles known as aerosols, which can stay in the air for long periods of time.
Recent COVID-19 variants in the Omicron family have been more infectious than the Delta variants from the pandemic’s early days, but they cause less severe symptoms and rarely lead to serious inflammation or pneumonia. However, even mild versions of COVID-19 can pose a serious threat to people over 65 and the immunocompromised, Southwick said.
“Just because we’re seeing milder variants of COVID-19, people over 65 should not be dissuaded from getting a booster. They do need the vaccine, and it could save their lives,” he said. “Immunity wanes about six months after a COVID-19 vaccine, and the older vaccines do not recognize these recent variants.”
People who spend time in closed-in public spaces where they may be exposed to aerosols should also consider getting a booster, which can accelerate their recovery if they do become infected, Southwick said.
It is safe to get the COVID-19 booster and a flu shot at the same time. If you test positive for COVID-19, stay home from work until the home antigen test turns negative, Southwick advised. If you must return to work before then, wear an N95 mask.
Southwick described the original COVID-19 vaccine, which is 92% effective at preventing hospitalization and death, as the most effective vaccine in history.
“You can still get infected, but it’s much milder,” he said. “You’re not infectious for as long, and some evidence now suggests your risk of getting long COVID is also lower. Vaccinations save more lives than anything else.”