The Looming Tripledemic—Is It RSV, Flu or COVID?

Have COVID restrictions stunted immunity against infection?

By Kamil Macniak/Shutterstock

Americans are set to face a triple threat of infectious diseases as the cold weather season advances.

According to experts, rates of respiratory syncytial virus (RSV), influenza, and COVID-19 are already infecting large numbers of people—and the normal flu season has barely started.

Have COVID Restrictions Stunted Immunity Against Infection?

“Part of the protection against a seasonal viral illness is the result of lingering protection from exposure in prior years,” Dr. Charles Bailey, MD, Medical Director, Infection Prevention Providence St. Joseph Hospital and Providence Mission Hospital, told The Epoch Times.

He explained that the significantly lower incidence of influenza and RSV over the recent two years when COVID shutdowns and other precautions were practiced has now left us without the immune protection from recent prior exposures.

The American Medical Association (AMA) reports that a surge in RSV cases is already overwhelming intensive care units (ICUs).

Dr. Robert G. Lahita, director of the Institute for Autoimmune and Rheumatic Disease at Saint Joseph Health and author of “Immunity Strong,” emphasized that RSV came extremely early this year, and can be especially severe in children who are immunocompromised.

He says it’s happening because the children have been free of immune exposure for the last three years, by not socializing with other kids in school.

Recent research has also shown that prolonged mask wearing could reduce our immune response to infection.

Scientists concluded that wearing masks for long periods “alters immunological parameters that initiate the immune response, making the body weaker in its resistance to infectious agents.”

Dr. Eric Cioe-Pena, director of Global Health for Northwell Health in New York, said he believes masking and other pandemic measures has affected our immunity, but the amount has been overstated.

“I don’t think patients are more severe,” he said. “But I do think the amount of spread of these respiratory viruses has increased because of the relative decrease in antibodies because of how good masking was at preventing a lot of these infections.”

Cioe-Pena noted that masking was better at preventing flu and RSV.

He also mentioned that given there is no vaccine on RSV and the flu vaccine uptake is low, it will be part of the reason for this year’s infection surge.

“I think that for some reason, people are being more lackadaisical about the flu vaccine this year,” said Cioe-Pena. “That’s going to affect severity.”

The Difference Between a Cold, Flu, or RSV

Dr. Christopher Calandrella, DO chair of emergency medicine at Long Island Jewish Forest Hills in New York, said that distinguishing which virus is causing infection can be “challenging” based on symptoms alone.

“All three share similar presentations with cough, congestion, runny nose and other respiratory complaints,” he explained.

While not always consistent, there are some symptoms that tend to be more often associated with one type of infection, noted Calandrella.

“Such as loss of taste and smell with COVID, muscle and body aches with influenza, and wheezing with RSV,” he said. “The onset may be variable with all three, however the flu tends to progress more rapidly compared to RSV and COVID.”

Lahita said that the greatest difference between a cold and RSV is that a cold doesn’t result in an adult or child having difficulty breathing and using accessory muscles, like the abdomen, to get enough air.

“Neither does the flu,” he added, although flu can be as or even more deadly than RSV.

RSV, however, could cause severe breathing difficulty. Lahita described the most obvious symptom of this infection:

“The child becomes tachypneic, which means rapid breathing–using his accessory muscles, not being able to breathe, and winds up on oxygen or in the intensive care unit on a respirator,” Lahita said.

“It’s pretty severe, and this apparently is going through the young population, infants and youngsters below the age of 3.”

Lahita advises that if your child is running a slight fever, and is struggling breathing, using their whole abdomen to help their lungs, and breathing very rapidly, then there is respiratory distress and parents shouldn’t waste time getting a professional opinion.

“Which means they should go to the emergency room and see a pediatrician or call 911,” he said.

Omicron Variant COVID-19 Most Dangerous for Immunocompromised

Unlike previous COVID strains that infect the lower lungs, the current spreading Omicron variant only causes upper respiratory infection, which is more mild.

According to the World Health Organization (WHO), in the year since the Omicron variant has appeared, it has proved to be much milder than previous strains. Yet, it has still caused a significant number of deaths worldwide.

Cases are marked in gray and deaths in blue. WHO

The WHO reports that the recent decline in COVID-19 testing around the world means that the true number of cases might be underestimated.

Lahita noted that this variant is most dangerous for people with weakened immune systems.

“Just like with RSV and influenza, there are adults–that is, people over the age of 12–who have inborn errors of immune function; when they get COVID Omicron, they’re at risk for dying,” he said.

“Somebody who has a known immunodeficiency, like something we call agammaglobulinemia, somebody who’s on chemotherapy and has B cell inhibition, somebody who’s on an immunosuppressant like azathioprine or high dose prednisone,” he continued. “These are people are at risk, because their immune system is already attenuated or weakened.”

Lahita said this means when they get something that’s usually a mild infection, it can be potentially fatal.

There are also some natural inhibitors of immunity, including:

• Alcoholism
• Addiction to cocaine and heroin
• Chain smoking

“These [smokers] are immunosuppressed to a certain degree because of the degree of smoking and we know that somebody who is smoking has attenuated or challenged lungs,” said Dr. Lahita. “We saw that early on in the Alpha COVID pandemic, when people that were smokers were getting sicker and having respiratory arrest more commonly.”

“So there are various subgroups of people who have compromised adaptive immunity,” he continued. “Their inability to make the appropriate antibodies to the viruses, [and] that maybe don’t have natural killer cells that are necessary to combat viral infections—these are people who succumb to the Omicron.”

Bailey said that older adults (those over 65) and young children are at increased risk from any of these three viruses as are those with asthma, diabetes, heart disease, and immunosuppression.

Boosting Our Immune Protection

Lahita said effective ways to boost our immunity include not abusing alcohol, not smoking, keeping a healthy lifestyle and eating properly, and not becoming obese.

“People who are very obese have major problems combating these infections–and this is a known fact,” he said. “In fact the fatter you are, the more likely you are to succumb to COVID in general, not necessarily Omicron, but the Delta is still out there.”

He also recommends we make sure we have enough vitamin D, and to make sure that we maintain high levels of vitamin C.