UVA epidemiologist provides update on respiratory illness season

It’s been over three years since the first vaccines came out, making the public health response to the novel coronavirus more manageable. The federal public health emergency ended on May 11, 2023, but the virus itself has continued to evolve. COVID-19 has joined influenza, RSV, and the common cold as one of a series of illnesses that become more widespread in winter months. 

“Early November and mid-November we really saw a lot of RSV amongst our kids and saw that as well in some of our older adults,” said Dr. Costi Sifri, director of hospital epidemiology at the University of Virginia Health System. “I think starting in mid-December we were starting to see also increased rates and increased diagnoses of both COVID and influenza. Those continued into the holidays and this is a pattern we’ve seen before of during the holidays, people come together, they’re traveling, they’re going to church, they’re going to movies, being indoors a lot.”

Dr. Sifri said a peak is being experienced across the entire country, and UVA’s emergency room and clinics are reporting many cases. 

“You know I think we’re in the middle of it, and I think we should find this as a no surprise and it’s probably going to be continuing now for at least several weeks, a couple months, before we start to see reduced rates.” 

With many different viruses out there, there are symptoms that may indicate what a person is carrying. 

“For example, the flu has this characteristic that people may be familiar with that it comes on very rapidly, people feel very sick very quickly often with headaches and high fevers and muscle aches and it’s very abrupt onset,” Dr. Sifri said.

“COVID can sometimes to that as well but occasionally it also has perhaps maybe not as much of a fever component and occasionally has other components such as perhaps more than flu, more [gastro-intestinal] illness, issues like diarrhea,” he continued.

“Then RSV has the ability to cause coughing and wheezing in individuals, particularly in elderly individuals,” Sifri added. 

Dr. Sifri said there is a lot of overlap and people who are symptomatic should test for all if possible. That’s what will happen if you end up hospitalized. It’s not unheard of someone to have more than one virus and knowing for sure can help inform potential treatments. 

Epidemiologists continue to track the structure of COVID and the emerging dominant strain of COVID across the world has the code JN.1, which derives from another strain called BA.2.86 which Dr. Sifri said emerged this past August.

“That was an interesting new variant because it had a significant number of mutations compared to previous variants, so it had 30-plus mutations compared to what had been circulating before,” Dr. Sifri said. “When that type of significant mutational shift occurs in a strain it leads us to be concerned that it can become a major player and cause a large spike of infections. That’s what was seen for example with Omicron when it emerged and was first recognized in South Africa.”

Dr. Sifri said not as much information is being tracked about COVID as had been occurring during the pandemic, but JN-1 is raising more scrutiny but not raising emergency alarms just yet. 

“Based on preliminary information right now, JN-1 is not causing more significant disease compared to previous variants so it does not appear to be causing more proportionally more hospitalizations and other negative consequences of COVID,” Dr. Sifri said. 

Dr. Sifri suggested people who have not received a booster or a vaccination should consider doing so now or wearing a mask in places where lots of people are present. According to data from the Virginia Department of Health, 12 percent of the population in Albemarle and Charlottesville had received an updated COVID-19 vaccine in 2023, whereas 30 percent have received a flu vaccine. 

Remember back to the winter of 2020 and 2021? That year there was a high prevalence of flu. 

“Circling back to thinking about the COVID-emergence, we really had no flu and even no cold symptoms when we did things like those non-pharmacologic measures to protect ourselves from COVID,” Sifri said. “We wore masks. We did some social distancing. We were very cognizant of washing and cleaning our hands. Those are practices that still work.”

Are you making any changes? Let me know in the comments. I’m curious to know what others think as winter continues.

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