Analysis & Opinions - Belfer Center for Science and International Affairs, Harvard Kennedy School

Navigating Through This Season's COVID-19, Influenza and RSV Surge

| Jan. 10, 2024

We are again in the season where multiple respiratory viruses, including COVID-19, Respiratory Syncytial Virus (RSV), and influenza, are prevalent. This concurrent circulation, once termed as a 'tripledemic,' has now become a recurring challenge. Importantly, COVID-19 has no set seasonality unlike influenza where we experience a large surge of cases in the fall and winter and RSV in the winter and early spring.  I wrote about how one of these respiratory viruses, RSV, landed my 3-year-old daughter in the hospital last year. Sadly, thousands of parents experienced a similar fate this year. 

The nation is experiencing high levels of respiratory activity, described as influenza-like-illness (ILI) characterized by fever plus a cough or sore throat. Nearly 7% of outpatient visits are attributed to ILI, surpassing the epidemic threshold defined by the CDC by double. Wastewater trends for COVID-19 also show concerning rises of viral activity throughout the nation though translating wastewater trends into actual infection rates is difficult.

Here are four things to know:

  • We’re close but may not have yet reached the peak for COVID-19 and influenza this season (peak refers to the period during which there is the highest level of disease activity or the maximum number of cases in a particular season). This has two critical implications. Firstly, we may continue to see increasing viral activity and more people getting sick. Secondly, even if the peak is reached shortly, the decline from such a high incidence rate is a gradual process, so the risk of infection will remain elevated. COVID-19 is causing a fresh wave of infections and hospitalizations. Already, 34,000 Americans are hospitalized with Covid-19, an increase of 20% from the previous week. Over 12% of emergency department visits are due to COVID-19. Deaths attributed to COVID-19 have also increased by 12.5%, averaging over 1,300 a week. CDC’s interim flu estimates show there’s been at least 10 million illnesses, 110,000 hospitalizations, and 6,500 deaths from flu so far this season. Luckily, RSV is on the decline though there are regional differences across the states and RSV activity remains elevated. 
  • The good news is we have vaccines and therapeutics against all 3 viruses. The updated Covid-19 vaccine for ages 6 months and older is still effective against the new JN.1 strain, with a new report showing about 60% effective against hospitalizations due to JN.1 and other circulating covid variants. The CDC also reports Paxlovid, the treatment for COVID-19 infection remains effective. The flu vaccine for ages 6 months and older is a good match against the circulating flu viruses this year. Based on data from the Southern Hemisphere, which experiences their flu season before ours, interim data shows the flu vaccine reduced the risk for influenza-associated hospitalizations by 52%. And RSV vaccines are available for adults 60 and older as well as those 32 through 36 weeks pregnant to protect infants. In addition, a new RSV preventative antibody treatment is available for infants and young children. 
  • The same Swiss Cheese Model of covid defense, a layered approach to infection prevention, is effective against all three viruses. Each layer (e.g., masks, social distancing, ventilation, washing hands) contributes to reducing infection risk.
  • The federal government has broadened its Home Test to Treat Initiative, providing free testing, telehealth consultations, and treatment for both COVID-19 and influenza to adults over 18. To find a participating Test to Treat site near you, visit here. This is in addition to the free covid test every home in the U.S is eligible for. 

As we navigate through another season marked by the co-circulation of multiple respiratory viruses, it's crucial to recognize the progress we've made and the resources at our disposal. Unfortunately, only 19% of eligible Americans have received the updated COVID-19 vaccine and less than 50% received this year’s flu vaccine. With elevated activity for COVID-19, flu, and RSV, it's not too late to benefit from vaccinations and available treatments. The Swiss cheese model of defense remains a reliable strategy for reducing infection risks, and the government's expanded Home Test to Treat Initiative offers a valuable resource for managing COVID-19 and flu. As we adapt to this new normal, it's imperative to utilize these tools and strategies to safeguard our health and that of our loved ones, especially the most vulnerable among us. The fight against these respiratory viruses is a collective effort, and by staying informed and proactive, we can navigate this season more effectively.


Statements and views expressed in this commentary are solely those of the author and do not imply endorsement by Harvard University, the Harvard Kennedy School, or the Belfer Center for Science and International Affairs.

For more information on this publication: Belfer Communications Office
For Academic Citation:

Madad, Syra. "Navigating Through This Season's COVID-19, Influenza and RSV Surge," Belfer Center for Science and International Affairs, Harvard Kennedy School, January 10, 2024.