Tip/Thought of the Day

Beware the Quadruple Whammy This Fall

It’s not surprising that the fall and winter seasons bring an influx of illnesses. The weather shifts and more people spend time indoors. The school year is in full swing and holiday gatherings will soon begin. Travel occurs as loved ones gather. Over the past several years the traditional “cold and flu” season has morphed this year the expectation is that it’ll be a quadruple-whammy: RSV, the flu, colds, and COVID.

This isn’t to say that we should all panic, however. With proper precautions and awareness of our habits and surroundings we can help prevent serious illness.

Respiratory Syncytial Virus (RSV)

RSV is a respiratory virus that infects the lungs and respiratory tract. In healthy people, symptoms are usually mild and self-limiting. Asymptomatic infections appear to be common and some individuals, including young children, can shed virus for long periods of time. In children and other vulnerable individuals, including many adults, RSV infection can cause serious illness or death. This year we saw the introduction of an RSV vaccine, which can be lifesaving for those with the highest risk of complications and death.

The CDC estimates that every year, RSV causes approximately 60,000–160,000 hospitalizations and 6,000–10,000 deaths among older adults. Adults at the highest risk for severe RSV include:

  • older adults (60+)
  • adults with chronic heart or lung disease
  • adults with weakened immune systems
  • adults living in nursing homes or long-term care facilities.

The CDC also recommends that infants under 8 months and some older babies at increased risk of severe illness caused by respiratory syncytial virus (RSV) receive a newly approved monoclonal antibody shot (nirsevimab) that provides infants and toddlers with antibodies to protect against severe RSV illness. the CDC shares “It provides critical protection during a baby’s first RSV season, when they’re most at risk for severe illness”.


Influenza (a.k.a. the flu) is a respiratory virus that infects the nose, throat, and lungs. The severity varies, but can be mild or very serious, even resulting in death. The CDC estimates that up to 20% of the United Sates population gets the flu each year. The flu isn’t just a bad cold, it can cause serious complications in those at high risk (like the very young, pregnant women, people over 65, and those with a compromised immune system).

  • 200,000 — Average number of Americans hospitalized each year because of problems with the illness.
  • 3,000 to 49,000 — Number of people who die each year from flu-related causes in the U.S.
  • $10 billion+ — Average costs of hospitalizations and outpatient doctor visits related to the flu.
  • 1 to 4 days –– Typical time it takes for symptoms to show up once you’ve caught the virus. Adults can be contagious from the day before symptoms begin through 5 to 10 days after the illness starts.


Covid-19 is the disease caused by the coronavirus, SARS-CoV-2, which can infect the respiratory tract. It can cause mild to severe illness and can lead to death. Asymptomatic infections and presymptomatic transmission are common, making tracking illness and preventing the spread difficult. Variants are aplenty, and According to CDC data, EG.5, sometimes called Eris, accounts for more than 21% of COVID-19 infections in the United States; FL.1.5.1 for more than 14%; and two XB.1.16 variants a total of 18%. A wide variety of variants make up the balance.

The latest variant, BA.2.86, and is a subvariant of the variant Omicron. Scientists are keeping close tabs on this variant as it has more than 30 mutations to the spike protein — which the virus uses to attach to and infect cells — and is why Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center said he and other experts believe it may be contributing to the increase in COVID hospitalizations in the U.S.

There is good news- the first new COVID-19 vaccines updated for this fall season are now expected to be available by the end of September, once both the Food and Drug Administration and the Centers for Disease Control and Prevention sign off on the new shots. The new shots are designed to target the XBB variants — strains of the virus descended from the original Omicron variant — which are now the most common form in circulation.

Hospitalizations due to Covid have never completely been eliminated but had significantly dropped since the last peak in January 2023. Most recently there were 6,400 recorded hospital admissions due to Covid July 1st, 2023 and now nearly triple that amount (17,418) as of August 23rd, 2023.

Serious complications may occur for:

  • people over 65 years old
  • people who are immunocompromised
  • people with certain chronic medical conditions

After infection, some people (estimates range as high as 30% of those who have been infected) also develop long COVID.

Long COVID—or post-COVID conditions—is a wide range of new, returning or ongoing health problems people may experience more than four weeks after being first infected with SARS-CoV-2. According to one large scale study that included over 5,000 people, the most common symptoms of long COVID include:

  • chest pain (up to 89%)
  • fatigue (up to 65%)
  • dyspnea (difficulty breathing) (up to 61%)
  • cough and sputum production (up to 59%)

Additional studies reinforce the findings. One published in June 2022 utilized artificial intelligence to classify tens of thousands of U.S. patients with long COVID using electronic medical records. The main symptom sets the study found include patients who primarily suffer from:

  • Blood and circulatory system issues like heart failure, arrhythmias, and chest pain.
  • Respiratory system issues like throat and chest pain, upper respiratory infections, asthma, and lower respiratory disease.
  • Musculoskeletal and nervous system issues like connective tissue disorders, osteoarthritis, and musculoskeletal pain.
  • Digestive system issues like abdominal and pelvic pain, nausea, vomiting, and disorders of the urinary system.

A study out of Britain, published in The Lancet found that symptoms have been found to impact 10 of the 11 organs, exposing just how destructive the COVID-19 is proving to be on the human body, even well beyond the scope of the initial infection. That same study found that for the majority of people (>91%) that experienced long COVID, the time to recovery exceeded 35 weeks.

How to distinguish between illnesses

Here are some simple ways to protect yourself and your loved ones during cold and flu season.

  • Wash. Your. Hands: It may seem simple, and like a no-brainer, but it is a scary fact that only 66% of people wash their hands after using the restroom. . .so consider how many people don’t regularly wash their hands throughout the day! Washing your hands with soap and water is the easiest way to remove any germs that you may have come into contact with; if you don’t have access to soap and water, hand sanitizer is a good option as well. Make sure you wash your entire hand for 20-seconds, and focus on washing every finger, as well as the nails.
  • Get Your Flu Shot: According to the Centers for Disease Control (CDC), everyone who is at least 6 months old should get a flu shot. It may not be fail-safe, but getting a flu shot can significantly lower your risk for developing the flu and even lessen its severity if you do get it. According to the CDC, “there are many different flu viruses that circulate every year. A flu vaccine is made to protect against the three or four flu viruses that research suggests will be most common.” Even if you end up getting sick from a flu strain that isn’t targeted by the flu shot, getting the flu shot will prevent your symptoms from being as severe than if you had not received the shot.
  • Keep Your Hands Off Your Face: Touching your face with dirty hands is one of the easiest ways to introduce germs to your system. The eyes, nose, and mouth are perfect doorways for germs to enter and cause illness. To protect yourself, be conscious of what you do with your hands- even try to use a stress ball if the habit of touching your face is a form of fidgeting.
  • Disinfect: Cold viruses have been shown to survive on indoor surfaces for approximately seven days. Flu viruses, can stay active from around a few minutes, up to 24 hours. To reduce the likelihood of contracting an illness from touching germ-laden surfaces, disinfect areas with high traffic, like door knobs, computer keyboards, phones, and even steering wheels.
  • Keep Away: This works two ways- if you start feeling sick, stay home. Don’t expose others who may be at high risk of developing complications. Stay away from others until any fevers break and symptoms lessen. If you have the flu, you can be contagious from one day before symptoms show up, up to 5-7 days after symptoms appear. Kids can be contagious even after symptoms disappear. Keeping your distance also works as prevention; since people can be contagious before and after symptoms are obvious, creating a bubble around yourself is one great way to avoid germs. I know it may sound cold and hard to do around the holiday season but keeping everyone healthy is the ultimate goal. To that end, opt to skip the kiss and hug at social events and gatherings. Secondary perk: you’ll also be able to pass on wet kisses and cheek tweaks from well-meaning Aunts and Uncles!
  • Don’t Spray It: If you sneeze or cough, use your elbow, sleeve, or tissue to prevent germs from spreading- airborne germs are the #1-way germs are spread. If you forget and use your hand. . .wash right away to help keep others from potentially getting sick.

There are two ways to become immune to an illness. Get sick, survive and make your own antibodies or get a vaccine. Vaccines expose us to a piece of the bacteria or virus which then results in our immune system producing antibodies. While there isn’t a vaccine for the common cold, those for the flu, COVID, and RSV can reduce severity of illness and decrease the risk of serious complications or death.

Herd immunity provides us protection, as viruses or bacteria can no longer find hosts to infect. There is safety in numbers. Each contagion requires a different level of herd immunity to be effective, but the answer is clear. The more we are protected, the less bacteria and viruses can adapt and overcome our defenses.

Most of the available vaccines have been around for decades. They are tried and true with hundreds of millions of recipients showing they are safe. Even COVID has now been out for over a year with hundreds of millions vaccinated worldwide. The initial argument it’s too new is no longer valid. The minimal side effect profile (0.07%) and demonstrable life saving effects are incredible. 

Vaccines don’t mean you won’t get sick. I hear all too often, “I got the vaccine and still got sick.” Vaccines don’t provide 100% immunity against an illness. But IF you become ill, it’ll be a far milder case rather than the worst-case scenario.

This is our new reality. Stay vigilant to protect your health and of those in your life. Even if you don’t experience serious complications, nobody enjoys being sick and we certainly don’t want to infect others if it can be avoided.















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