Dr. Sheryl Henderson Talks about the COVID, Flu and RSV Season; Tripledemic Primer (Part 1 of 2)

Sheryl Henderson

Above: Dr. Sheryl Henderson is a pediatric infectious disease specialist with UW Health and the UW-Madison School of Medicine & Public Health.

Below: The package cover of free COVID tests available at Madison public libraries that include a pre-paid envelop that allows people to send in positive test kits to researchers to help track COVID.

Sheryl HendersonGraphics

By Jonathan Gramling

While COVID-19 is no longer a pandemic, forcing community-wide measures like masking and spacing and sheltering in place, it doesn’t mean it is gone. It may not be in the headlines of the media or discussed at the water cooler at work, but it is present.

“We still have to recognize that it’s a virus that can really harm some people significantly,” emphasized Dr. Sheryl Henderson, a pediatric infectious disease specialist with UW Health and the UW-Madison School of Medicine & Public Health. “And it is still present. It hasn’t gone away. It’s still Omicron. The variants have changed over time since Omicron first made its presence. Omicron is here. There are different variants. There are scientists who are still following the variants overall. But right now, we don’t know of a variant that is taking off like Omicron did when it first came or Delta did when it first came.”

Back in the days of the pandemic, due to wide-scale testing, it was relatively easy to track the virus and determine how many people were becoming infected. But now with only home testing that doesn’t necessarily get reported to health authorities, the healthcare system has had to rely on other indicators to estimate the impact that COVID-19 is having.

“What’s being followed more prominently now is the number of hospitalizations,” Henderson said. “That indicates who is getting very sick from COVID. The other thing that has been monitored that is more of a proxy is the sewer water, looking at COVID in sewer water. When they are sampling sewer water, they are looking for the DNA, the nucleic acid of the virus. It’s not necessarily growing the virus. It’s looking for parts of the virus. I actually don’t know where that is now. But I know in the middle of the summer here in Dane County, that went up a little bit. I don’t know if that has gone down. But if we look at hospitalizations, there’s been a slow creep upwards. It’s nowhere near the peaks that there were when it seemed like everyone was getting sick. The number of patients in the ICUs is not increasing. That’s a good thing that we aren’t seeing a significant number of severely ill people. But if you look at the hospitalizations, it’s going up. It’s indicating that COVID is still around and we have to think about it. There are still people who are immune-compromised and have high-risk factors such as diabetes or high-blood pressure who could still be at higher risk for getting the virus, higher risk for being in the hospital and getting severely ill.”

As people begin to spend more time indoors, sometimes in close proximity to strangers, there is the risk that the number of COVID-19 could begin to increase. And it just takes one exposure, one moment of no precautions taken, for people to get COVID-19 no matter what prevention measures they have taken in the past.

“There is a possibility that hospitalizations could continue to rise as we spend more time indoors,” Henderson said. “That’s why it is being tracked. I know there are some communities in which healthcare workers are masking again, just being prepared.”

Last year, healthcare professionals labeled the threat of respiratory diseases as “Tripledemic,” referring to the threat of not only COVID-19, but also influenza and RSV, Respiratory Syncytial Virus that have the possibility of spiking in frequency during the same season.

“The other thing that we have to think about is what was coined ‘The Tripledemic’ last year where there were more hospitalizations also for the flu and RSV, respiratory syncytial virus along with COVID,” Henderson said. “All three of those viruses can be caught in the long run. So even if someone tests negative for COVID, they could have another virus. We usually see the pattern of flu go up in the winter. It used to be that RSV would go up October-March. We see that more in the little kids. But now there are vaccines for all three. Flu we are very familiar with having yearly vaccines. COVID is very likely that there is going to be a yearly vaccine because people’s immunity goes down overall and like the flu, there are variants and changes. And then this year, there are new RSV vaccines. There are now recommendations for people over 60-years-old to get a RSV vaccine.”

While these three viruses are different and not necessarily related, they can still have the same impact on people.

“They can all start out like the common cold.,” Henderson observed. “COVID when it first came, some people lost taste and smell. Some had cough, fever, and body aches overall. The loss of taste and smell is not as prominent in the current variants. The ones that we are seeing now are more like the common cold with sniffling, runny nose, cough, and sore throat. Sore throat was a big one when Omicron came around. RSV can be like that. If three different people or 10 different people had RSV, their symptoms aren’t going to be exactly the same. But it’s more of the upper respiratory, meaning your nose, your throat. You have immune cells in your nose that are like the first defense against these viruses. And that’s what proliferates and causes the snot and goo, the cough and the sneezing and everything to try to force that virus out. As soon as the virus contacts your nose — regardless of what it is — that’s your immune system thing of trying to push the virus out.”

During the past month, a new booster vaccine came out that targets just the Omicron variant of COVID-19. But people should start thinking about getting a flu vaccine as well.

“There are different types of influenza,” Henderson observed. “There are A and B. But the influenza virus can change from year to year. The proteins are slightly different from year to year. That’s why the vaccine actually changes each year where scientists anticipate, ‘Well I think the influenza virus is going to look like this, so we are going to create the vaccine to go after that virus.’ Sometimes it matches what they anticipate. Sometimes it doesn’t. But they do the best they can because you have to make the vaccine before the influenza hits. Within Influenza A, there have been small changes too.”

And then there is RSV.

“Most haven’t seen much about RSV because it can cause the common cold in most people,” Henderson said. “I’ve had RSV many times because I’ve had kids. It predominantly causes the most problems in young children who have lung disease. They might have been born prematurely and have lung-disease. And so RSV gets down into their lungs. Some have heart disease. So we’ve had medicines to try to prevent them from getting significant RSV infections that they usually get during the winter months. But this past year, more vaccines were developed, not only for these young kids, but also for older adults. I don’t think adults are always tested for RSV. We do it a lot in pediatrics because we see it a lot in pediatrics.”

There are times when the Tripledemic viruses do not by themselves cause severe illnesses. Other actors can move in to do their damage after people’s immune systems and health are severely weakened.

“We know that someone can get a virus,” Henderson said. “There are many more viruses than the three that I mentioned. And that could be a set-up for pneumonia. Trying to reduce the chance that any virus can really take hold and set someone up for a bacterial pneumonia is important. The virus starts and then the bacteria follows.”