INDIANAPOLIS — Coughing, sneezing or blowing your nose? Stuck with a gnarly cold that won’t scram?
You’re not alone.
Respiratory illnesses are spreading across the country, in tandem with marked upticks in both COVID-19 and influenza. Indiana is now among the states handling a "trifecta" of respiratory illnesses that tend to percolate in communities as cold weather settles in.
But doctors reiterate the uptick is normal this time of year, and it's not because of the cold. Rather, people are spending more time with each other indoors, and not protecting themselves against germs.
"The viruses can vary in their structure and sometimes evade your own immune system or sometimes even evade the immunization,” said Yancy. “So, the more clustered together you are, the more things you're going to likely see."
People are also, Yancy said, becoming lax in some pandemic protocol: failing to cover coughs and sneezes, not washing our hands, and going to work even if you're sick.
"We saw very few of these during the time when everyone was sequestered and wearing masks. It's like the viruses were hiding, now they’re saying, 'Let me back out. Let me back out,'" Yancy said.
Still, respiratory illnesses are a now-yearly trend health experts and epidemiologists have come to anticipate since the start of the coronavirus pandemic. They told 13News the three respiratory viruses are interacting somewhat differently than they did in the winter of 2022-2023, but are still having an impact on public health.
“Since COVID got introduced, we're seeing all three respiratory viruses, as anticipated, during the winter months. And, when push comes to shove, we’re going to see overlap in these. And, certainly, each of these viruses can impact all age groups, and people with different risk factors,” said Dr. Samina Bhumbra, who is the medical director for infection prevention at Riley Children’s Hospital in Indianapolis.
Bhumbra told 13News she estimates 30-40% of patients in the emergency room at Riley Hospital complain of respiratory problems, whether influenza, COVID-19 or RSV. Surges in these types of respiratory illnesses tend to start in southern states then work their way north, so doctors had some warning before the viruses spread through Indiana.
“Certainly we heard from colleagues down in the southern states that they were seeing RSV sooner than we were, which is expected,“ Bhumbra said. “What we're seeing is still high numbers of influenza positivity, RSV positivity and COVID positivity.”
Outpatient respiratory illness has been above baseline nationally since November and is above baseline in all ten Human Health and Services regions, according to the CDC. Researchers from Indiana University found through an analysis of CDC data that RSV, specifically, first increased during the end of September.
Oftentimes, complications from those viruses will land young children and the elderly in the hospital.
“RSV actually started going up in terms of emergency room visits in late September and through October, and sort of plateaued in November or December in terms of positive tests. Testing stayed high relatively through October, November and December. And now it's actually starting, maybe to decline a little bit,” said Dr. Thomas Duszynski, director of epidemiology education at Indiana University’s Department of Epidemiology.
Meanwhile, influenza rates may be on a slight rise. The CDC reported that during Week 52, starting on Dec. 25, 2023, of the 651 viruses reported by public health laboratories, 581 of those, or 89.2%, were influenza A and 70, or 10.8% were influenza B. Of the 342 influenza A viruses subtyped during that same week, 300 - or 87.7% - were influenza A(H1N1) and 42, or 12.3% were A(H3N2).
The CDC estimates that there have been at least 10 million illnesses, 110,000 hospitalizations, and 6,500 deaths across the country from flu so far this 2023-2024 season. A CDC dashboard slotted Indiana in the top high risk for influenza during the week ending Dec. 30, 2023, but the state is just shy of the very high risk category.
“Influenza is sort of leading the pack,,” Duszynski said. "But it doesn't matter whether RSV, influenza or COVID. Among the the older populations we see a diminished immune system, meaning that it's not as robust as it was when they were younger. And in the very young, we see immature immune systems, right? Those that haven't seen some of these respiratory diseases before may have no other protections against it."
In the United States, on average, 5% to 20% of the population gets the flu and more than 200,000 people are hospitalized from seasonal flu-related complications, according to the Indiana Department of Health. Some people, such as older people, young children, pregnant women, and people with certain health conditions, are at high risk for serious flu complications.
Although experts said the symptoms can vary in subtle ways between RSV, influenza and COVID-19, they are spread throughout communities in similar ways.
“The majority of them are spread by droplets. So, what that means is sneezing, coughing, when those droplets can land on surfaces. And we touch those surfaces, like door knobs, counter tops. Places that a lot of people touch, elevator buttons, all those things once we touch, and then one thing or the other, we touch our face.
Experts reiterate there is still time to get a vaccine to protect yourself against any of these viruses, and to get tested even if you think you have a cold.
“There's always time to get vaccinated,” Duszynski said. “And getting tested is really important, because then we know how to maybe treat. So if you had COVID-19, we want get you - if you're in that high risk category - we can get you something called Paxlovid, or some of these other treatments, right? For influenza, there are antiviral specific for that. For RSV, there are just other supportive treatments that we can give, but we wanna give the right treatment for the right disease."
Differences between RSV, influenza, and COVID-19
RSV
People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include:
- Runny nose
- Decrease in appetite
- Coughing
- Sneezing
- Fever
There are two options for protection of infants against RSV: maternal vaccine for the pregnant person and preventive antibodies given to the baby. Only one of these options is needed for most babies to be protected.
There are two RSV vaccines licensed by the U.S. Food and Drug Administration for use in adults 60 and older in the United States:
- RSVPreF3 (Arexvy)
- RSVpreF (Abrysvo)
Both vaccines contain a part of the RSV virus, and work by causing an immune response that can protect you from respiratory disease if you are infected with RSV in the future.
The CDC recommends a single dose of RSV vaccine for pregnant people from Week 32 through Week 36 of pregnancy for the prevention of RSV disease in infants under 6 months of age.
This vaccine is recommended to be given from September through January for most of the United States, according to the CDC.
Covid-19 - JN.1 variant symptoms
A descendant of omicron, JN.1, has also been spreading throughout several states, including Indiana.
Although it first appeared in September, CDC data from before the holidays show the new variant represented 39% of total COVID-19 cases. There have been 927 COVID cases in Indiana throughout the last seven days, up 20 from the previous seven days.
Doctors believe, in addition to the possibility of more sore throat and upper respiratory distress, symptoms include:
- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
Influenza symptoms
Symptoms usually start about 1-4 days after being exposed and can last 2-7 days. Complications may include pneumonia, hospitalization and death.
Flu is spread from close contact with people who are sick with flu or from touching surfaces or objects that have flu virus on them.
Symptoms usually include:
- Fever
- Chills
- Headache
- Cough
- Sore throat
- Muscle aches
- Diarrhea and nausea occasionally in children
Infection can occur when flu viruses contact the eyes, mouth, or nose, and through breathing in droplets from a sneeze or cough.
People may be able to spread the virus to others about one day before they show symptoms and up to seven days after becoming sick. That means that you may be able to spread the flu to someone else before you even know you are sick, as well as while you are sick.