Harvard doctors warn of viral triple threat for the holidays

RSV cases have plateaued, but an early, aggressive flu could disrupt gatherings.

A 6-week-old child was hospitalized with a case of respiratory syncytial virus last year in Illinois.LaRanda St. John/Associated Press

As Americans gather for the holidays, Harvard doctors are warning that three dangerous respiratory viruses are circulating — and threaten to become unwelcome guests at the festivities.

“We are in the midst of a true triple-demic,” said Dr. Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital.

First there’s RSV, or respiratory syncytial virus, which is most threatening to young children. This common, seasonal infection has arrived early this year and has proven unusually severe. RSV is typically mild in healthy adults, but can send a baby to intensive care.

RSV cases seem to have plateaued, and doctors are hopeful they will start to decline, said Dr. Lael Yonker, a pediatric lung specialist at Mass. General for Children.

But coming hard on its heels is influenza, another seasonal illness that typically peaks in February but this year seems to have shown up in force early. Based on flu cases that have occurred in the South, “it sounds more invasive and more aggressive” than in the past, Yonker said.

And then, of course, COVID-19 has not gone away; indeed, it continues to kill at a steady rate, and spawn new variants.

“I don’t want to say, ‘Cancel Thanksgiving,’ “ said Lemieux, speaking at an online press briefing Thursday by the Massachusetts Consortium on Pathogen Readiness. “I also don’t want to say, ‘Don’t worry about respiratory viruses.’ “

If you’re feeling sick, even if it’s just a cold, doctors say it’s more critical than ever to stay home. This is especially true if the people you’re visiting include elderly folks or young children. It’s a good idea to test for COVID-19, but even if the test is negative, keep in mind it won’t rule out RSV or other infections.

“We are definitely seeing a ton of RSV right now, so much so that our hospitals are filled, the ICUs are filled,” Yonker said. Mass. General has had to postpone elective surgeries and repurpose other floors because the ICUs are full. “Kids are waiting in the emergency room for days on oxygen, waiting for beds,” she said.

Lemieux said RSV is currently affecting his own household. He’d like to travel to visit other family for Thanksgiving, but won’t go unless everyone is healthy.

“People need to make a risk benefit assessment and be open to dynamically changing plans,” he said. “People need to understand that there’s a risk with any human interaction, and that the more density you have and the more indoor poor [air] circulation, the higher the risk.” That risk can be lessened by testing for COVID-19, wearing masks, opening windows, and making sure that everyone is vaccinated, he said.

COVID-19 continues a steady pace of destruction, killing 300 people a day nationwide. If that rate continues for a year, the COVID-19 death toll will be double or triple that of a typical flu season, Lemieux said.

“COVID-19 is still the most severe respiratory viral illness in the adult population at this time, and it’s a major cause of death nationally,” he said.

Asked about her plans for the holidays, Dr. Kathryn E. Stephenson, director of the clinical trials unit at the Center for Virology and Vaccine Research at the Beth Israel Deaconess Medical Center, said she has COVID-19 right now, and so plans to skip celebrating Thanksgiving with older relatives. “And I’ll be wearing a mask,” she said.

Stephenson urged people to “get back to the basics”: stay home when sick, and if you must visit a vulnerable person, wear a high-quality mask.

“As we move into a new world where lots of pathogens are going around, we should always go back to those principles,” she said.

Yonker said she plans to host 19 people on Thanksgiving and has been taking extra precautions and having her kids wear masks at school. Yonker is asking guests who have symptoms to test ahead of time, or stay home and let her bring them food.

Dr. Jeremy Luban, professor of biochemistry and molecular medicine at the UMass Chan Medical School, expects to host even more people than Yonker. He’s inviting scientists from overseas who work in his lab and have no family nearby. They’re mostly young, and, as infectious disease specialists, well aware of the risks. He’s asking everyone to take a rapid COVID-19 test before they come, and to stay away if they have symptoms.

Such precautions are especially important if there are elderly people present, Luban said. “I do know plenty of people who have had relatives get sick, and even died from COVID,” he said. “It’s something that you will live with for the rest of your life. So it’s important to think it through.”