‘Tripledemic’ of flu, COVID and RSV jams Ga. ICUs with sick kids, adults

As flu and other seasonal viruses continue spreading rapidly across the state, COVID-19 cases are climbing again, possibly putting Georgia on the verge of yet another winter surge of the deadly pandemic virus. The collision of RSV, flu and COVID viruses — dubbed a “tripledemic” — could overwhelm hospitals already stretched thin.

“We are used to being busy in the wintertime,” said Dr. Hugo Scornik, a local pediatrician and former president of the Georgia chapter of the American Academy of Pediatrics. “We always say pediatrics is a winter sport because we are used to seeing flu cases in the winter.

“But this year has been exceptional for a number of reasons. First, the flu came early… In addition, viruses we are seeing seem to be tougher on the kids. And we hypothesize that’s because children have relatively not been exposed to these viruses over the past two years because everyone has been separate and masking due to COVID concerns.”

Health officials are worried about what lies ahead because of the low uptake of both flu and COVID booster vaccines by children and adults.

In Georgia, only 20% of people who are age-eligible for flu vaccine have been immunized so far this season, according to data from the state Department of Public Health obtained by The Atlanta Journal-Constitution. And only 6.8% of people in Georgia who are age-eligible for an updated bivalent COVID booster have received one, according to the Centers for Disease Control and Prevention.

A flu vaccine can prevent infection, and among those who still become sick with flu, vaccination can reduce the severity of the illness. The same is true for COVID vaccines and boosters which can help protect against severe outcomes like hospitalization and death.

The current situation is dire. Many hospitals in Georgia are running out of beds and are on diversion, meaning they’re requesting ambulances to transport patients to other hospitals. But it can be hard to find a nearby hospital with space.

And that’s leaving some very sick people waiting for several hours in emergency rooms for hospital beds to open up. In Georgia, 84% of pediatric ICU beds are occupied, according to the most recent federal data. Adult ICU beds are even more full at 84.5%.

The emergency room tent expansion at the Children's Healthcare of Atlanta Scottish Rite Hospital.

Credit: Children's Healthcare of Atlanta

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Credit: Children's Healthcare of Atlanta

At Children’s Healthcare of Atlanta, flu is the big driver of hospitalizations, followed by rhinovirus, enterovirus, and respiratory syncytial virus, or RSV. For healthy adults, rhinovirus and enteroviruses are among the causes of the common cold but for children, they can be severe. Symptoms of RSV often look like a common cold and can include a runny nose, congestion, and fever. But in some cases, RSV can turn dangerous, especially among infants and older adults, leading to breathing trouble and complications such as pneumonia.

Dr. Andi Shane, division chief for pediatric infectious disease at Children’s Healthcare of Atlanta and Emory University, said the system’s hospital units for such respiratory support as a ventilator, occupancy is between 90% and 100%.

In the last two weeks, Shane said the hospital has seen a steady uptick of patients testing positive for COVID-19. As of last week, 12 patients at Children’s Healthcare of Atlanta were hospitalized for COVID-19, according to the hospital system.

Flu activity remains high in Georgia. And while flu activity took a dip in mid-to-late November, DPH reported a slight increase in the number of patient visits to doctors for flu or flu-like illness: 6.8% for the week ending Nov. 26, up from 6.4% from the previous week.

There were 110 people in metro Atlanta hospitalized with influenza during the week ending Nov. 26. The latest DPH report also shows a total of 26 adults have died as a result of the flu in Georgia so far this season, including one in the most recent week. Death numbers are often adjusted in the future because of a lag in death reporting.

The Southeast is being hit by a particularly nasty flu strain that is often associated with severe illness and hospitalization, according to the CDC. The dominant strain in Georgia continues to be a subtype of the influenza A virus — known by the scientific name of H3N2 — which can be especially hard on children and older adults.

Meanwhile, COVID cases in Georgia have been steadily rising with the 7-day average of new confirmed cases increasing to 646 as of Wednesday, up from 428 — a 51% increase from a month earlier, according to DPH data.

Now that at-home COVID-19 tests have become commonplace, actual case numbers in the U.S. are far higher than what’s being reported to health agencies. Case counts have always been an imperfect measure of actual infections because they are dependent on the number of people getting actually tested for COVID.

Another tool gaining traction is wastewater surveillance, which can provide an early warning of a virus spread in a community. People infected with the coronavirus and other viruses can shed the virus in their feces even if they don’t have symptoms. A growing number of sewage surveillance projects across the country run jointly by universities, public health agencies, and local utility departments send their findings to the CDC’s National Wastewater Surveillance System. Data from WastewaterSCAN, a program run by researchers at Stanford University and Emory University, and includes surveillance of eight locations in Georgia, shows an increase in the presence of coronavirus at most sites.

Scornik said COVID and flu vaccines are “super important,” stressing it’s not too late to get the shots. Public health officials say anyone 6 months old and older can get the vaccine. Everyone living in a home with an infant younger than 6 months should be vaccinated, not only to protect themselves but the infant as well.

Rachel Roberts-Galbraith said her family experienced the importance of vaccination first-hand.

Rachel Roberts-Galbraith’s 7-year-old daughter Magnolia was sick twice in November. The first time was during the week before Thanksgiving. Roberts-Galbraith suspected COVID-19, but her daughter tested negative on home tests. Magnolia seemed fully recovered, and then less than a week later, she woke up with a slight fever and runny nose. With plans to visit family, including siblings and older parents, in Kentucky for Thanksgiving, Roberts-Galbraith decided to bring her daughter to an urgent care center for a flu test, and it was positive.

Rachel Roberts-Galbraith, husband, Kyle Galbraith, and their daughter, Magnolia.
Photo credit: Sarah Lynn Photos

Credit: Sarah Lynn Photos

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Credit: Sarah Lynn Photos

“I was surprised, to be honest, how mild it was,” said Roberts-Galbraith, a professor of biology at the University of Georgia who lives in Athens. “She didn’t have body aches or muscle aches or anything like that.”

But she doesn’t think there’s any mystery about it it. Every year, the Roberts-Galbraith family gets their flu shots. They are also vaccinated and boosted against COVID-19.

Magnolia seemed better by Thanksgiving. No one else in the family got the flu. Even so, the Roberts-Galbraith said, “We weren’t sure if she would still be contagious so we decided to play it safe” and stay home.

“The worst thing that happened was we missed time with our family and that’s a pretty good outcome to me when you think of alternatives like hospitalization,” said Roberts-Galbraith. “It was reassuring to have her case be so mild and made us even more convinced to get the flu shot every year.”

AJC reporter Alex Anteau and database specialist Stephanie Lamm contributed to this article.