Georgia’s fourth pandemic Thanksgiving may feel like the most normal gathering in a long time. With virtually every American having some immunity from COVID-19 now, no major surge of virus is expected this winter, according to the Centers for Disease Control and Prevention.
But the outlook is not all rosy.
The coronavirus remains part of the mix of circulating viruses, increasing the overall strain on the health care system.
“What we worry about,” said state epidemiologist Dr. Cherie Drenzek, is when you add COVID numbers to the respiratory season, even at moderate levels, “it can really push up the overall numbers.”
After a late-summer-rise, COVID hospitalizations in Georgia have fallen and they are nearly at their lowest levels since the start of the pandemic. Unlike other respiratory viruses, COVID continues to hit older adults the hardest and by a wide margin, Drenzek said. Doctor visits for both flu and respiratory syncytial virus (RSV) so far this season have been highest among young children 4 and under, according to Drenzek.
The precise severity and timing of this season’s outbreaks can’t be predicted.
“The wild card with COVID is that the circulating variants can change rapidly and can (lead to) high levels of transmission,” said Drenzek at a recent Georgia Department of Public Health board meeting. “So we have to keep a close eye not only on those surveillance indicators but on those variants that are circulating.”
CDC scientists predict two possible scenarios for the holiday season. But neither forecast comes close to the staggeringly high levels of illness and hospitalization of the 2021-2022 winter season when the original omicron variant dominated.
In both scenarios, COVID activity is predicted to be only “moderate.” That’s because most Americans — 97% according to the CDC — have some immunity to COVID through vaccination, infection, or both. In the first scenario, flu and RSV are also moderate, and the peaks are staggered. In the second scenario, flu and RSV activity is severe, and the peaks overlap, leading to levels of illness similar to what was seen last winter.
Credit: Olivia Bowdoin
Credit: Olivia Bowdoin
Here in Georgia, flu activity is up slightly, but it is much lower than it was this time last year, according to data from the Georgia Department of Public Health. RSV infections, however, have risen sharply in Georgia and other parts of the country and is expected to be a primary driver of viral illnesses this winter.
For the first time in U.S. history, vaccines for all three major respiratory respiratory viruses — COVID, RSV, and flu — are available. Higher levels of vaccinations across the population will help reduce the number of hospitalizations and ease hospital strain, according to the CDC.
RSV, which has symptoms that can mimic colds or the flu, is especially dangerous for infants and the elderly. To help counter the surge of RSV, federal officials on Thursday announced they were releasing 77,000 more doses of a new RSV shot for newborns that has been in short supply.
Reports of the seasonal virus are rising nationally, but experts said RSV is not expected to generate the kind of widespread patient traffic seen last fall, when hospitals were overwhelmed with sick, wheezing kids.
Children’s Healthcare of Atlanta hospital system is in “surge” mode because of RSV, with a high volume of patients straining staff, said Dr. Jim Fortenberry, the system’s chief medical officer.
“Our emergency departments, our urgent cares are extremely busy. The pediatricians’ offices are extremely busy too,” Fortenberry said.
Not helping matters: The newly available shots to protect newborns against RSV have been difficult to get, meaning a new medical weapon is not being fully deployed.
“It was really going to help and unfortunately there is a shortage, and we at Children’s are also seeing that shortage,” Fortenberry said.
The CDC estimates that RSV causes 100 to 300 deaths and 58,000 to 80,000 hospitalizations each year among kids aged 4 and under. Its toll is even greater in adults 65 and older, causing 6,000 to 10,000 deaths and 60,000 to 160,000 hospitalizations, the CDC says.
RSV infections fell during the beginning of the pandemic, but it roared back last year. The wave was bolstered by surges in other kinds of respiratory viruses, which often infected children at the same time and made their condition worse, said McMorrow, of the CDC.
During this busy respiratory season, we're seeing an increase in emergency department and urgent care center visits, particularly children with #RSV. As RSV is spread by contact, remember to practice hand hygiene and stay home if sick. Learn more at https://t.co/LOPJ93Rs9M. pic.twitter.com/M7Jfh2Ug3v
— Children's (@childrensatl) November 7, 2023
Data on RSV is limited, but available information shows that diagnoses in some states — including Georgia, Tennessee and Virginia — are near the levels seen last year. There are signs, however, that the virus is already peaking in some states, Dr. Meredith McMorrow, an RSV expert at the Centers for Disease Control and Prevention.
For the week ending Nov. 11, Georgia’s hospitalization rate for RSV was down slightly. But the rate among children — especially infants under six months of age is down sharply. Georgia reported 48 of every 100,000 children under six months old were hospitalized with RSV. That’s down from 88 the previous week, though those figures could be adjusted because there’s a lag in reporting.
The CDC monitors RSV hospitalizations through a voluntary reporting program that includes 58 counties in 12 states. In Georgia, eight metro Atlanta counties report the number of people hospitalized with lab-confirmed cases of RSV.
Demand for the RSV vaccine for infants has outpaced supply, prompting the CDC last month to ask doctors to prioritize doses for infants at highest risk of severe RSV disease.
Part of the problem: The shots’ list price is about $400 to $500 per dose and some doctors were wary of ordering many syringes until they were certain insurance programs would fully reimburse them, said Dr. James Campbell, a University of Maryland pediatric infectious diseases expert.
Some doctors ordered a lot anyway, which is why it’s been more available from some health care providers than others, he said.
The Associated Press contributed to this article
Georgia current COVID, RSV and flu activity
COVID
358 -- New COVID hospitalizations in Georgia for the week ending Nov. 4.
A year ago, it was 510.
Flu
5.3% – percent of patient visits to doctors were for flu or flu-like illnesses during the week ending Nov. 11.
A year ago, it was 7.9%.
107 – total flu-related hospitalizations in the 8-county metro Atlanta region (Fulton, DeKalb, Clayton, Cobb, Douglas, Gwinnett, Rockdale, and Newton) from the start of flu season in early October until the week ending Nov. 11, most recent week of data available.
A year ago, the total for this same time period was 941.
RSV
1.9 per 100,000 people –The overall rate of RSV hospitalizations in Georgia for the week ending Nov. 11, based on a voluntary reporting program that includes hospitals in metro Atlanta. This is also preliminary data.
A year ago, the rate was 1.2 per 100,000 people.
