As COVID-19 wanes, UAB doctors warn of potential “triple-demic”

Alabama is in a good spot right now with COVID-19, UAB leaders said in a Friday conference, as cases and hospitalizations continue to decline.

However, the doctors warned to be cautious of the potential for a “triple-demic” in the winter as flu and RSV is on the rise and COVID-19 variants continue to cause concerns.

Dr. Jeanne Marrazzo, director of the UAB Division of Infectious Diseases, said flu is on the rise a bit earlier than usual, and a higher number of cases than usual.

“And that’s worrisome,” Marrazzo said. “It’s very much parallel to what Australia in the southern hemisphere— they just finished their winter and what their flu season experiences is often what our society experiences in the northern hemisphere in the subsequent seasons. They had a very tough year with influenza: lots of cases, lots of hospitalizations and early onset. So I’m hopeful that that isn’t what we’re going to see, but I do think it’s possible.”

One positive side effect of the response to the COVID-19 pandemic was the quelling of the flu and RSV as people wore masks and limited engagement. But now that people are returning to normal activity, doctors are concerned that more people will be hospitalized.

Marrazzo cited a theory that the two years with very little flu and RSV activity could lead to an “immunity gap” as people have not had to produce antibodies for longer.

“We’re now seeing sort of double the volume of children who will be exposed who will get symptomatic and will present to health care,” said Claudette Poole, associate program director of pediatric infectious diseases with UAB and Children’s of Alabama. “RSV season typically starts in October and will run all the way through to March. And the same is true for influenza. I think what may be a little bit unusual is that we’re seeing a pretty steep upward surge in these viruses early on in the season, which does give everybody a little bit of pause that this may be a sort of long winter.”

Poole advised parents to be on the lookout for RSV by seeing if their child develops a fever after the “cold phase” of the virus has run its course over about a week. 

As far as COVID, the doctors urged patients to get the new bivalent COVID booster as new variants could emerge that continue to challenge earlier vaccinations. They also prompt everyone to get the flu shot and practice good hygiene, particularly hand-washing, to try to curb the spread of all three potential threats this winter season.