Does it feel like everyone you know is sick right now? It’s not your imagination: It’s been a particularly fierce season for all kinds of respiratory infections, from mild colds to more serious bugs.
According to the Centers for Disease Control and Prevention (CDC), health care visits for coughs and sore throats with fever were “above baseline” for the eighth consecutive week by the end of December. Hospital admissions for flu, RSV, and Covid-19 are ticking up ahead of schedule.
The increase isn’t itself atypical. “Pre-Covid, we always saw a surge of hospitalized patients in this winter time period, especially after New Years,” said Dhaval Desai, who oversees hospital medicine at Emory University’s St. Joseph’s Hospital in Atlanta. But compared to five years ago, “we are at a more intense spot from a respiratory illness standpoint,” he said.
It’s not entirely clear why this particular season is so gnarly. Although the CDC focuses its tracking on the viruses most likely to cause severe illness and death — Covid-19, flu, and RSV — lots of other germs with less name recognition are landing people in the hospital.
A broader age group is turning up very sick, too. In addition to the usual severe illness in people with chronic conditions, who are typically more vulnerable to bad outcomes, Desai said, “we’re also seeing those that may be younger or middle-aged who really don’t have any other major contributors to their medical history, but are coming in really sick, from whether it’s the flu, RSV, or some of the other common viruses.”
If you’re one of those fortunate people who’s not yet gotten sick, there are ways to reduce your risk, most of which will be especially familiar after living through the pandemic. If you are sick, there are ways to lower the chances you’ll spread your ick to people around you — and ways to feel better faster.
Why are so many people sick right now?
This isn’t the first weird cold and flu season in recent memory: Every respiratory virus season since Covid-19 came on the scene has been strange in one way or another. During the years when many people were taking precautions to avoid the coronavirus, rates of most other germs that cause respiratory illness hit historic lows. When those precautions stopped, lower population-wide levels of short-term immunity to those germs led to broader transmission than usual.
Many experts caution we haven’t yet reached a “steady state” as far as cold and flu season goes. “I don’t actually think we know what sort of the ‘normal’ is post-pandemic yet,” said Richard Webby, an influenza researcher at St. Jude Children’s Research Hospital.
It does seem that at least for a while, seasonal respiratory illness rates will stay higher compared with pre-pandemic years. That’s due to the simple fact that Covid-19 continues to cause a lot of additional illnesses, both during cold and flu season and during other times of the year. So far this season, Covid-19 has led about 60 out of every 100,000 Americans to be hospitalized — more than both flu and RSV combined. Older adults are at particular risk for hospitalization due to the virus, but so are infants under 6 months old — a risk many people seem unaware of, said Brendan Jackson, a respiratory virus expert at the CDC.
On top of that, the viruses that were considered the heaviest hitters before Covid-19 came on the scene — flu and RSV — made their debuts earlier than usual this season. According to the latest estimates, hospitalizations for both viruses are two to three times higher than at the same time point pre-pandemic, and doctor visits for cold and flu symptoms are also much higher than usual for this time of year.
Desai wonders if this season’s severity has to do with a particularly ugly flu virus this year: He’s noted unusually high levels of inflammation in flu patients he’s been caring for. Jackson said low vaccination rates for both flu and Covid-19, especially among older and chronically ill people who are at highest risk for complications from these infections, aren’t helping.
This doesn’t necessarily mean that once the season is over, more people will have gotten sick than in a typical pre-pandemic season. It depends on the quirks of each particular pathogen: Last year, flu season started with an early and astonishing bang, but also ended pretty quickly, without leading to lots of excess hospitalizations. Meanwhile, RSV’s early peak caused a record-breaking number of severe illnesses.
Jackson also noted that while Covid-19 is causing a substantial number of emergency room visits and hospitalizations this year, these numbers are still over 30 percent lower than last year — even as test positivity and wastewater data suggest that actual infections are about 25 percent higher. These trends suggest a phenomenon of “decoupling” infections from severe disease: “As we gain more immunity over time, from vaccines and from previous infections, each infection is less likely to result in severe disease,” he said.
If you’re feeling well, here’s what can help keep it that way
Vaccination is the single best way to boost immunity to the worst of the circulating nasties.
Everyone over 6 months old is eligible for flu and Covid-19 vaccines, and getting vaccinated for these viruses during pregnancy is one of the best ways to protect newborns from severe illness. RSV vaccination is also recommended for pregnant people, newborns, and adults 65 and over. (The newborn formulation is technically an antibody infusion rather than a true vaccine, but the protective effects are the same.) Although September or October was prime time for getting these vaccines, there’s still a lot to gain from getting them now: Protection kicks in a couple of weeks after you get the vaccines, and transmission will likely still be going on.
Other measures will sound familiar to most people: “handwashing, masking, and distancing — those are the big three,” said Desai. Cleaning your hands before touching your face or preparing food, and after touching shared surfaces or using the bathroom, is a key way to reduce the likelihood that any germs on your hands make it into your nose or mouth. Masking is particularly effective for preventing transmission through the air, which is more likely to happen in crowded places, and in the case of the especially transmissible Covid-19 infection; a surgical mask offers a lot of protection, although if you’re really worried about Covid-19, an N95 or KN95 is best.
Ventilation is also a powerful tool for preventing viral transmission, said Jackson. He recommends opening windows and turning on fans if the space and climate you’re in allow. “That can really make a difference, especially in a crowded space,” he said. He also recommends considering a portable air purifier for use if you’re gathering with others at home.
People with chronic illnesses are more likely to have severe outcomes from even plain old colds, said Desai. To minimize their risk, he recommends ensuring symptoms are as controlled as possible throughout the season. He uses the analogy of a tightrope: It’s easier to get knocked off by a cold — and harder to get back on afterward — if you have a chronic illness. So if you have asthma, have enough inhalers on hand and use them as prescribed; if you have diabetes, make sure your blood sugar levels are controlled.
If you get sick, here’s what to do
When you do get sick, it’s important to rule certain infections out — but most people don’t need to undertake extensive laboratory testing.
“We are never wrong to take a Covid test to start with,” said Desai. If your first at-home test is negative, you’ll want to test again 48 hours later for the most accurate results; you can order free tests from the US government at the Covid.gov website.
If Covid-19 isn’t the culprit, it’s smart to visit a health care provider to get tested for the flu. That’s especially true if you plan to be around lots of other people, you live with people who have weaker immune systems (including babies and older adults), or you have persistent or severe symptoms (like shortness of breath, or more than three days of fever). A confirmed flu test may make you eligible to take the antiviral medication oseltamivir, which can reduce symptom severity and get you feeling better sooner; some of your more vulnerable close contacts might also benefit from taking the medication as prevention.
Just as there is antiviral treatment for the flu, there is also prescription medication to help treat Covid-19. If you get diagnosed with Covid-19, check with a health care provider or a pharmacist about whether it makes sense to take Paxlovid. It’s a lifesaving drug that’s still broadly underused, especially in older people whose lives it’s most likely to save. Many pharmacies can prescribe the drug without a separate health care visit, so check with your local drugstore if that’s an option for you.
Regardless of which virus is causing your illness, rest and hydration are among the most important treatments. Sleep boosts immune function, and drinking plenty of fluids (including at least some that contain salt and sugar, like electrolyte-rich sports drinks, juices, and broth) helps reduce the risk of dehydration while you’re sweating it out.
Over-the-counter fever controllers like acetaminophen (brand name Tylenol or generic will do) and ibuprofen (brand names include Motrin and Advil) can also provide a lot of relief, and importantly, enable you to get the rest you need. If you’re very congested, pseudoephedrine (often sold under the brand name Sudafed) is the only decongestant worth reaching for. A lot of people also get relief from nasal irrigation — but make sure you follow the package directions to avoid other infection risks.
There’s a dizzying array of cough medicines on pharmacy shelves that claim to make the hacking stop, or at least to make coughing more effective at clearing out respiratory gunk. While most of these medications won’t hurt adults, review studies have found little evidence to suggest they help — and they can be dangerous to young children. However, there is evidence that a couple teaspoons of honey reduces nighttime coughing, making it a safer and more cost-effective choice for most people (note that honey is not safe for babies less than a year old).
It may also help reduce nighttime cough and congestion to sleep propped up on lots of pillows, or even to elevate the head of your bed by putting a brick or cinder block under the top legs.
A lot of the measures we can take to keep from spreading our germs are the same as those we take to keep from catching others’.
If you’re sick, the best way to keep from spreading your infection is to stay home. If you do have to be around others, mask up (a surgical mask is fine, although an N95 or KN95 is better if you have Covid-19). Make a habit of coughing into your sleeve, and wash your hands frequently, but especially after blowing your nose or coughing into your hands.
When to see a health care professional
Most respiratory infections start to get better after a few days. Signs that things are going in the right direction include receding fevers (typically after two or three days), decreased snot production (usually within five to seven days), and improving cough (although a dry, irritative cough can hang around for weeks after a nasty cold, the worst of it should be over within a week).
If things don’t get better in that time frame, it might be time to get professional help. See a health care provider — whether it be your primary care physician, or someone at your neighborhood urgent care clinic — if you have a fever that lasts for more than three days, or if you have severe symptoms like shortness of breath, a throat so sore you can’t stay hydrated, persistent dizziness, or trouble getting out of bed. If you have anything else going on that feels atypical or concerning to you, check in with a provider to determine whether it’s something that needs more than the usual home care.