Q&A: What’s in store for the upcoming respiratory virus season?

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Last year’s “tripledemic” of flu, COVID-19 and RSV left many of us wary of what the coming respiratory virus season might bring. But this year’s landscape is already different, with new vaccines and treatments, like the game-changing antibody that protects kids from RSV, offering new ways to tamp down infections and transmission.

In this Q&A, adapted from the July 28 episode of “Public Health On Call,” infectious disease epidemiologist David Dowdy, a professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, discusses what we can learn from last year’s virus season, how and why this year might be different, and why vaccinations continue to play a key role in determining how severe the viruses’ toll will be.

Last year we saw a big respiratory virus season after a couple of years of not seeing as much flu and RSV. Should we be worried about another difficult season this year?

I think people have reason to be on edge. The COVID pandemic threw us all for a loop.

Last year, we did have quite a large spike in RSV, and the flu season was earlier but not necessarily worse than usual. It’s hard to know exactly what’s going to happen this year, but given that COVID hospitalizations and deaths are at all-time lows, and people are getting back to behaving as they did before the pandemic, I think we’re likely to get back to the way things used to be with respiratory viruses as well.

We don’t know for sure what’s going to happen. But we don’t have any evidence to strongly suggest that things are going to be much, much worse this coming year than they were pre-pandemic.

We’ve seen some reports of an uptick of COVID in some wastewater surveillance. What’s going on here?

We are seeing a slight uptick in wastewater surveillance, but it’s important to couch that in the probably more meaningful data on hospitalizations and deaths being at an all-time low. Both of the last two years, we saw a noticeable summer peak in COVID admissions and deaths. We really aren’t seeing that at all this summer, for the first time since the start of the pandemic. So I think that’s overall good news. So people may still be getting sick, but they’re not getting really sick.

We also just had the Fourth of July, when a lot of people were gathering. Could that be why we’re anecdotally hearing about more people getting sick?

That’s certainly possible. A fair amount of immunity to COVID-19 now is due to people having gotten sick themselves, not just the vaccine, and I think that’s providing some ongoing protection now. But certainly we’ve seen this both of the past two summers as well: There was a big surge in the winter, and then a smaller rebound right around this time—which, again, we’re not seeing in terms of serious illness, but in terms of cases we might.

Last year it seemed, especially for families with younger children, that someone was sick at any given time. Is that part of this coming out of COVID? Do you think we might see that again this year?

There are probably a number of factors at play here. First of all, I think there is some component of coming out of COVID. A year or year and a half ago, lots more people were wearing masks and still distancing themselves much more than they are now, so there was this added layer of behavioral protection. Once that went away, these viruses that have been with us for centuries came back.

Since there are many of these viruses, you’d have one wave of one sort of virus, and then another wave of another, so people would feel like they were always sick. This is even more true for young kids. For example, those who were infants during COVID season never had that opportunity to build up that first layer of protection. But of course, if you ask any parent who has had a kid in daycare, even before the pandemic, you’re always a little sick. Kids are coming in and infecting each other and then bringing those things home, and that happens in the summer as well as during the winter. There’s probably an element of that as well.

So what you’re saying is that humans are going to be humans and viruses are going to be viruses. We’re just paying a lot more attention right now.

I think that’s true. I do think that during the pandemic we were slightly different humans, so we didn’t have quite as many of these viruses circulating. It took a little time to get back to our usual ways, but I think we’re pretty close to being back there now.

What about the potential for an early flu season? Should people get flu shots earlier?

The advice hasn’t changed. The advice is and has always been to get the flu shot in September or October, before the start of the flu season, and the flu shot is designed to give protection throughout the season. Those who participate in mandatory flu vaccine programs, like health care workers, are used to getting their flu shots in September to October. Given the fact that we had an early flu season last year, where the flu really spiked in November as opposed to January/February like it usually does, it’s a little more relevant now. We probably are a bit more likely to have an early flu season this year—again, just because the last flu season was pushed early, too. And it might take another year or two for us to get back to the usual way of things.

The third virus in our “tripledemic” was RSV. Some big news just came out that there is a new antibody for RSV. Can you tell us a little bit about that?

On July 17, the FDA approved a new antibody for RSV called nirsevimab. This is the second antibody that’s available for protection against RSV. But unlike the first antibody, this one lasts longer. It’s designed to be stable in the body for four to six months, and it’s been approved not just for those infants who are at highest risk, but for all healthy infants as well. We’re expecting to see a lot more uptake of this antibody, and hopefully that will help protect our youngest infants against RSV this coming winter.

COVID deaths and hospitalizations are down. Last year’s flu season was early but otherwise not that different from what we’ve seen before. What’s the lesson to take into the upcoming respiratory virus season?

Get your vaccines. It’s true that we’re seeing hospitalizations and deaths due to COVID 19 declining, and for the first time since the beginning of the pandemic, we’re seeing all-cause mortality starting to normalize. All of this is good news. But we have to remember that these are still deadly viruses. Tens of thousands of people die from COVID and the flu every winter, and that’s likely to continue being the case.

Just because we’re coming out of the pandemic doesn’t mean that we’re suddenly immune to these other viruses, and we need to continue to do what we can to prevent those viruses from taking hold. That means getting your flu shot when it’s available, getting your monovalent COVID vaccine when it becomes available, getting your infant children these new antibodies for RSV, and if you’re indicated to, getting an RSV vaccine yourself. The way that we prevent the brunt of deaths from all of these viruses is to take each of these different steps in tandem.

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