COVID, flu, RSV cases may grow over winter, Waco experts say

The number of COVID-19 cases in Texas in the week ending Dec. 9 increased by 10% over the prior week, according to a Texas Department of State Health Services report issued Wednesday.

But the 12,702 cases reported statewide that week is by far the lowest early December number in the past three years, DSHS data show. 

Detailed COVID-19 case numbers for McLennan County are no longer reported, but Waco-McLennan County Public Health District officials estimate that the county is seeing about half the number of cases it saw a year ago.

In early December 2022, the health district was reporting 60 to 80 cases per day, according to Tribune-Herald archives.

Waco-based Baylor Scott & White Hillcrest Medical Center has seen slightly increasing numbers of patients with the big three respiratory illnesses of winter: COVID-19, influenza and respiratory syncytial virus, or RSV.

Patients with the most severe infections of COVID-19 tend to be elderly people over 65 who also have significant other conditions, Dr. Marc Elieson, chief of medicine at Hillcrest said Wednesday.

Elieson recommends that people wash their hands frequently with soap and warm water, wear a mask when visiting a large number of people they don't see often, and get vaccinated.

Simon Haeder, a Texas A&M University public health researcher, said Thursday that he expects a surge across the South in numbers of cases of COVID-19, RSV and flu in January and February when cold weather hits. Haeder recommends vaccines for all three diseases as the best prevention.

"When cold weather comes and people want to be indoors, plus no one wants to miss holiday gatherings with their relatives, we will probably have big spikes in all three," Haeder said.

"January and February will probably be when the disease burden occurs."

Haeder recently published a study on parental intent to vaccinate children against these three diseases. He found that nearly 41% of parents intend to vaccinate their children for COVID-19, around 63% for flu and around 71% for RSV.

The research on parental attitudes toward vaccines revealed more parents wanting give their children the brand-new RSV vaccine than those who were willing to give the COVID-19 vaccines that have been around for about 2-1/2 years, Haeder said.

The COVID-19 vaccines are still effective, particularly the newest bivalent vaccine that’s designed to counter omicron and the earlier strains, Elieson said. Everyone eligible for a new COVID-19 vaccine should one, he said.

In COVID-19 data voluntarily reported by laboratories in the week ending Dec. 9, the most recent statewide report from Texas Department of State Health Services shows new and probable COVID-19 case increased by 1,130 to 12,702. Some 1,200 patients were hospitalized across the state with COVID-19, up 114 from the prior week.

Hospitalization numbers may be more accurate that new cases, experts say.

RSV, flu and COVID-19 are so common and widespread that many people don’t seek treatment when they have them so there is no way to maintain an accurate count of cases, Lara Anton, a DSHS spokesperson said in a Thursday email. Mandatory reporting of COVID-19 ended when the governor’s disaster declaration expired in June, she said.

“The group of voluntary reporters help us to see the trends in the spread of these diseases over time,” Anton said.

Recent COVID-19 patients at Baylor Scott & White Hillcrest have been admitted with several other conditions as well, Elieson said.

“For COVID, typically the patient comes in with several other things and it’s part of milieu,” Elieson said. “The current strains of COVID are not as bad as it was.”

The current strains are not producing as severe a disease as the alpha and delta strains did at the beginning of the pandemic, he said.

“We’re not seeing respiratory failure due to COVID, we’re seeing respiratory failure due to something else,” Elieson noted.

He said the sight of patients struggling to breathe on ventilators is much less common now than early in the pandemic, but dangers persist.

“COVID wears down the elderly," he said. "They’re not eating, they’re not moving and we see cascade of events, leading to hospitalization.”

The highest hospitalization rates for patients with COVID-19 are among people 65 years and over, Elieson said. Most of these elderly patients with the COVID "milieu" have additional complicating long-term conditions such as diabetes, heart disease or a respiratory ailment.

In treating COVID-19 and keeping people out of hospitals, the antiviral drug Paxlovid is particularly helpful in treating the disease, preventing hospitalization in most cases, according to a May article from the Associated Press.

In May, the U.S. Food and Drug Administration granted full approval to Paxlovid to treat COVID-19 for adults who face high risks of severe disease. Generally those at highest risk include adults 65 and over and those with additional long-term medical conditions such as diabetes, respiratory disease, heart disease and obesity.

In the early December reporting period, COVID-19 associated deaths in Texas dropped by 11 from the prior week to 41, according to DSHS.

“We’re not seeing COVID-19 deaths in the large numbers we saw early in the pandemic,” Elieson said.

Baylor Scott & White Health declined to provide exact numbers of current COVID-19 patients or recent COVID-19 related deaths at Hillcrest Hospital.

Hillcrest is already seeing cases of RSV, flu and COVID-19, Elieson said. But he believes that most people are able to manage at home.

"We do have a lot of cases, we're seeing a lot of RSV, more cases than I remember seeing last year," he said.

RSV, or respiratory syncytial virus, produces symptoms comparable to a common cold in most people, but it can be severe and even life-threatening for certain older adults at high risk and for very young children, according to the American Lung Association.

The U.S. Centers for Disease Control and Prevention estimates RSV kills 100 to 300 children younger than 5 across the United States each year.

This past summer, the U.S. Food and Drug Administration approved two vaccines for RSV for the first time, one for older adults and one for pregnant women.

In the most recent statewide RSV surveillance report from DSHS, new RSV positive tests dropped in the report released Dec. 14 continuing a downward trend now in its fourth week.

In Public Health Service Region 7, which includes McLennan County and around 30 counties total, extending from Hill County in the north to Caldwell County in the south, RSV peaked in the week of Nov. 25 with a positive test rate around 23% and around 400 positive tests. In that most recent report containing data through Dec. 9, there were 15% positive results and around 300 to 350 positive results.

RSV data in Texas comes from the same network of testing laboratories that voluntarily report COVID-19 data.

The people who come to the hospital with RSV, flu or COVID-19 tend to be people who have another complicating condition, particularly a respiratory condition, Elieson said.

"People with asthma, chronic bronchitis, COPD (chronic obstructive pulmonary disorder) and emphysema are more likely to have severe RSV," Elieson said.

Hillcrest treated a young girl not long ago with RSV who also had asthma, Elieson said.

"She was a young girl with asthma, well-controlled with the use of an inhaler, and when she got an RSV infection, she had to go into the hospital for three days," Elieson said. "We had to put her on oxygen. She was so short of breath, she couldn't even walk to the bathroom by herself."

While RSV has dropped off recently, flu admissions to Hillcrest Hospital increased by 30% this week over last week, Elieson said.

From the beginning of the pandemic until now, Texas hasn't really had a traditional flu season, Stephanie Alvey, deputy director of the Waco-McLennan County Public Health District said in a Thursday email.

Haeder, the A&M researcher, said flu season was really early last year.

"We're in a more traditional flu season this year, heading into the peak," Haeder said.

A state report on flu surveillance came out Friday showed that so far this year, Thanksgiving had the highest percentage of patients reporting influenza-like illnesses, just over 6 percent. The week ending Dec. 2, this percentage dropped the slightly over 5%. The week of Dec 9, it increased back to nearly 6%

Also, the percentage of positive flu tests statewide jumped 5.5% from 9.9% to 15.4% from the prior week to the most recent week.

Last year statewide, the number of patients reporting influenza-like illness peaked just under 10% in the middle of November. The year before, the number didn’t peak until January at slightly under 6%.

In Waco and McLennan County during this same week last year, there were 572 confirmed cases of flu, Alvey said.

In the most recent reporting week, the district had 180 confirmed cases of flu, Alvey said.

From Oct. 1 through Dec. 9 across Texas there were fewer than 10 deaths due to pneumonia among children 4 and younger, and also less than 10 such deaths among youths ages 5-17. In that time, pneumonia and flu claimed the lives of 89 people between 18 and 49 years as well as 236 people between 50 and 64. During those months, 1,166 Texans 65 years and older died of pneumonia and flu, with total flu deaths during this year’s flu season so far numbering 1,496.

Elieson recommended that all who are eligible for the RSV, flu and COVID-19 vaccines should get them.

The health district has given given slightly more flu vaccines this year compared to this time last year, Alvey said.

“However, we have given significantly fewer COVID vaccines compared to this time last year," Alvey said. “That is likely due to changes in the vaccine recommendations, which delayed receiving and being able to administer vaccinations this season compared to last year." 

Those who are sick with a cough and flu-like or COVID-like symptoms should be tested and stay home from holiday plans and work, Alvey said.

For those who are healthy, Elieson recommends taking preventive measures and continuing with plans.

“If you’re flying, wear a mask on the airplane and in the airport,” Elieson said. “Also wear a mask to indoor gatherings with large numbers of people you don’t see often, or to outdoor gatherings where you’ll be standing very close to a lot of people you don’t usually see.”

He said a mask isn’t necessary when in well-ventilated areas and outdoors where people aren’t standing very close together. He recommended washing hands frequently with warm water and soap as well as covering coughs and sneezes.