The news lately has been full of stories about the triple epidemic, or tripledemic.

It is called that because we are seeing three different viral respiratory illnesses surge at the same time, namely COVID-19, Influenza and respiratory syncytial virus.

The precautions of masking, social distancing and remote learning, which were necessary and effective in controlling COVID-19, meant that children, especially very young children, did not have the typical exposure to many respiratory viruses. Therefore, they did not produce the antibodies needed to fight the illnesses caused by those viruses. Some refer to this as the immunity gap.

COVID-19, influenza and RSV are the big three, but there are many other respiratory viruses that cause illness in the fall and winter months. Rhinovirus, enterovirus, human metapneumovirus and parainfluenza virus are some of the other culprits.

Kids are being bombarded with all of these viruses now, and children’s hospitals are running out of beds.

All respiratory viruses present with similar symptoms, such as cough, runny nose, sore throat, headache and fever. Vomiting and diarrhea can sometimes be present, but they are rarely significant symptoms.

Influenza often has a more sudden onset than the others, and body aches and fever can be more severe.

Your healthcare provider can take a nasal swab and test for COVID-19, influenza, RSV and/or some of the other viruses.

COVID-19 has been with us for three long years. Things are better, but COVID has not gone away. In the United States, there are still hundreds of deaths every day, and thousands of hospitalizations. With the Omicron variants, and more new variants to come, we expect the situation to worsen this winter.

Kids are back in school, and the cold weather will force us all to spend more time indoors. Close contact means increased spread of all viruses. Many experts expect COVID to become an endemic (regularly found) virus that will peak every winter, just like influenza.

Influenza, also known as the flu, is epidemic every year, usually peaking in mid- to late winter. This year the flu is already spreading rapidly. In fact, for this early in the flu season, this has been the worst year for hospitalizations since the flu season of 2010-11.

The flu is not just the common cold. It is a respiratory illness that can be very serious. It tends to be more severe for the very young, the very old, and those with chronic medical conditions. Every year in the United States, there are millions of cases and many thousands of deaths due to the flu. During an average flu season in the U.S., about 100 children will die from influenza.

Respiratory syncytial virus has also come early this year. And because of the immunity gap mentioned above, it is rampant and more severe than in normal years. Most adults and older children exposed to RSV will experience mild common cold symptoms. However, in younger children (especially infants), older adults and those with chronic medical conditions, RSV can cause significant issues such as wheezing, difficulty breathing and difficulty feeding. This can lead to the need for oxygen, a breathing tube and/or intravenous fluids.

RSV is the No. 1 cause of hospitalization in children under 1 year old.

Antibiotics are not effective against any virus. Viral illnesses cannot be cured.

There are antiviral drugs and infusions that can lessen the severity of COVID. There are antiviral drugs that can also modify influenza. However, in order for them to be effective, they must be taken soon after the illness has begun.

In the United States, there is no antiviral drug for RSV. The main home treatments for all viral illnesses are to drink lots of fluids, eat as well as possible, rest, and if needed for discomfort, take acetaminophen or ibuprofen. Especially in infants and young children, it is important to watch for signs of respiratory difficulty. These include rapid breathing, pulling in of the chest or stomach muscles, flaring of the nostrils, or cyanosis, a blue color of the lips and the area around the lips. If you see any of these, seek medical attention right away.

The most effective treatment is to prevent illness in the first place. For both COVID and influenza, there are very safe and effective vaccines. There is almost no medical reason to not get these vaccines. Immunizing yourself and your children is by far the most important measure to prevent COVID and the flu. Vaccines may not be 100% effective in preventing illness, but those who are vaccinated will rarely experience hospitalization or death.

We learned from COVID that precautions such as hand washing, masking, physical distancing and staying home when sick are very effective strategies to prevent respiratory illness. We need to continue to follow those measures. That does not mean we need to restart strict precautions such as closing schools or always staying at home. We need to do the simple things, such as avoiding crowded situations when possible, and masking when crowded situations cannot be avoided.

We cannot cure or get rid of COVID, influenza or RSV. We can, however, do a lot to protect ourselves and others, and lessen the burden of these illnesses.

Have a wonderful holiday season and a healthy, happy and joyful 2023!

Beacon Pediatrics LLC is at  18947 John J. Williams Highway, Suite 212, Rehoboth Beach. Call 302-645-8212 or go to

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