During the last two holiday seasons, COVID-19 was pretty much the only virus on peoples’ minds. But this year, a “tripledemic” of COVID, influenza and respiratory syncytial virus (RSV) is straining the U.S. health system, causing lengthy emergency department wait times and medication shortages.
It's unusual that these three viruses are all spiking at the same time, Dr. Eric Cioè-Peña, director for global health at Northwell Health in New York City, tells TODAY.com. While the RSV wave appears to be slowing down after surging much earlier in the season than usual, flu started early, causing more hospitalizations at this point in the season than over the past 10 years, and COVID cases are up 36%.
What's more, people are taking fewer precautions, such as masking and distancing, compared to the last two winters, and the holidays mean spending lots of time with large groups mostly indoors.
In short: a lot of people will be spreading respiratory viruses instead of holiday cheer over the next few weeks.
Fortunately, there are actions you can take to reduce transmission and keep yourself and your loved ones — especially those who are high risk for severe illness — safe during the holidays.
Limit exposure before seeing loved ones
This time of year comes with lots of parties, and the safest choice may be not attending them all, NBC News medical contributor Dr. Natalie Azar said during a Dec. 19 segment on TODAY.
"You want prioritize (and) really think about how many exposures you want to actually encounter, and then you do your own risk assessment for yourself and for your own family," she explained. "If you’re traveling, limit your exposure beforehand."
Stay up to date on your COVID-19 vaccines
Vaccines not only reduce transmission, but they also prevent severe illness and hospitalization, Dr. Michael Phillips, chief hospital epidemiologist at NYU Langone Health, tells TODAY.com. "Even if you're young and otherwise healthy, if you're visiting your grandparents who may be at risk for severe disease, vaccination makes a difference."
And people hosting holiday gatherings should encourage guests to get up to date on their vaccines before attending (meaning the two-dose primary series and the most recent booster recommended by the Centers for Disease Control and Prevention), says Cioè-Peña.
The new COVID-19 booster targeting omicron variants and the original strain is approved for everyone 6 months and older. Although Christmas is six days away, "you're going to be more protected after a booster than before a booster, no matter what the duration, so I'd certainly strongly recommend it," says Cioè-Peña.
Get a flu shot as soon as possible
It’s not too late to get your seasonal influenza shot, as cases and hospitalizations surge across the country, the experts note. The flu shot is recommended for everyone 6 months and older. Even if it may not preventing you from catching the flu, it will reduce how sick you get, which is important as hospitals are already struggling.
All of the flu shots available this season are quadrivalent, meaning they protect against four different flu viruses, and there are already signs that the vaccine is a good match for the strains circulating right now, Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, previously told TODAY.com.
Stay home if you're feeling sick
Try to avoid holiday gatherings or travel if you're feeling sick, the experts emphasize. Even if your COVID-19 test is negative, you should stay home when you have any cold- or flu-like symptoms, Cioè-Peña says, because it could be influenza or another respiratory virus that might make a vulnerable person, like a grandparent or a young baby, very sick.
Parents should try to keep their sick children home or away from gatherings, especially if they have a fever, a sign that "they're probably very infectious," says Cioè-Peña.
If you’re hosting an event, Cioè-Peña suggests checking in with guests about how they're feeling in the days leading up to the event, and encouraging anyone who feels sick to stay home or attend via Zoom, for example.
“We know that folks that are at real risk for severe disease can get really sick and die, so let’s do everything we can to protect them,” says Phillips.
People who are high risk for COVID, flu, RSV or other respiratory viruses include: anyone over 65, immunocompromised people, those with underlying medical conditions like diabetes or heart disease, pregnant people and young children.
Test for COVID-19 before gatherings
The current testing guidelines per the CDC are that anyone who has COVID-19 symptoms (cough, sore throat, congestion, fever, fatigue, aches) should test immediately, and anyone exposed to COVID-19 should start testing five days afterward.
But even if you're feeling well and have no known exposures, it's a good idea to test before spending time unmasked with anyone high risk, because you can be infectious before symptoms appear and many COVID infections have no symptoms or they're so mild that you might not notice them, Phillips advises.
“Getting a COVID-19 rapid test just before you’re about to visit somebody really vulnerable is a good way to protect them,” he says.
If none of the above circumstances apply to you, it's still reasonable to test before holiday gatherings or travel simply to know your COVID status. But keep in mind that rapid antigen tests tend to be less accurate at detecting infections without symptoms, and a negative rapid test doesn't guarantee that you don't have COVID.
Regardless of your circumstances, the best time take a rapid antigen test before a gathering is right beforehand; if you're traveling, test before leaving and when you arrive at your destination.
Wear a mask when traveling or in crowds
When worn properly and consistently, masks are an effective way to reduce the spread of COVID-19 and other viruses like influenza, the experts note. A well-fitted, high-quality surgical mask or N95-type respirator can protect the mask-wearer even if people around them are unmasked, says Cioè-Peña.
Anyone can benefit from wearing a mask in crowded indoor settings with poor ventilation, Phillips says, but masking up is especially important if you're vulnerable or traveling to someone vulnerable.
Last week, the CDC director Dr. Rochelle Walensky recommended wearing a mask when traveling by plane, train, bus or other public transportation, if you're immunocompromised, at increased risk of severe disease, or if you live in a county with high COVID-19 levels.
People who are sick but must leave the house should wear a tight-fitting mask or N95 to protect other and should only travel if it's an emergency — while wearing a mask — Cioè-Peña says.