How Bad Will This Respiratory Virus Season Be? CDC Weighs In.

The CDC predicted that this year’s fall and winter virus season will look a lot like last year’s.

“The bottom line here is we’re likely to have a similar number of total hospitalizations as we had last year,” Dylan George, PhD, director of the CDC’s Center for Forecasting and Outbreak Analytics, told reporters during a webinar on Wednesday.

The CDC is predicting a “moderate COVID-19 wave ” and a “typical” influenza and respiratory syncytial virus (RSV) burden, George said, noting that these forecasts are based on expert opinion and historical data, as well as “some modeling results,” especially for the group’s COVID projections.

“Now, we have to be very humble about this assessment because there’s lots of uncertainties associated with this,” he cautioned, particularly in relation to the timing and the magnitude of the peaks of each virus.

The three questions that CDC scientists considered and that would change their assessments if any were answered affirmatively are the following:

• Is there a COVID variant that is behaving differently — for example, causing a higher degree of spread?
• Is there a “coincidence” of the peaks of the RSV, influenza, and COVID viruses?
• Is the country experiencing an “unusually bad” flu season?

Currently, there is no such COVID variant, no confluence in the peaks of the viruses, and flu activity is low, George said, “but we need to stay vigilant and watch all three areas.”

While the projection for COVID is for a “moderate season” in a post-pandemic world, it’s important to recognize that “having three circulating respiratory illnesses is worse than having two,” George noted.

“We’re learning more about each of these pathogens on a daily basis. As we learn more, we will update our assessments and we will update you at that time as well,” he added.

In addition to these forecasts, Demetre Daskalakis, MD, MPH, acting director of the CDC’s National Center for Immunization and Respiratory Diseases, outlined the agency’s specific vaccine recommendations against all three viruses.

• COVID vaccine: Anyone ages 5 years and up who is not immunocompromised should receive one dose of the updated mRNA vaccine, regardless of that individual’s prior vaccination history. For children 6 months to 4 years who have been previously vaccinated, they should receive one or two doses of the updated vaccine, depending on how many previous doses they have received. Those who are immunocompromised may also receive additional doses of the vaccine after discussion and in accordance with the clinical judgment of their provider.
• Influenza vaccine: Anyone ages 6 months and older who is not contraindicated for a flu vaccine should receive one. Given that older adults and infants tend to be at higher risk of complications from influenza, Daskalakis stressed that these groups should prioritize vaccination. For adults over 65, new guidance states that a higher dose, or adjuvanted vaccine, is preferred; however, if such formulations are not available, individuals should get whatever vaccine is available.
• RSV vaccine: Adults over 60 may receive a single dose following a discussion and shared clinical decision making with their provider. There is also a vaccine for pregnant women, which has been recommended for women at 32 to 36 weeks’ gestation, to prevent lower respiratory tract RSV infection in infants. In addition, the monoclonal antibody nirsevimab (Beyfortus) is recommended for all infants younger than 8 months born during or entering their first RSV season and those ages 8 to 19 months entering their second RSV season who may be at increased risk for severe illness.

Daskalakis also noted that treatments are available for influenza and COVID, and in both cases, “speed is the key.” In other words, to be most effective, these therapies should be started as soon after symptoms develop as possible.

“While we don’t know what’s in store for this fall and winter … we know that it’s critical to take advantage of safe and effective immunizations, the treatments that we know work, and all the precautions that we’ve learned to help protect ourselves, not just from one, but from three, viruses,” Daskalakis said.

Finally, as the responsibility for distribution of COVID vaccines shifts from the federal government to the private sector, CDC officials acknowledged that there have been hiccups.

CDC Principal Deputy Director Nirav Shah, MD, JD, noted that some individuals have had trouble getting the vaccine for themselves or their children in recent weeks, but urged them not to give up.

“Please know that vaccine is available … more and more vaccine is getting out there every single day, every single week,” Shah said. “And so please check back in with your provider, with your pharmacist, because it’s likely if they didn’t have vaccine 2 weeks ago, they will have it or have it now.”

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