Is everyone sick right now? How this virus season compares to previous ones

After a relatively hellish season last year, the patterns this time around are reminiscent of pre-pandemic years, only now we have COVID thrown into the mix

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“Horrid” coughs. Colds that “Just. Won’t. Go. Away.” Whole households “taken down” by the flu. A rush of people seeking sick notes from doctors to verify that they’re sick.

There’s a sense from social media posts that almost everyone is sick, or knows someone who is sick, or who got sick, recovered and is sick again. “Is anyone else here experiencing this,” one reddit user asked. “Is something different this year?”

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“Our memory is short,” said Dr. Paul Roumeliotis, medical officer of health at the Eastern Ontario Health Unit. People seem to have forgotten what respiratory virus season feels like. We’re also paying more attention to symptoms than we did before COVID.

After a rough season last year, the patterns so far this year are reminiscent of pre-pandemic years, only now we have SARS-CoV-2, thrown into the mix.

“We’ve got lots of COVID. Flu is on a surge. RSV (respiratory syncytial virus) is at a peak,” said Dr. Gerald Evans, chair of the division of infectious diseases at Queen’s University in Kingston.

So, “yeah, there’s probably going to be quite a few people who are picking up these viruses,” some of whom are at particular risk for developing serious complications and who are going to end up in hospital, he said.

Influenza and RSV are behaving within expected ranges for this time of year, unlike last year’s influenza season, which was early, brutal and short.

We’re into a period where the numbers of these viruses, particularly the serious ones — SARS-CoV-2, influenza, RSV — are starting to peak

COVID levels are high. For the week ending Dec. 2, the national test positivity rate was 18 per cent. The percentage of tests positive for RSV was seven. When it comes to its prevalence in the community, SARS-CoV-2 “just blows the other viruses out of the water,” Evans said.

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“There’s no doubt we’ve had a really ongoing fall wave of COVID, and we have very low uptake right now of the vaccine, the result of which is, yes, there are a lot more people who are getting COVID, sometimes maybe a second or third time.”

Federal data show just 15 per cent of Canadians outside Quebec had received the updated XBB.1.5 shot as of Dec. 3. Alberta had a higher uptake (14.3 per cent) than Ontario (11.5).

Last year’s respiratory virus season was particularly harsh, when an early and unprecedented surge of both RSV and flu converged at the same time against a backdrop of lingering COVID, Roumeliotis said.

Hospitals, children’s hospitals in particular, were overwhelmed.

So far, influenza A is following a typical seasonal trajectory. “We’re around seven per cent positivity. Last year this time we were close to 30 per cent,” Roumeliotis said.

The prediction is a slow rise of influenzas, peaking at the end of December and early January and then settling high for six to eight weeks before starting to climb down again by the end of February or early March.

“If it wasn’t for COVID I would say this is an absolutely typical pre-pandemic season,” Roumeliotis said.

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Other respiratory viruses are also circulating again. Enterovirus. Rhinovirus. In the pandemic phase of the pandemic (we’re now in the transition phase to endemic) “a lot of people were careful, thoughtful,” Evans said. “They washed their hands a lot; they did everything they could to prevent respiratory virus infections. Now they’re getting those rhinoviruses.”

Fall saw the usual fall surge in rhinoviruses, with the return of kids to school. Rhinoviruses, which cause common cold symptoms, tend to be harmless. In the middle aged and older, however, they can cause a prolonged triggering of “airway reactivity” in the lungs, Evans said. The result: a lingering cough that can easily last two to three weeks or longer.

“I know my family physician colleagues and primary care docs get a lot of visits like that to their offices: ‘You know doc, I know I had a cold, but holy mackerel. Four weeks later I’m still coughing like crazy,’” Evans said.

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Rhinoviruses are also a leading cause of asthma or COPD (chronic obstructive pulmonary disease) flare-ups.

“Of course, now we’re into a period where the numbers of these viruses, particularly the serious ones — SARS-CoV-2, influenza, RSV — are starting to peak and cause more severe problems,” Evans said.

Last year’s brutal RSV season was thought by many a “catch-up” year from a lack of exposure during COVID lockdowns. But it’s not necessarily a single season effect, McMaster University infectious disease scientist Matthew Miller said in an earlier interview. It can take multiple seasons to catch up.

Kingston Health Sciences Centre this week said it was “bursting at the seams” and that a number of children were being admitted each day. “It’s RSV,” Evans said.

RSV is surging right now. We’re probably at the peak of RSV and are likely to be at that peak for another few weeks, he said. People who suffer the most are young children under the age of one.

Alberta which is reporting widespread flu activity, higher than any other province, is seeing a spike in flu hospitalizations, as well as severe cases of COVID. In British Columbia, COVID indicators are falling, but RSV and influenza are on the rise.

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Some on social media have posited that previous COVID infections have left people more vulnerable to getting sick from other viruses. But Evans said there is no consistent, reliable signal that swaths of the population now have some form of immune suppression as a byproduct of COVID.

Some researchers have reported that SARS-CoV-2 may trigger a genetic predisposition to autoimmune diseases like rheumatoid arthritis or lupus.

“But if you look at those diseases, they’re actually due to an upregulation of immunity,” Evans said. “Your body attacks itself in a weird way.”

He doesn’t buy that immunity is being impaired by COVID, “and that that’s what’s causing the rise in cases of other viruses that are out there.”

With the risk of severe illness projected to increase, and hospitals already grappling with staff shortages and pandemic-driven backlogs in care, public health officials are recommending people, particularly older adults, get updated COVID and flu shots, especially ahead of the holidays and family gatherings. RSV vaccines have also been approved for people 60 and older.

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But messaging implying that COVID is over, sort of, isn’t helping uptake, Evans said. “A lot of people say, ‘well, gee, if it’s not that big a deal … I don’t need to take a vaccine.’” Flu vaccine uptake among health-care workers is also down.

“And, of course, nobody is doing anything anymore,” Evans said. “Even public health says, ‘Oh, we recommend you do a few things to try to avoid it.’ But there’s no concerted effort to try and reduce transmission other than some real diehard people who say, ‘If I’m out there and I’m in a crowded situation, I’m putting a mask on, I’m gonna be careful.’ They’re in the minority, particularly among younger and middle-aged folks.”

“This is a transmissible virus. Lots of people get it.”

Roumeliotis suspects many people are feeling “vaccined-out. Some of the elderly have had five, six doses already.”

“I think that because the World Health Organization has declared the emergency over, a lot of people seem to think COVID is gone, and don’t need the vaccination,” he said.

“It’s not over yet, unfortunately.”

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