Reports of a “tridemic” have been circulating since late 2022 in response to the increase in cases of flu, COVID-19, and RSV in pediatric and adult populations. Some of pediatricians’ youngest and immunocompromised patients could have their health at risk during this sickness surge, while the majority of kids and parents are struggling to maintain attendance to work, school, and childcare. How can pediatricians help support families and maintain high volumes during another busy winter sick season? In this article, we’ll cover an early 2023 update of respiratory illnesses and dive into ways practice managers and physicians can help protect children.
Editor’s note: The words “tridemic” “tripledemic” are terms coined by media sources to refer to the 2022 to 2023 sick season’s high occurrences of flu, COVID-19, and RSV among children and adults. At the time of this post’s writing, there is no scientific consensus on whether the rates of these illnesses are endemic in the United States. In this article when referring to the group including flu, COVID-19, and RSV, we’ll refer to the American Academy of Pediatrics’ use of the term for all three conditions: respiratory illnesses.
RSV, or respiratory syncytial virus, is a respiratory illness especially threatening to children below the age of 2 and for any child with a high risk for respiratory illness. The U.S. Food & Drug Administration (FDA) is taking steps towards a long-acting RSV antibody for young children which could go into effect later in 2023.
According to data from the Centers for Disease Control and Prevention (CDC), the peak of RSV infections has passed, but the rates for RSV were significantly higher than immediate past seasons. The complications for pediatricians and children’s hospitals were exacerbated by the combination of RSV with other concerns like seasonal flu, COVID-19, and the ongoing childrens’ mental health emergency.
Seasonal flu is spiking as it does during most winter seasons in the United States. Rates of COVID-19 are also a concern. While the U.S. has seen similar rates of COVID-19 before (470,000 weekly cases as of January 9, 2023), compounded with RSV and other illnesses, hospitals, pediatricians’ offices, schools, and daycares continue to struggle with maintaining health and protecting vulnerable patients.
COVID-19 continues to spread in communities, with the several variants being called “scrabble variants” for their many letters. According to Yale Medicine, none of the newer variants seem to be increasing hospitalizations.
An update on MIS-C: as of January 1, 2023, the American Academy of Pediatrics has released a new definition for the diagnosis of MIS-C or Kawasaki disease, which can occur after a COVID-19 infection. The condition is affecting younger patients than earlier in the pandemic, and the AAP cautions physicians to examine clinical results carefully for accurate diagnosis.
The primary struggle for families, apart from caring for a sick child or children, is managing the logistics of childcare, school, and work for all family members. Currently, CDC guidelines recommend a 10-day isolation period for children who test positive for COVID-19. Alternatively, the child may test negatively for COVID-19 twice in 48 hours to be deemed safe to re-enter school or daycare.
Some schools and childcare centers have more or less stringent rules around quarantine and testing requirements for children who are sick, even if a child is negative for COVID-19. Families may use vacation days to care for children at home if they cannot work remotely, or may even need to quit the workforce to care for their children.
Pediatricians should encourage families to call the office if a child shows signs of fever or coughing. It’s also important to monitor your practice’s volumes to ensure the sickest patients receive appropriate care promptly and to protect staff and physicians from burnout.
If your practice is experiencing high volumes this winter, here are some actions you can do to handle it:
Fundamentally, pediatric practices are on the front lines of combating winter illnesses, including respiratory ones. Preparing families with routine vaccinations, plus flu and COVID-19 vaccines, are an excellent start in protecting children from respiratory illness.
Children’s mental health may also be fluctuating during periods where their schedules are uncertain. Parents and pediatricians should be on the same page in supporting kids’ mental health needs, including updating medications, maintaining routines, and practicing activities that help kids build resilience.