Here’s why Utah doctors are worried about how well you’ll be breathing this winter

Respiratory illness is already increasing among patients at University of Utah Health, doctors say.

(Trent Nelson | The Salt Lake Tribune) In November 2020, a sign encouraged masks at City Creek in Salt Lake City. Heading into this winter, Utahns may want to return to using masks with a possible 'triple-demic' of COVID-19, flu and RSV viruses circulating, University of Utah Health doctors said Wednesday.

Winter is coming, Dr. Andrew Pavia cautioned Wednesday — a warning Game of Thrones fans may recognize, he quipped, but all Utahns should heed as COVID-19, influenza and RSV viruses start to drive more illness.

The increasing number of cases of COVID-19 and RSV in Utah already, combined with the burgeoning flu season, are raising the possibility that all three illnesses could surge here at once, said Pavia, chief of the Division of Pediatric Infectious Diseases at University of Utah Health.

Childrens’ hospitals elsewhere in the country are operating at 120% percent of capacity and running out of beds, Pavia said, “driven largely by RSV,” with an uptick of COVID-19 cases.

Australia had a busy flu season, he noted, and the southeastern U.S. is seeing cases increase now. “We really haven’t had a bad flu year since COVID started,” he said. “This is likely to be our first bad flu year, so we’re going to have to learn as we go about the interactions of these two viruses.”

And heading into this winter, there is concern that coronavirus variants could fuel a surge in cases “that could overwhelm many of our systems,” Pavia said.

He and Dr. Russell Vinik, chief medical operations officer at University of Utah Health, urged Utahns to get vaccinated against the flu, boosted against the coronavirus, stay home when sick, wash their hands frequently — and to find the masks, particularly the high-quality masks, they may have put away.

It is unlikely masks will be widely mandated, Pavia said in a Zoom news conference, “because of the politics, but that doesn’t mean you shouldn’t use them to protect yourself.”

Here are other points raised during their discussion.

What’s happening now in Utah?

University of Utah Health is just beginning to see a rise in COVID-19 cases from the low point a few weeks ago, and while there were no flu cases a month ago, they now are showing up in urgent care clinics.

“The good news is [coronavirus] hospitalizations haven’t increased significantly yet,” Vinik said. “The bad news is what we’ve seen in previous waves is first we start to see an increase in cases and then hospitalizations.”

Of the Utahns now hospitalized with COVID-19, a majority are still unvaccinated; they are not as sick as patients infected with the Delta variant, but some are still experiencing respiratory failure, Vinik said.

Utah has been reporting daily coronavirus case counts under 500 since the end of August, with seven-day averages hitting low points in the low 200s earlier in October. For instance, the seven-day average was 209.7 on Oct. 13, and it has begun to rise slightly since then.

Meanwhile, cases of RSV, a common respiratory virus that causes more serious illness in infants, toddlers and the elderly, are starting to increase rapidly in Utah.

“We’re not anywhere near our peak levels where we start running out of beds, but it’s combined with an increase in flu, which we think is going to get much worse,” Pavia said.

When children catch the RSV virus in the first two to three years of life, it can cause cold symptoms, “or a much more nasty infection,” he said. About 50,000 kids are hospitalized every year.

“As you get much older, you lose immunity to RSV, and it becomes really important again,” he added, with 177,000 hospitalizations a year for older patients.

What’s coming next?

In the next two years, or sooner, RSV vaccines will become available, he predicted. “That’s not going to help us this winter. This winter looks to be pretty bad.”

Pavia, also director of hospital epidemiology at Intermountain Primary Children’s Hospital, also expects sub-variants of COVID-19 to fuel a surge in cases.

The newer variants are better at escaping immunity from past infections and from treatment with monoclonal antibodies, which “does portend more problems this fall and winter,” he said.

But, he added, “I’m hopeful that we’ll never see anything quite like the impact that Delta and Omicron” variants had on case counts.

”Most kids who get COVID, luckily, won’t end up in the hospital or ICU,” Pavia said, “but at any given time, we have about a dozen kids in the hospital with COVID.”

Pavia said he “can’t really speak to” preparations by the state health department. “There are contingency plans,” he said, “but a lot of the [coronavirus] funding has disappeared, so opening mass testing facilities is difficult without funding to do that.”

Department of Health and Human Services staff are monitoring COVID-19 trends and the need for testing throughout the state and will make adjustments “as demand ebbs and flows”, spokesperson Jenny Johnson said.

There are 450 locations where Utahns can get tested, she said, including state-run sites for people who face barriers to health care, private testing providers and retailers, and sites at health clinics and hospitals.

She said the state has partnered with libraries, senior centers and food pantries to provide at-home test kits for free. More information about testing sites and at-home tests can be found at coronavirus.utah.gov/utah-covid-19-testing-locations.

The challenge of staffing

Utah health care workers remain burned out or exhausted by the demands of their jobs since the beginning of 2020, Pavia said. So as more Utahns may need care and hospitalization, he warned, “we don’t have the surge capacity that we had three years ago to deal with some of the threats we may face.”

When Vinik speaks with colleagues in the region and across the nation, he said, “this story is playing out over and over again. ... We struggle to staff all of our beds every day.”

At the start of the pandemic, health care workers were ready and able to work the extraordinary hours that were needed, he said. Now, “we just don’t have the people and the staff that are willing and able to do that at this time,” he said. “We have to be careful.”

What can Utahns do?

COVID-19 and flu vaccines for children are effective and safe, Vinik said.

“We know pregnant women are more likely to be hospitalized if they have COVID or the flu,” Vinik added. “... Please, please consider getting vaccinated for yourself and for your unborn child.”

“Vaccines aren’t perfect, we can’t expect them to be perfect, but they’re very good at protecting you against the most severe outcomes, including hospitalizations and death, and [there’s] pretty good evidence that it protects from long COVID,” Pavia said.

In health care settings, “we are very concerned about safety of patients and staff, so if you come into a hospital, whether patient or visitor, we expect you to wear masks,” Vinik noted.

And masks, particularly high-quality masks, can protect you elsewhere “as things get more heated and as you go into crowded settings,” Pavia said. Masks work to protect against COVID-19 by stopping the dissemination of respiratory droplets, the doctors explained.

“Masks are probably even more effective of stopping the spread of flu than they are for COVID,” Pavia added.

For RSV in kids, masking advice has relied on older studies showing masks may not be as important to stop spread, he said. ”But that’s not true. Mask are also quite helpful in preventing RSV, more so because they contain the highly infectious snot which you make when you’ve got RSV.”