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Exploring the Potential Impact of a Second Tripledemic on Society

-Editorial

The US is facing a simultaneous rise in COVID-19, flu, and Respiratory Syncytial Virus – RSV – cases — what some medical experts call a “tripledemic.” The surge of respiratory illnesses threatens to burden already-overstretched healthcare systems, with possible lapses in care for vulnerable communities.

The Centers for Disease Control and Prevention reported 29,000 Covid hospitalizations in the week ending Dec. 23. The new JN.1 sub-variant accounts for nearly half of new COVID-19 infections. The US is also facing a surge in RSV cases, a respiratory illness without a cure, largely seen in infants and older adults. And, in just the last quarter of 2023, there have been 14 million cases of flu with 13,000 deaths, according to CDC estimates.

Dr. Jose Perez, Chief Medical Officer, of South-Central Family Health Center said upper respiratory infections (URIs) encompass over 100 viruses, including COVID-19 (SARS-CoV-2), Respiratory Syncytial Virus (RSV), and the Influenza virus. These infections manifest with symptoms in the nose, throat, and eyes, accompanied by fever and muscle aches. All three viruses can lead to lower respiratory infections (LRIs), affecting the bronchial tree and lungs, causing conditions like bronchitis and pneumonia. 

These infections are more prevalent in winter, as people spend more time indoors during inclement weather and holiday gatherings. The viruses spread through contact with infected individuals’ body fluids, primarily through coughing and sneezing. 

“Transmission occurs when uninfected individuals touch contaminated surfaces and subsequently their faces or inhale infected air,” Dr. Perez said. “Identifying the specific virus based on symptoms alone is challenging, and most infected individuals experience a cold-like illness, requiring supportive measures such as rest, fluids, pain relievers, and cough syrup.”

Dr. Benjamin Neuman, Chief Virologist of the Global Health Research Complex at Texas A&M University said that when it comes to viral infections, distinguishing between variants becomes crucial when facing potential hospitalization and mortality, emphasizing the importance of vaccination in mitigating these risks, albeit not eliminating them.

The latest concern is the JN one variant, a relative of the older A.2.86 strain and a descendant of early Omicron strains. Unlike its extinct or mutated counterparts, JN one comprises approximately 50% of reported global cases, growing at an accelerated rate. This marks a deviation from the linear evolution seen in previous strains, with the virus now presenting two distinct lineages, challenging existing vaccines.

“The unique challenge with JN one lies in its divergence from the current vaccine strain, akin to the gap between previous vaccine iterations. Approximately 8 mutations in the receptor binding domain, the virus’s contact point with cells, necessitate vaccine updates for optimal efficacy,” Dr. Neuman said. “While JN one is not significantly faster in growth, estimates suggest it may be around 10% more efficient in producing virus particles.”

As COVID-19 slips to seventh place in the CDC’s causes of death list, the impact of long COVID emerges as a potential contributor to other health issues. Post-COVID complications include elevated risks of heart disease, brain fog, substantial brain shrinkage, and long-term respiratory difficulties. 

Investigating the extent to which long COVID contributes to these outcomes is crucial, as new variants like JN one introduce neurological symptoms such as anxiety and sleeplessness, reminiscent of early COVID reports. Understanding and addressing these complexities remain essential in navigating the evolving landscape of viral infections.

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