Respiratory viruses appear to be getting an early start in Colorado, raising concerns about whether a more-severe cold and flu season lies ahead.

The last two flu seasons have been unusually mild, at least partially due to COVID-19 prevention efforts during the pandemic, though some other viruses primarily affecting children rebounded last year.

The bugs typically associated with fall and winter have been showing up earlier in Colorado and behaving differently this year, however, which makes it difficult to predict how much damage they might do.

Since the start of October, four adults and 94 children have been hospitalized in Colorado for respiratory syncytial virus, or RSV, which is more than is typical at this time of year. RSV hospitalizations usually peak in January or February, according to data from the Colorado Department of Public Health and Environment.

The rate of hospitalizations for RSV compared to the state’s population is already close to the peak of the pre-pandemic 2018-2019 season, though the state health department cautioned that there was less testing before 2020, making comparisons difficult. It’s still a long way from the high point set in December 2021, but this season is also off to a faster start.

Dr. Kevin Messacar, an infectious disease specialist at Children’s Hospital Colorado, said the number of children needing care for respiratory viruses started rising over the summer because rhinoviruses and enteroviruses were spreading. Now, kids are coming in with RSV and parainfluenza viruses, Messacar said. (Despite the name, parainfluenza viruses aren’t closely related to the flu.)

All of those viruses typically cause colds, but a small percentage of young children who get them can become seriously ill. Most kids can ride out respiratory illnesses at home, but parents should seek medical care if their child isn’t getting enough fluids or is breathing harder and faster than normal, Messacar said.

The first flu cases are starting to show up earlier than expected, which may not be a good sign for the rest of the season, Messacar said.

“With influenza season rapidly approaching with what appears to be an early start, we are concerned about the persistently increased volumes of sick children requiring hospitalization,” he said in a statement.

The same defenses work against all respiratory viruses, including washing hands, staying home when sick and covering coughs and sneezes. Vaccines against flu and COVID-19 are available for anyone six months or older.

So far, Colorado hasn’t been hit as hard as the East Coast.

A children’s hospital in Connecticut announced Thursday that it was considering asking the National Guard and the Federal Emergency Management Agency for help staffing a tent for patients awaiting hospital beds. Another hospital, in Washington, D.C., recently urged parents to consider taking their kids to their pediatrician or an urgent care center for illnesses that aren’t an emergency, citing long wait times for care.

The Colorado state health department has urged everyone who is eligible to get their flu vaccine as soon as possible, to prevent the virus from spreading to higher-risk people. Infants and toddlers, people over 65, those with chronic conditions and pregnant women are more vulnerable to severe illness.

“Flu seasons can be unpredictable and vary across different countries. However, recent data from the Southern Hemisphere, and in particular Australia, is concerning. For Coloradans, this could mean an earlier or more severe influenza season than we have seen in the last few years,” state epidemiologist Dr. Rachel Herlihy said in a news release.

Australia’s flu experience isn’t a perfect predictor of how Colorado’s will go, but the conditions are in place for a more difficult season than in the past two years, said Heather Roth, immunization branch chief at the state health department. Schools are functioning normally again, and most people have stopped wearing masks in public, she said.

“All of the precautions that had been in place for COVID are gone,” she said.

It’s difficult to predict how severe the flu season will be since much remains unknown about how different respiratory viruses interact. It also isn’t clear how much of an effect the lack of a flu season in the past two years will have on population immunity.

In the 2019-2020 flu season — the last typical one — 3,500 people in Colorado were hospitalized for the flu and three children died. The state lumps adult flu deaths in with pneumonia caused by other infections.

The Centers for Disease Control and Prevention reported signs of increased flu spread in the South, in what appears to be an earlier-than-usual start to the season. As of Friday, however, the CDC showed “minimal” flu activity in Colorado.

As of Wednesday, 651,000 people in Colorado had gotten their flu shots, which is ahead of last year’s pace but behind the record set in 2020, Roth said. Ideally, people will get their shot before Halloween so their immune systems have time to prepare before their holiday travels, she said.

“October is really the perfect month” for flu shots, she said.

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