The “Tripledemic” is Here

Get ready, because Santa is coming to Boca Grande – and he is bringing along COVID-19 and his cousins Flu and RSV for Christmas dinner!  As you all have probably read, RSV (Respiratory Syncytial Virus) is spreading across the U.S., as is influenza. And like Cousin Eddie in the movie “Christmas Vacation,” COVID-19 just will not seem to get the hint to move along. 

Should we go back to lockdown and isolation? That plan was not good for our kids and was psychologically isolating and stressful on all of us. Here are my recommendations based on science, not politics.There is a handy tool that should always be in your pocket or purse that can reduce your risk of catching a bug from someone else. It is cheap and easy to replace, and you should never leave home without it. We have been using them to lower infection risk in medicine during surgery for 125 years. 

Please do not kill the messenger, but I am talking about a mask. No, they are not perfect. When I see someone constantly adjusting their mask and pinching the front of the mask with their hand, the microbiologist in me imagines all the viral particles and bacteria from everything they touched today being rubbed onto the mask so they can inhale it. In fact, studies have shown that we touch our face and adjust our mask so often that we can transfer infectious particle to our face, which is why early in the pandemic they said no masking. Frequent handwashing helps lower risk and being outdoors lowers risk.  Did you read the studies that show we unconsciously touch our face on average 70 times a minute, with one-half those near mucous membranes which could transmit illness? A study done in 2019 at an airport suggested transmission of illness could be lowered 70 percent by having people wash their hands to lower this transmission. If only I could hypnotize you all right now: “DO — NOT – TOUCH – YOUR – FACE”.   

Proving masks work in the hospital is much easier, since the number of viral or bacterial particles expelled are quite high in very sick people and the specific strains are often the worst around. That is why we have continued to see masks required in many hospitals and some outpatient settings like cancer infusion centers. But it starts getting gray from there and requires each person to be informed to make their own decisions.  Let me share some facts before moving onto recommendations.  

The three uninvited guests

RSV has infected most of us by age 2 but it’s a gift that can keep giving (like fruitcake), and you can get it again like the flu. There is currently no RSV vaccine, but one may be available next summer for adults. We know RSV causes about 8,000 deaths in folks over 65 each year, but flu causes almost 10 times as many deaths in folks over 65 and currently we already have had well over 7,000 adult flu deaths in the U.S. – and flu season has just barely started. It is looking like the worst flu season in the U.S. in a decade and predictions suggest over 60,000 adult deaths are likely by April 2023. 

And COVID-19 is much more deadly than RSV or flu and it is not done with us. The current Moderna COVID-19 vaccination offered at the clinic has Omicron protection as well and in people over age 50, your risk of death is 12 times less than those unvaccinated. Yes, you can still get sick, but you are much less likely to die if vaccinated. Never in medicine has such an effective vaccination been so maligned. We offer this to protect not just you, but those at risk in your community. Please do not become numb to the fact that more than 1,000 Americans died from COVID-19 just in the past week. People are dying of COVID while you read this. These numbers are real. Although there has been a decline in deaths since September when deaths were over 2,000 a week, the rate of deaths is expected to climb through December and January, with our national hospital occupancy already at about 80 percent capacity due to the addition of RSV and flu cases.    

Continue to follow the COVID-19 level updates where you live, and you should be more likely to use that mask when levels are higher where you live. Currently Boca Grande remains at a moderate level. As you decide whether or not to mask, you should first consider your risks. If you are over 65 and have lung problems, diabetes, or a weakened immune system, then your risks from these respiratory illnesses are higher. 

Here are my recommendations  

There is poor science that people quote to support their personal and political views and there is good science that is reproducible, and much of it is new science that is evolving. There are so many factors that affect the protection masks provide, but we can lower our risk of catching COVID-19 and other viruses by about 50 percent by wearing a cloth mask in public places, about 60 percent with the better surgical masks, and about 80 percent with tight fitting N95 masks. These numbers are affected by many factors such as how long you are in a room, how many people are spreading viral particles, how many viral particles you are exposed to (more if someone is unmasked and coughing), air turnover in the room, and others. 

For those over 65 I continue to recommend putting your mask on while out to get groceries or in a public building with lots of other folks to lower your risk and use hand sanitizer as you walk to your car and then remove your mask.  Mask when you travel through the airport. Choose outdoor seats when you can or take-out meals. Wash your hands often and thoroughly because you ARE going to touch your face. Carry hand sanitizer to use when you go in or out of a door in a public place and after shaking hands. Encourage adults and children over 2 with a runny nose or cough to wash their hands and wear a mask to lower spread if they must go out, but better to stay home and not spread that bug. If we mask for each other in crowded public places, we can lower the spread of these respiratory bugs. It is safer outdoors and the red tide is waning, so get out and enjoy the cooler weather. 

After watching our community work together recovering after Hurricane Ian, I know we can look out for each other and manage the bugs among us. I hope Santa brings you hugs and kisses without viruses, and you have a happy new year!

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About the Author

Raymond A. James, D.O.

Dr. James joined the Clinic in March 2018 and serves as Medical Director of the Clinic. A graduate of Des Moines University College of Osteopathic Medicine, he completed his residency at Metropolitan Hospital in Grand Rapids, Michigan. He is board certified in emergency medicine and has been awarded fellowship status by the American College of […]