Understanding the Rise of the Tripledemic, Vaccination Minimizes Risk

December 05, 2022 - As more and more providers warn against the tripledemic — including RSV, COVID, and influenza — it is crucial to understand the projections and impacts of these cases. Additionally, an in-depth understanding of the tools and interventions, such as vaccination, masks, and more, available to address the rising rates of infection can help minimize disease burdens and improve prognosis.

Healthcare industry members have become exceptionally well-versed in the impacts of COVID. Although multiple aspects of the disease are not well understood, providers have seen how infectious and dangerous this disease can be. Coupled with the rising rates of RSV — which the CDC estimates to be 53% greater than in previous years — and influenza season, it is critical that healthcare providers put their best effort into ensuring that rates are as minimal as possible.

PharmaNewsIntelligence sat down with Julie Swann, PhD, affiliate faculty in the Department of Biomedical Engineering at NC State and the University of North Carolina Chapel Hill, to gain additional insight on the impacts, trajectories, and risk management strategies for COVID and influenza.

Projections and Trajectory

PharmaNewsIntelligence asked Swann to explain the current trajectory of COVID and Influenza cases. She began by explaining the short-term course.

Short-Term Trajectory

“We are currently seeing shortages of medical beds and personnel in hospitals, such as pediatric services, associated with the simultaneous numbers of infections of influenza, RSV, and COVID,” began Swann. She notes that the shortages are not limited to pediatrics but have had a remarkable and significant impact on pediatric healthcare as that population is more heavily affected by RSV.

The CDC states that, in the 2022–2023 season, the cumulative RSV hospitalization rate per 100,00 individuals was 2.9. Comparatively, the 2021–2022 rate was 1.9, and the 2020–2021 rate was 0.

The current trajectories come with a plethora of different causes. Swann notes, “children have started school and have a lot of changing behavioral patterns and ventilation that's different from how it is in the summer.” These behavioral changes, the start of the influenza season, and the higher level of risk for the pediatric population have made an impact.

Habit changes alone are not driving the short-term trajectory. Many public health experts and industry leaders, including Swann, postulate that reduced immunity from the two prior seasons, which included periods of isolation and social distancing, may also contribute to these rising rates.

Long-Term Trajectory

These factors are attributed to the short-term trajectory of cases; however, looking at the long term, additional factors come into play. Long-term trajectories heavily depend on the viral mutation rate, vaccine uptake, and other habits.

“A lot will depend on what happens with variants that arise and what people do with vaccine boosters and the reformulated vaccine,” shared Swann. “Public health officials know that vaccine uptake is lower in younger ages and that the recent booster or this fall’s booster is pretty low.”

According to USA Facts, only 68% of eligible patients in the United States are fully vaccinated. Less than half of that, 33%, have gotten a booster.

Swann notes that this fall’s infection, hospitalization, and death rates have not been exceptionally high. However, she, like many others, anticipates a spike as the holiday season approaches and passes.

“I am still expecting more to come through the holiday season as people gather together, perhaps at Thanksgiving or in December or January, and then also go back to their community,” mused Swann.

Going into the holiday season, risk factors and appropriate safety measures may vary based on the individual’s age, medical history, and vaccination status.

Vaccination — An Essential Tool Against Viral Infections

It is well understood that vaccines are a critical tool to prevent and reduce the impacts of viral infections. “The healthcare industry needs to vaccinate more people against influenza — there are several ways to do that — and we need to continue vaccinating with the fall COVID vaccine,” responded Swann when asked how to minimize these rising rates.

Encouraging Vaccination

With the vaccine uptake rate being less than ideal, Swann commented on who and how to open conversations on vaccination and encourage vaccination.

“There's a role for many decision-makers, including payers, providers, physicians, parents and caregivers, and individual patients. All of those have a responsibility to think about how they can ensure their population, community, neighborhood, and household are protected not only for themselves but also for their neighbors and friends, family members, and the broader community,” emphasized Swann.

She shared observations on how schools, offices, and physicians send out regular reminders on checkups, but many fail to remind patients of influenza and COVID vaccinations. “Providers and payers can send reminders and messages to individuals, especially those at higher risk, and make sure they're aware of where they can get the vaccines in their community,” said Swann.

She also emphasized the importance of targeted outreach to communities less likely to be vaccinated, whether that’s due to misinformation, access, or other factors.

“Targeted outreach is hard because it takes resources,” acknowledged Swann. “If healthcare workers want to increase vaccination rates in historically marginalized populations who might have lower access to care, we might need phone calls, partners, specialized clinics, or to utilize the existing infrastructure of community clinics and pharmacies where possible.” She explained that vaccination tactics used in 2021 could be leveraged this year and in years to come.

Encouraging vaccination isn’t limited to only COVID vaccines and boosters; providers are also urged to emphasize the importance of a seasonal flu vaccine.

Addressing Vaccine Misinformation and Enhancing Educational Efforts

Swann commented that one of the most challenging issues in the current healthcare system — affecting wellness and prevention in the United States — is misinformation and lack of educational outreach. She notes that there is no straightforward solution to combat medical misinformation or improve education efforts related to healthcare.

“Health agencies have tried to focus on getting the right messengers and messages to audiences — that is part of it. One of those groups of trusted messengers is the healthcare provider, the primary care provider, the specialist provider, or the pharmacist,” she explained.

“Each person has an opportunity and a responsibility to invite questions and conversations during patient interactions. There are several cases where individuals have heard the information, maybe not just once but sometimes several times, and then come back around and get vaccinated. Unfortunately, that does take time, and it takes repeated work in that space with professionals who are already overworked and overburdened.”

Swann shares that healthcare professionals, including nurses and many more, can open conversations with patients during one-on-one interactions. They may even offer to engage in group settings by talking to nonprofits, schools, churches, etc.

“Looking for those personalized interactions that can help address those individual concerns and not only individual concerns but concerns that may be different among different populations is critical,” said Swann. “Public health officials know that some populations have misinformation about safety or long-term impacts. Others may have had misinformation related to the severity of the disease. We also know that it's a combination of factors that lead people not to make an effort to change their vaccination status; knowledge, information, and beliefs are part of it.”

Another way to improve vaccination rates is to improve the access or convenience of vaccination. Attempts to make vaccination easy or alleviate the burden of immunization can determine whether a patient gets vaccinated.

Anticipated COVID Booster Schedule

Many individuals have anticipated that annual COVID boosters will become a regular part of preventative healthcare in the same way flu vaccines are recommended. However, this will be dependent on multiple factors. 

“Currently, COVID is mutating faster than influenza, and whether we need a booster every year will be based on several factors,” noted Swann. “One will include how quickly the disease mutates, a function of how many cases are being transmitted. Because the more it spreads globally, the more chances it has for mutation.”

Additionally, waning immunity may contribute to the need for annual boosters. “Healthcare professionals know that, with the current variance and vaccines, protection against it tends to wane, on average, around four months. It's probably faster for older people, probably slower for younger people, and also depends on the vaccine itself,” she added.

“In the short-to-medium term, the public is looking at likely needing boosters on a semi-regular basis,” predicted Swann. “It could be that some people need them more than once a year, especially if they have compromised immunity or are at a higher risk. Some people may need them once a year, but the hope is that we’ll have vaccines that give us longer protection than six months or a year.”

Looking Ahead

Moving forward, healthcare professionals and industry leaders must tackle issues of infection head-on. “When hospitals fill up, mortality increases across all categories,” stressed Swann. Encouraging vaccination and other public health strategies, such as masking or social distancing, when necessary, can help mitigate the disease burden on patients, payers, providers, and the overall healthcare system.