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RSV cases may be peaking, CDC says, but flu hospitalizations remain at a decade high

Cases of respiratory syncytial virus are declining in some parts of the country, but the flu is rampant and Covid is on the upswing.

The spread of RSV appears to be slowing, though Covid cases have risen since Thanksgiving and flu hospitalizations remain at a decade high, CDC Director Dr. Rochelle Walensky said Monday.

"This year’s flu season is off to a rough start," Dr. Sandra Fryhofer, board chair of the American Medical Association, said at a CDC press briefing. "Flu is here. It started early, and with Covid and RSV also circulating, it’s a perfect storm for a terrible holiday season."

Approximately 78,000 people have been hospitalized with the flu since the start of October. Around 19,500 were newly hospitalized in the week ending Nov. 27, according to data from the Department of Health and Human Services — nearly double the number of flu hospitalizations reported the week prior.

The CDC estimates that the flu has already caused 8.7 million illnesses since Oct. 1. That's close to the 9 million cases estimated for the entire 2021-22 flu season.

Flu deaths are already approaching last season's total as well: The CDC estimates this year's toll to be at least 4,500 since Oct. 1, compared to 5,000 in all of last season.

The combined burden of these viruses is straining hospital capacity nationwide. Around 79% of U.S. hospital inpatient beds are full, according to HHS data.

However, cases of respiratory syncytial virus (RSV) have most likely peaked in some parts of the country, such as the South and Southeast, and plateaued in the Mid-Atlantic, New England and Midwest, Walensky said.

Nationally, the number of positive weekly RSV tests fell from more than 19,000 in the week ending Nov. 12 to around 7,500 in the week ending Nov. 26.

Average daily Covid cases, however, have risen 16% over the last two weeks, according to NBC News' tally. The CDC recorded a nearly 18% increase in average daily hospital admissions due to Covid from the week ending Nov. 22 to the week ending Nov. 29.

Walensky said the uptick "is especially worrisome as we move into the winter months, when more people are assembling indoors with less ventilation, and as we approach the holiday season when many are gathering with loved ones and across multiple generations."

Since the three viruses have many symptoms in common — including runny nose, cough, congestion and sore throat — Fryhofer noted that it can be difficult to diagnose a patient right away. Unlike Covid tests, RSV and flu tests must be performed at a doctor’s office or ordered via prescription.

"It is going to be a confusing respiratory infection season. Figuring out what’s making people sick is going to be a conundrum," Fryhofer said.

Walensky said the most important way to protect oneself from these viruses is to stay up to date on Covid vaccines and the annual flu shot. There is no vaccine yet to prevent RSV.

CDC data suggests that people who have received updated Covid boosters were less likely to die than those who were vaccinated but had not received a new booster. The bivalent boosters also seem to lower one's chance of a Covid infection relative to the original shots.

Fryhofer said flu vaccines are also a good match for circulating strains this year.

But Walensky pointed out that some groups with the highest rates of flu hospitalization — those who are pregnant, under age 5 or over 65 — have lower vaccination rates now compared to the same time last year. Flu vaccination rates among pregnant women are about 12% lower than last season, she said.

Walensky recommended that people wear masks if they are traveling by plane, train, bus or other forms of public transportation; if they are immunocompromised or at increased risk for severe disease; or if they live in counties with high Covid levels.

She added that the CDC is looking into the possibility of officially recommending masks in some counties based on the overall spread of respiratory viruses — not just Covid — but that "one need not wait for CDC action in order to put a mask on."