Oregon Health & Science University nurse practitioner Shelby Freed (left) sanitizes her hands between glove changes on Friday, March 20, 2020, in Portland, Ore. Health officials are warning of a possible spike in respiratory viruses this winter, including COVID-19, influenza and RSV.
Bradley W. Parks / OPB
As far as respiratory illnesses go, COVID-19 has been top of mind for much of the last three years. But state health officials are now warning of other viruses that largely stopped circulating during the pandemic. Oregon Gov. Kate Brown issued an executive order this week to help address rising pediatric cases of respiratory syncytial virus, commonly known as RSV. And health officials have warned of possible influenza and COVID-19 surges as winter approaches.
Joining us to talk about concerns around these viruses going into the winter season is Dr. Tom Jeanne, deputy state health officer and deputy state epidemiologist with the Oregon Health Authority.
This transcript was created by a computer and edited by a volunteer.
Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. As far as respiratory illnesses go, COVID-19 has been top of mind for most of the last three years. Now. health officials around the country are warning about other viruses that largely stopped circulating during the beginning of the pandemic, but are currently raging. That includes a virus called RSV, which disproportionately affects young children. Oregon Governor Kate Brown issued an executive order this week to help address rising pediatric cases of RSV and other respiratory viruses. And then there is flu season and COVID, which hasn’t gone away. Dr. Tom Jeanne joins us to talk about all of this. He is the deputy state health officer and deputy state epidemiologist with the Oregon Health Authority. Welcome back to the show.
Dr. Tom Jeanne: Thanks Dave, good to be here.
Miller: What is RSV?
Dr. Jeanne: RSV stands for respiratory syncytial virus, and despite perhaps not being a virus that most of us think about, it is a very common respiratory virus. Almost everybody gets it when they’re young. Thankfully, in most people it causes pretty mild cold-like symptoms. Unfortunately, in the very young and the very old it can cause more severe illness, and so that’s what we’re concerned about, especially in infants under six months. They’re at much higher risk of hospitalization, as well as those over 65 years of age and those with weakened immune systems.
Miller: It seems like one of the challenges here is based on what you’ve just outlined. Given how common this virus is and how likely it is that it’s going to present as the common cold, or it could be confused with the common cold, what should either older adults or parents of young kids be on the lookout for?
Dr. Jeanne: Great question. Well, for the youngest kids, their airways are just so small that if they do have a more severe reaction to this virus, which includes inflammation of the bronchioles, they can really have extreme difficulties breathing. Unfortunately we don’t really have a good treatment or cure for it. So the care that they get would be oxygen and supportive care to help them get through that illness. And most of them would. But we do see the youngest kids who can sometimes need intensive care to get them through it.
Miller: What does pediatric ICU bed availability look like right now then?
Dr. Jeanne: That’s one of the concerns that we have. And I will emphasize this is a nationwide problem, right now. Oregon is doing a little better than many states, but one of the reasons that we did have this executive order from the governor was concerned about the pediatric ICU beds. We have about 40 total staffed pediatric ICU beds in the state. The latest info I have is we have about three of those available. But it’s really dynamic. You know, that number can change on a minute to minute basis statewide but certainly, capacity is stretched thin right now.
Miller: RSV doesn’t just affect young people as you noted, older people could also suffer from serious consequences. CNN reported yesterday that, nationwide, the RSV hospitalization rate for seniors is 10 times higher than usual, for this point in the season. Is that reflected in Oregon as well?
Dr. Jeanne: I don’t have the exact numbers [on] hand for seniors, but we are seeing generally increasing across all age groups. I will say, even though it is a lot higher for RSV than it has been in the past couple of years across all age groups, the older adults, their rates are still quite a bit significantly below those of infants and children under two. So just to put it in perspective, relatively speaking.
Miller: It’s really striking, when I looked at the pediatric RSV detection rates in the last three Novembers. Meaning this one, 2021 and 2020. In November of 2020 in Oregon, it was basically non-existent. And then last year, there was a biggish bump, and this year, right now, the most recent numbers are higher than last year. In 2020, is it just that people were either wearing masks if they were going out or just not going out?
Dr. Jeanne: Yes, that’s exactly what we think happened. The pandemic was a big disruption to everybody’s usual routines. We had people staying home, we had people masking, avoiding gatherings and all those steps to prevent COVID transmission, of course, also prevent most respiratory viruses in terms of their transmission as well. So influenza, RSV, common cold, all those things were at lower levels during the past couple of respiratory virus seasons. That’s really what we’re worried about this year. We don’t have the masking and some of these other measures in place this season. So we’re worried about RSV and influenza, not only just for the symptoms and the disruption they cause, but also because people can be hospitalized and that puts strain on hospitals across the state.
Miller: Is it possible that the big spike that we’re seeing right now is a result of both the lack of those extraordinary measures that we were taking population wide, and the lack of previous infections? I mean, if a whole bunch of young people didn’t get affected in 2020, but now the virus is circulating, is it possible that more young people are getting sicker?
Dr. Jeanne: Certainly could be a factor. One thing to remember for RSV is, you know, the youngest children, who are most at risk, they’re not gonna have much immunity from previous seasons anyway because some of them are less than a year old and it’s just gonna circulate in a normal winter. I think there are multiple factors here. The other thing to keep in mind is for influenza and for COVID, we have great vaccines that can really make a big difference here. For RSV, we don’t yet have a vaccine. It sounds like next year there may be a vaccine available at least for adults, but that is of course one of the best steps that everybody can take to help reduce their risk of flu and COVID is to get their shots this year.
Miller: I want to go back briefly to the executive order that the governor released at the beginning of this week. What exactly will it mean?
Dr. Jeanne: The executive order allows [the] Oregon Health Authority to exercise certain authorities if needed. And that would include things like deploying extra medical personnel, medical volunteers through our SERV-OR network and designating emergency healthcare centers. It also potentially gives hospitals more flexibility for their nurse staffing to help spread the load and improve care for pediatric patients, specifically around RSV care.
Miller: You mentioned the importance of people getting vaccines when they can and that includes COVID and a new bivalent Omicron-specific booster, as well as the flu vaccine. What does flu vaccine uptake look like right now?
Dr. Jeanne: Flu vaccines are the standard. Every year we have new flu vaccines based on the best guess for what the circulating strains are. This is the prime season. I think normally September is when we would start to see flu vaccines available. And that was true this year as well. It’s certainly not too late to get a flu shot, though, and we know that there’s still a lot of people who can get their flu shot. But also say that getting the flu vaccine along with the COVID vaccine in the same visit is a great option. And there’s certainly a lot of reasons to do that. And there’s no risk or problem with getting both vaccines in the same appointment.
Miller: Has the politicization of the COVID vaccine led to a decrease in people in Oregon getting the flu vaccine?
Dr. Jeanne: I’m not aware of any indication of that. Flu vaccine uptake is never as high as we would like. I think some people think that the flu doesn’t have a potential to be a serious illness. But quite the contrary is true. Many people, including adults who are otherwise pretty healthy, can have a pretty severe illness and even require hospitalization from influenza. In a typical season, influenza, nationwide, kills tens of thousands of people. So it’s something not to take lightly. And the influenza vaccines are super well studied and just have lots of evidence of their safety and effectiveness.
Miller: How transmissible are RSV or influenza compared to the once novel coronavirus?
Dr. Jeanne: COVID is certainly one of the more infectious respiratory viruses out there, in terms of how easily it spreads. RSV is kind of in between there; it’s pretty easily spread as well. Influenza somewhere in the middle as well. So these are not the most infectious. Measles, for example, would be one of the most transmissible viruses out there. None of these quite approaches that. But COVID is definitely probably the most transmissible that we’re worried about right now, even though the numbers we’re seeing in Oregon right now are relatively low level.
Miller: Let’s turn to COVID, then, before we say goodbye. The numbers are lower now than they have been at various peaks over the last almost three years. But what does the coming winter look like to you, COVID-wise?
Dr. Jeanne: Well, I wish we knew. We can’t know for sure. But we’re hoping and expecting that this winter’s COVID-19 wave will not be as severe as last year’s omicron wave. We certainly anticipate fewer peak hospitalizations than we saw during the omicron/delta surges. Part of that is from high levels of population immunity, both from people who’ve been infected and people who have been vaccinated and boosted. So that’s our expectation.
However, we are expecting a bit of a surge, and there are new variants that are circulating including the BQ.1 and BQ.1.1 variants, are subvariants at this point. Those are increasing in Oregon, but are still accounting for a small portion of all the variants that we’re seeing. So thankfully the bivalent booster provides protection specifically against the BA.5 subvariant, which is still the majority of what we’re seeing in Oregon.
Miller: So finally, if you put all these things together, the flu, RSV, other respiratory viruses and COVID, what is your simplest message for listeners?
Dr. Jeanne: Get vaccinated. Be aware of the things that you can do, which still includes masking. I think masking in indoor, public places is still a great step. And we’ve got Thanksgiving and holidays coming up very soon here. If you’re gathering indoors [with] people outside your household, especially if there’s a young child or older adult or somebody with a weakened immune system, wearing masks is still one of the great things you can do to minimize your risk. And then of course covering your coughs and sneezes and good hand hygiene are important as well.
Miller: Tom Jeanne, thanks very much.
Dr. Jeanne: Thank you.
Miller: Tom Jeanne is deputy state health officer and deputy state epidemiologist with the Oregon Health Authority.
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