Are you sick and tired of being sick? Maybe you should stop reading.

By now you’ve probably heard of the looming “tridemic,” or triple-pandemic. Get ready for the next scary numerical prefix: “quademic.”

Laura Forman, Chief of Emergency Medicine at Kent Hospital, says the situation may be even worse than the already daunting triple threat of influenza, RSV and COVID.

“I would actually call it a quademic, added the significant spike of mental illness and behavioral health emergencies,” Forman said Tuesday, adding that the trend in mental health emergencies appears “pandemic related.”

That’s four major health emergencies hitting Ocean State hospitals at once.

Joseph Wendelken, Public Information Officer for the Rhode Island Department of Health (RIDOH), warned that “health officials nationally and locally anticipate this being a bad year for respiratory viruses.”

“We saw an early spike in cases of RSV, a common virus that can be serious for some higher risk children and adults,” Wendelken said Monday. “Cases of RSV usually peak in Rhode Island in early January. Fortunately, we seem to be coming down from that peak. Flu is circulating in Rhode Island now as well.”

Schools have been seeing an increase in school-wide absenteeism.

“We are definitely seeing more absences than usual with both teachers and students,” Johnston Superintendent Dr. Bernard DiLullo Jr. said Monday. “The primary cause has been flu.”

According to Darlene Amalfitano, Cranston Public Schools nursing program supervisor, the city has experienced a manageable spike in cases of illness, but the district is doing well overall.

"We've had an increase in absences, but overall we're not doing too badly," said Amalfitano. “It's out there. We know it'll be worse this year because we've had masks on for the past three years, but I'd say we are probably following the trends of the state.”

Added to those concerns, following the isolation and societal changes resulting from the COVID pandemic, and a shortage of mental healthcare providers, emergency workers particularly have been seeing a rapid rise in mental health emergencies at local hospitals.

“We’re all weary what winter might bring,” Forman said. “We get more concerned the more people (gather) inside; relaxation of mask mandates and precautions in general. It’s not a far reach (to predict) numbers will spike.”

Public health data confirms three different illnesses, each with respiratory symptoms (and other symptoms unique to each illness), have been sweeping through the nation, and Rhode Island particularly, forming a so-called “tridemic.” In November, PBS reported that “more than three-quarters of pediatric hospital beds nationwide are occupied, seniors are hospitalized at a higher rate for respiratory illness and flu hospitalizations are at a decade-level high.”

Forman said the staff at Kent is busy, but keeping pace.

“In the hospital, we’re doing well,” she explained. “Overall, nationwide there have been staffing constraints. There are still long waits to get in to see primary care doctors.”

The next few months may be difficult for both patients and healthcare providers.

“The percentage of patients presenting to primary care providers with influenza-like illness is already above what we have seen at this time during the last few flu seasons,” Wendelken explained. “And of course, hospitals are still treating patients with COVID-19, and we could see an increase in cases in the coming weeks and months.”

The COVID pandemic, still changing and unpredictable, merged with rising RSV cases and the annual flu season.

“Early in the fall, RSV numbers started spiking,” Forman explained. “We knew flu season was right around the corner.”

According to the U.S. Centers for Disease Control (CDC), respiratory syncytial virus (or RSV) is “a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.”

The CDC has warned clinicians and public health professionals to “be aware of increases in respiratory viruses, including RSV.” “CDC surveillance has shown an increase in RSV detections and RSV-associated emergency department visits and hospitalizations in multiple U.S. regions, with some regions nearing seasonal peak levels,” according to the agency.

While RSV has primarily afflicted the young, severe influenza and COVID typically prove most deadly for infected elderly.

According to RIDOH, one person has died from the influenza so far in the 2022-23 flu season. The patient was “an adult over 65 years of age.” RIDOH started reporting influenza-associated deaths in 2013.

A recent report (“Rhode Island Weekly Influenza Surveillance Update, 2022-23 Influenza Season,” Nov 27-Dec. 3) prepared by Abby Berns, Public Health Epidemiologist with Rhode Island’s Center for Acute Infectious Disease Epidemiology, declared “the activity level of influenza-like illness in Rhode Island is high.”

“Influenza circulation is increasing in Rhode Island,” Berns wrote. “Since Oct. 2 … there have been 182 influenza-associated hospitalizations and 1 influenza-associated death. There have been 19 non-COVID respiratory outbreaks at congregate living facilities. There have been 535 positive influenza specimens at the State Health Laboratories. Multiple strains of influenza are currently circulating in Rhode Island; Influenza A (H3N2) is the predominant strain.”

“We’re seeing very, very high numbers of influenza,” Forman said. “And we’re still seeing a fair amount of COVID.”

Which illness should people worry about most? Forman answered it’s “difficult to say.”

“There’s a lot more data on influenza,” she said. “We’ve been dealing with it for a lot more years. Influenza can be quite deadly; it varies year-to-year, strain-to-strain. But COVID is of significant concern. We don’t know what COVID might do next.”

COVID  killed 11 Rhode Island residents during the last week reported by RIDOH on Dec. 8.

RIDOH reports 1,652 new COVID cases among Ocean State residents last week (out of 15,877 tested). So far, throughout the COVID pandemic, the virus has claimed the lives of 3,762 Rhode Islanders.

The state lists Rhode Island’s 39 cities and towns, ranking their COVID statistics. Out of the Ocean State’s 39 municipalities, Cranston ranks fifth, Johnston sixth, and Warwick nineteenth, in COVID-19 cases per 100,000.

The state also ranks each municipality by total deaths in each city or town. In that ranking, Warwick ranks third in Rhode Island (with 267 COVID deaths); Cranston ranks fifth (with 234); and Johnston ranks sixth again (with 208), according to RIDOH.

Halfway through December, public health officials are watching the data closely and offering advice to those about to gather with family.

“I always try to remind people to stay safe,” Forman said. “The holidays are coming up; be mindful of what you’re exposed to.”

Wendelken said “there are steps everyone should be taking to help themselves be healthy and safe.”

HEALTHY CHECKLIST

RIDOH recommends Rhode Island residents:

• Get your flu shot. Everyone older than six months of age should be vaccinated every year.
• Be up to date on your COVID-19 vaccinations. For many people, that means getting a booster. Cough or sneeze into your elbow.
• Wash your hands often with soap and water.
• Consistent with recommendations from the CDC, people who are at high risk for getting sick should wear masks when COVID-19 levels are “medium,” and everyone should consider wearing masks in crowded indoor settings when COVID-19 levels are “high.”
• Clean and disinfect frequently touched surfaces at home, work, and school.
• Stay home if you are sick.
• Keep children home from daycare or school who have fever, especially with a cough, difficulty breathing or shortness of breath, congestion, runny nose, or sore throat, until they are fever-free for 24 hours without medications that reduce fever. Contact your pediatrician or healthcare provider if you believe your child needs medical care. Your provider can offer advice on whether your child needs to be evaluated in person, tested for COVID or flu, and the best location (doctor’s office, urgent care, emergency room) for care.

SOURCE: RIDOH