December 14, 2022

Winter Tripledemic, Health Challenges Loom

By Donald Gilpin

COVID-19, flu, and RSV (respiratory syncytial virus) are all on the rise, and with cold weather and holiday gatherings bringing people indoors together in large groups, the medical challenges of the weeks and months ahead are daunting.

The particular situations and risks are different for every individual and every family, but in Princeton and throughout the country, people will be living with the threat of these three viruses during the coming months.

Reported cases (unquestionably an undercount) of COVID-19 and COVID-related hospitalizations are up more than 25 percent in the past two weeks, and test positivity rates are rising quickly across the country, according to the December 13 New York Times. “The current surge is milder so far than at this point in previous winter waves, but its nationwide scope is concerning,” the Times reported.

In Mercer County, reported daily cases are up 66 percent over the past 14 days, but rates and hospitalization levels for COVID-19 in Mercer remain relatively low.

A December 7 New Jersey Hospital Association (NJHA) press release urged New Jerseyans to take precautions to protect themselves against a triple threat of respiratory illnesses “as flu season starts with a vengeance.”

The NJHA article noted, “Among currently active respiratory illnesses, influenza accounts for the highest number of emergency department visits, while RSV is responsible for the highest number of hospitalizations.” There was a record number of nearly 950 emergency department visits for children with respiratory illnesses in the days following Thanksgiving, and about 70 percent of New Jersey’s pediatric beds have been filled throughout November.

The press release also reported that New Jersey has already reached “very high” levels of flu, still early in a flu season that lasts until April.

NJHA President and CEO Cathy Bennett warned of a challenging season ahead that “will test the health care system’s capacity and resiliency,” and urged

New Jerseyans to protect themselves with flu shots, updated COVID-19 boosters, and familiar COVID-19 precautions.

In a December 10 telephone interview, Penn Medicine Princeton Medical Center (PMPMC) Chief Medical Officer Dr. Craig Gronczewski acknowledged the challenges facing the hospital and the community, but expressed optimism that those challenges would be met. PMPMC had a record number of emergency room visits in November this year.

“In many way I feel we are more challenged than ever in the emergency department of the hospital, but I feel we are better prepared than ever as well,” he said. “Even though we’re busier than we’ve been, this is the most comfortable I’ve been heading into winter since before COVID.”

Gronczewski commented on each of the three viruses. “I think the worst of COVID is behind us,” he said. “It’s still present and clearly impacts our community and our patients, but we’ve gotten much better at understanding how to manage the virus. We’re not seeing nearly as many severely ill patients with COVID coming to the hospital.”

Describing last winter’s Omicron surge as “the most challenging winter of my career,” Gronczewski does not anticipate similar conditions this winter.  Based on indicators at this point, he is expecting hospitalizations to be about one-third or one-fourth as high as in past years.

As far as RSV cases at PMPMC are concerned, Gronczewski also expressed cautious optimism. He pointed out that it’s the worst RSV season he’s seen in his 20 years of work in emergency medicine and it’s also unusual to see serious cases in adults. He added, however, “We’re very early in the season, but there are some very good indicators in the past couple of weeks that it is not taking an exponential trajectory. It’s very present, but not growing outside of what we can manage.”

Gronczewski anticipates a high intensity flu season at the hospital, “much worse than average,” but again, not beyond the hospital’s abilities to manage.  “It’s going to bring volume to the ER, volume to urgent care centers, and it’s going to bring more volume to individual practices, and it’s going to cause more staff to pull out of work for themselves or their children who are ill,” he said. “We see this almost every year at this time of year.”

Gronczewski emphasized that extensive planning and the hospital’s preparations for surge capacity were paying off. “We’ve spent a lot of time and money ensuring that we are reinforcing the ER to confront the impact of these three respiratory illnesses in particular that are representing the outbreak in our community. We’ve done a lot of work over the past months to plan and implement surge capacity,” he said.

“Feel safe, feel protected, but be patient if you need to come to an emergency department — and be kind to our staff,” Gronczewski added in response to a request for advice to the local community. “Be kind and respectful to health care workers. We’ve sacrificed a lot for our community. Being a health care worker in an emergency department is one of the riskiest jobs in the country when it comes to workplace violence.”

He continued, “We do the best we can, and we expect our staff to provide excellent care, to communicate effectively, to be compassionate and respectful, but we also expect mutual respect for anyone in the emergency department, whether you’re an employee or a patient.”

Dr. George DiFerdinando, an internist and the chair of the Princeton Board of Health, also offered advice for individuals as they confront the prospects of a long winter of COVID-19, flu, and RSV ahead. Anticipating rising numbers of infections for all three viruses in the coming months, DiFerdinando emphasized the value of vaccines and masks. 

“We can prevent disease and death, but the persistence that is required is challenging us all,” he said. “This staying with the plan — it’s really hard.”   He noted that he’s back to wearing a mask indoors in crowded settings like grocery stores, coffee shops, and other crowded indoor spaces, but he sees only about one in 10 others wearing masks.

DiFerdinando noted that only 35 percent of people over 65, the most vulnerable group, have gotten the bivalent booster shot. He added, “It’s a good time to get vaccinated,” in the weeks before the holidays when families and friends gather in close proximity.

“We’re all weary of this,” he said. “It’s a balance between acknowledging the weariness and highlighting the fact that we have data that this new bivalent booster works.”

He pointed out that northeastern New Jersey counties are seeing high COVID-19 rates, New York City has reported high rates, and that Mercer County is likely to follow. “We should expect COVID to continue to go up through the holiday season,” he said. “It’s not that COVID is back. It never really went away.”