A viral 'triple-demic' of COVID, two other viruses hits hard

Hospitals are feeling the strain from a COVID surge, a bad flu season and an increasing number of RSV, or respiratory syncytial virus, cases. Child-friendly versions of cold and flu medications are scarce on store shelves in the face of this "triple-demic," and the CDC is recommending masks again to mitigate the spread during holiday socializing.

It may feel like the pandemic is over, but we're still experiencing the fallout, USC experts say. And COVID remains in widespread circulation as people pack into shopping malls and get together for celebrations.

"COVID has proven to be the costliest disaster in U.S. history, both in terms of loss of life and economic activity. Although the economy continues to recover, my analyses indicate that previous surges significantly stunted such progress," said Adam Rose, a research professor at the USC Price School of Public Policy and an expert on the economics of natural and human-made hazards.

"In contrast, flu has historically proven to be only a relatively minor blip in terms of any decline in economic activity," Rose said. "However, we need to be sensitive to the fact that both COVID and flu disproportionately affect the aged and people of color."

'Triple-demic': Kids aren't mini-adults, so use care with medications

Hospitals are not the only ones dealing with a triple whammy of illnesses. At home, parents are struggling to deal with children who are sick with any one or a combination of the three viruses.

Those seeking to control their children's symptoms with over-the-counter medications are finding that pediatric formulations of acetaminophen and ibuprofen are hard to find, as are other over-the-counter medicines for relieving runny noses and coughs.

It may be tempting for some to use a smaller amount of a medicine packaged for grown-ups—but USC pharmacists warn not to do it.

"The use of acetaminophen and ibuprofen is best guided by clinical providers. With a shortage of child-specific dosage forms, caregivers may risk inexact and potentially toxic dosing if they try using adult dosage forms," said Irving Steinberg, an associate professor of clinical pharmacy and pediatrics at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences.

Steinberg notes that 1 in 5 toxic exposures from adult acetaminophen dosages in 2020 were in children less than 6 years old, according to national data from 55 U.S. poison control centers.

Children with a fever who have not been eating well are especially at risk of liver toxicity if given an adult dosage.

"Similarly, risks of acute kidney injury increase with repeated high doses of ibuprofen, especially if the child is dehydrated," Steinberg advises. "The over-the-counter availability of these medicines makes it more important for pharmacists and pediatricians to be aware of these concerns and communicate effectively with patients and caregivers."

COVID hits the homeless population especially hard as 'triple-demic' looms

Across Los Angeles, more than 40,000 people who are unhoused face some of the highest risk of dying from COVID.

During the first 22 months of the pandemic, 256 homeless people died with COVID, according to a new USC-UCLA study in JAMA Network Open. Their risk of death was more than twice that of the general population.

"Given higher rates of mortality from COVID-19 that we found among people experiencing homelessness in L.A., the rise in other infectious diseases including flu and RSV is concerning," said study co-author Benjamin Henwood, a professor at the USC Suzanne Dworak-Peck School of Social Work.

"COVID-19, like many infectious diseases, is what we call a 'housing-sensitive condition." More aggressive housing and homelessness prevention interventions are needed to mitigate these conditions," Henwood said. "We also need better data on the specific risks that make homeless people vulnerable to COVID-19."

A record number of flu admissions; vaccination still important

Edward Jones-López, a Keck School of Medicine of USC infectious diseases expert, reports a high number of hospital admissions for flu. It's common for viral illnesses to peak when colder temperatures force people indoors, he said.

But there's a remedy for that.

"The COVID bivalent vaccine is incredibly important," Jones-López said. "The acceptance rates right now are dismal. There is also an effective vaccine against the flu, and this year's formulation is a pretty good match. It may be a little late in the season, but it's never too late to get vaccinated."