A “Tridemic” is a Scary Possibility


We’ve all heard about bad things coming in threes. It’s a superstition that has persisted across generations and cultures. Any time three catastrophes happen to fall on top of each other, some point to it as a product of that old adage. There’s no scientific evidence of its validity, of course.

But this flu season, it’s very possible that one of those validating trios of unfortunate events could come to pass as one big catastrophic event – plunging Texas communities into illness and our hospitals into the most strained state we’ve seen since the worst days of COVID-19. That is unless we take the steps that we know can prevent it.

With COVID-19 stubbornly sticking around, flu season in full swing, and a surge of respiratory syncytial virus (RSV) driving a national pediatric hospital bed shortage in October and early November, we face the sobering possibility of a “tridemic” – all three of those maladies overwhelming us at once to create a troubling storm of sickness. With the last three years being perhaps the worst for the nation’s health care system in modern memory, I don’t have to detail how crucial it is to avoid a three-pronged public health disaster.

The annual refrain from healthcare-focused organizations like the Texas Hospital Association to “Get your flu shot!” is taking on even more significance this year. The Centers for Disease Control and Prevention (CDC) has already sounded the alarm. Before this writing, CDC released an Oct. 28 weekly influenza surveillance report that estimated at least 880,000 flu illnesses have occurred so far this season, with 6,900 hospitalizations and 360 deaths. The Washington Post reports that’s the highest flu burden since the 2009 H1N1 swine flu pandemic.

RSV has already made a troubling mark this season as well. Along with the flu upswing, RSV is credited with driving the pediatric hospital bed shortage that recently left more than 70% of all such beds occupied across the country. And as for COVID-19, while we might finally be past the worst of it, its impact continues to be significant. CDC’s most recent 21-day average as of this writing logged more than 37,000 new cases. At the end of October, the Texas Department of State Health Services’ COVID-19 dashboard was reporting daily new-case counts for Texas in the 700s.

So, the data suggest a tridemic is a very real possibility. But the tools we have to combat it are effective.

It starts with vaccines. Stress to patients that getting their annual flu shot and getting up to date on their COVID-19 vaccines are both essential to protecting themselves and others from these diseases. The newest bivalent COVID-19 boosters greenlit by CDC and the Food and Drug Administration target the variants that have made up the overwhelming majority of cases in recent months.

And prevention of RSV – or either of these two other threats – comes down to being vigilant, careful, and clean in the ways health authorities have stressed since the pandemic began. Physicians and other practitioners should reinforce these proven methods with patients: Cover your coughs and sneezes using a tissue. If you don’t have a tissue, cough or sneeze into your elbow, not your hands. Wash your hands for at least 20 seconds. Avoid sharing cups and utensils. If you have a child at high risk for developing severe RSV disease, help them do the same. Recently, encouraging new evidence suggests an RSV vaccine could be just over the horizon. Until then, these common-sense, everyday steps are the best preventive tools in our toolbox.

Our health and our communities depend on us being mindful of each of the three prongs of this potential tridemic to keep it from becoming a reality. What’s more, hospitals – pushed near, at, or beyond capacity repeatedly these past three years – depend on it, too. Let’s do what we need to do to give our communities and healthcare heroes a flu season they can manage – and hopefully, a respite from the public health turmoil that’s become commonplace.

Originally published by the Houston Medical Journal.
Nov. 18, 2022