The covid, flu and bronchiolitis cocktail that is hitting Europe this winter threatens to put health systems under “serious pressure”

The triple epidemic of influenza, covid and syncytial virus (RSV) threatens to put European hospitals under "serious pressure" in the coming weeks.

This has been warned by the European Center for Disease Control (ECDC), which has reported an early start to the proliferation of two common seasonal viruses until before the pandemic (flu and syncytial, which causes bronchiolitis). now joining the circulation of SARS-CoV-2.

“The festive period at the end of the year, with social gatherings, shopping and travel, pose an additional risk of transmission of RSV and other respiratory viruses.

Strengthening healthcare systems and supporting healthcare workers should be prioritized due to the risk of severe pressure on healthcare systems in the coming months.

Vaccination against flu and covid should also be prioritized among risk groups," Andrea Ammon, ECDC director, said in a note.

Virus circulation rates are not unusual, but they are early relative to typical dates.

So much so that in Spain RSV seems to have reached its peak, according to the latest epidemiological report from the Carlos III Health Institute, which measures up to December 4.

The flu is taking over, with a decided rise, the coronavirus has been staying at stable levels for weeks.

This cocktail adds up, according to the sentinel surveillance network (the one used for surveillance of respiratory viruses before the pandemic), 845.8 cases of respiratory infections per 100,000 inhabitants, approximately double that of the same week last year.

This increased circulation of the virus is also what may be causing a higher incidence of severe cases of streptococcus A, according to the ECDC itself.

Some countries, starting with the United Kingdom, have reported rates much higher than expected on these dates and at least nine deaths from this pathogen, one of the most common in humans and which in the vast majority of cases results in mild infections.

In conjunction with viral infections, it can lead to a more worrisome pathology in some children, who bear the brunt of severe cases of strep.

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The doctors consulted by this newspaper do not believe that the situation is very exceptional and see it as a return to the winter virus epidemics prior to the pandemic, which each year put health systems under stress.

Pedro Gullón, from the Spanish Epidemiology Society, recalls that "every year we had a saturation" of emergencies due to flu and bronchiolitis in children.

"That does not mean that these infections are not worrisome and hopefully it helps that we do not see the difficulties of managing the high numbers of hospitalizations or RSV as something normal, as if they were new each season."

Along the same lines, Vicente Martín, professor of preventive medicine and member of the Spanish Society of Primary Care Physicians (Semergen), manifests himself: "It is a peak that, although it does not go far beyond expectations, it does contribute to overloading the system" .

Martín affirms that the situation is still a long way from the great waves of covid that saturated the primary school "not so much because of the cases, but because of the bureaucratic tasks to give sick leave."

In order to attend these cases correctly in primary care, Semergen claims a "diagnostic capacity" that does not exist today.

“Antigen tests are only indicated to detect covid in people over 60 and health workers.

We have to tell others to do it at the pharmacy.

And they don't usually take it well”, complains José Polo, its president.

That is to say: anyone can buy a test that distinguishes flu from coronavirus, but your doctor cannot do it in the office.

Nor does the hospital load reach the harshest levels of the pandemic and specialists believe that it will stay far from those extremes.

Although the number of people admitted for causes other than covid is at the highest levels since the coronavirus broke out, it is partially offset by fewer hospitalized due to covid, according to data from the Ministry of Health.

And, although respiratory viruses are surely contributing to an increase, there may be other causes that explain it, such as the operations that are now being carried out and that were not carried out at other times during the pandemic.

The ISCIII statistics show that today the flu is causing more hospitalizations than the covid (2.5 vs. 2.3 cases per 100,000 inhabitants), although this may be partly due to greater circulation: 160 vs. 108 cases per 100,000 inhabitants.

The respiratory syncytial virus is between the two figures: 131 diagnoses per 100,000 inhabitants, according to measurements made by sentinel physicians in primary care.

Recommendations against viruses

Given the increase in infections, the ECDC recommends to the health authorities what Gullón describes as "fairly generic" advice, such as communicating the risks to the public, increasing awareness in health workers, guaranteeing RSV prophylaxis for high-risk infants or promote hygienic activities, such as the use of masks or adequate ventilation.

The center also calls for increased flu and covid vaccination.

In Spain, the fourth doses (the second reinforcement) have not exceeded, according to the latest Health data, half of the population over 60 years of age, which is the one for which it is indicated because it is more vulnerable.

The elderly population is also at risk from RSV, which, although it can be more serious in children under five years of age (especially in babies under six months), "is considered an important cause of mortality in older adults and people of high risk”, recalls the ECDC.