Viral ‘tridemic’ hits hard; vaccines and masks advised

December 12, 2022

LA hospitals are feeling the strain from a COVID surge, a bad flu season as well as a burgeoning number of RSV cases. Child-friendly versions of medications are scarce on store shelves in the face of this “tridemic.” And the CDC is recommending masks again to mitigate the spread during holiday socializing. USC experts are available to discuss the impact. (Photo by Oğuz Kandemir via Pexels)

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Kids aren’t mini adults; exercise care with medications

“Caregivers during this ‘tridemic’ are concerned about their children’s symptoms and want to provide comfort measures at home,” said Irving Steinberg, an associate professor of clinical pharmacy and pediatrics at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences.

“It’s important to note that cough and cold products are discouraged by the American Academy of Pediatrics for use in young children. In addition, antibiotics such as amoxicillin, do not treat RSV, influenza or COVID-19. The remaining supply should be restricted to children with defined bacterial infections.

“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.

“National data in 2020 from 55 US poison control centers demonstrated that among reported toxic exposures from non-combination adult acetaminophen dosage forms, 21% were in children less than 6 years of age. Febrile illness with poor food consumption adds to the risk of serious liver toxicity in children if this drug is misused.

“Similarly, risks of acute kidney injury increase with repeated high doses of ibuprofen especially if the child is dehydrated. 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

The risk of COVID-19-related death among the homeless in Los Angeles County was more than twice that of the general population, according to a new USC-UCLA study in JAMA Network Open.

“Given higher rates of mortality from COVID-19 that we found among people experiencing homelessness in LA, the rise in other infectious diseases including flu and RSV is concerning,” said study co-author Benjamin Henwood, a professor at the USC 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. We also need better data on the specific risks that make homeless people vulnerable to COVID-19, and that caused nearly 2,000 people to die on the streets during the first year of the pandemic.”

A record number of flu admissions; vaccination still important

“Nationwide, there is a record number of flu admissions. The COVID measures not only interrupted COVID but other viruses including flu,” said Edward Jones-López, a Keck School of Medicine of USC infectious diseases expert. “We’re seeing the result — the measures for COVID made things worse for flu later. There’s a gap in immunity, even if it’s short-lived.

“Particularly in cold areas of the country, this is when we see a peak in viral illness. There could be more than one infection occurring at the same time. The more infections you have, the more potential there is for serious outcomes.

“The COVID bivalent vaccine is incredibly important. The acceptance rates right now are dismal. There is also an effective vaccine against the flu; this year’s is a pretty good match. It may be a little late in the season, but it’s never too late to get vaccinated.

“In preparation for upcoming festivities where people meet indoors with closed windows – the idea would be to avoid symptomatic people; if you’re sick stay home. If you go out, make transmission a little more difficult by wearing masks and keeping your distance from symptomatic patients.”

The costliest disaster in US history

“COVID has proven to be the costliest disaster in US 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.

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

Adam Rose is a Research Professor in the USC Sol Price School of Public Policy and an expert on the economics of natural and man-made hazards.

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