Winter Illnesses

Covid no longer plays the dominant role that it once did in most of our lives. But the risk of Covid — and other viruses — persists. This winter, experts expect cases, hospitalizations and deaths from viral diseases to rise once again.

The increase may have already begun. Covid cases, hospitalizations and deaths are up over the past two weeks. The upswing resembles the trend we have seen in recent years after Thanksgiving, typically continuing through the holiday season and into the following year. (Check case counts in your area with The Times’s tracker.)

Flu cases are up, too. The C.D.C. classifies the vast majority of states as having “high” or “very high” activity for the flu and related illnesses. “Hospitalizations for flu continue to be the highest we have seen at this time of year in a decade,” the agency’s director, Rochelle Walensky, said last week.

Cases and hospitalizations from R.S.V., which typically causes cold-like symptoms but sometimes can be more serious, also spiked earlier this fall. But they seem to have already peaked.

The infectious disease climate in the U.S. right now is not a picture of Covid’s going away, but of its falling in line alongside other endemic respiratory illnesses in the fall and winter. In some years, Covid could be the worst of the bunch. In others, the flu or R.S.V. could be. “This is the reality that we’ll be living with moving forward,” said Dr. Céline Gounder, a senior fellow at the Kaiser Family Foundation.

Today’s newsletter will look at this new normal for Covid and other viruses.

A viral season

By now, the disease trends of the fall and winter may seem familiar: As people gather for the holidays, and generally indoors to avoid the cold, respiratory viruses spread more easily — true for Covid, but also for the flu and R.S.V.

The biggest risks are for the very old and very young.

Covid is still a threat, in large part because many people do not have recent immunity from vaccines or infections. But the virus is now largely a disease of older adults, as David Wallace-Wells explained in Times Opinion: Americans 65 and older now account for 90 percent of deaths. (Some younger groups, particularly the immunocompromised, also remain vulnerable.)

R.S.V. and the flu often afflict an additional population, hitting both the very young and old hardest.

The flu and R.S.V. have been around for a long time. They were tame in recent years, largely because widespread actions to prevent Covid, such as masking and social distancing, worked against them, too. But because a lot of people have had no recent exposure to the flu or R.S.V., they are also more vulnerable. That has allowed for a comeback by both viruses.

“The combination of flu and Covid for older people is going to mean a pretty tough winter for hospitals,” Gounder said. “People talk about patients in the hallway — that was not uncommon, actually, before Covid. We’re going to see more of that.”

What to do

You probably know by now how to reduce your risk of Covid: Get vaccinated and boosted. When the virus is spreading quickly, mask indoors and get tested regularly. If you get sick, isolate to avoid spreading the virus and try to obtain a prescription for Paxlovid to reduce the risk of hospitalization or worse.

“It’s all the obvious things,” Gounder said. “It’s really a question of whether people want to do them or not.”

Similar advice applies to the other two viruses, since they spread in similar ways. You can get an annual flu shot along with a Covid booster at your local pharmacy. No vaccine exists for R.S.V., although some are in development.

The spread of the viruses amounts to a mixed picture. The bad news is that the three pathogens will likely be a regular part of our lives, especially in the fall and winter. The good news is that we are not totally helpless against them.

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