Hospitals brace for the possibility of a ‘quad-demic'

Whether you call it a “quad-demic” or three respiratory illnesses with a side of the stomach flu, combining respiratory syncytial virus (RSV), influenza (flu), COVID-19 and norovirus sounds like a miserable proposition. Unfortunately, it’s what hospitals, urgent care clinics and doctors' offices nationwide are seeing.

According to the Centers for Disease Control and Prevention (CDC), RSV, flu and COVID-19 are caused by different viruses. Still, there are several similarities between the three. They share common symptoms, affect the respiratory system, are contagious, and can cause mild to severe illness. Add increasing cases of the stomach bug norovirus, which can cause vomiting and diarrhea, and health care providers are at risk of being overwhelmed by illness.

In San Diego, hospitalization rates for COVID, flu and RSV have been rising since November 2024. Children up to age 4 account for the highest percentage of emergency department visits for respiratory symptoms, often due to RSV. In December 2024, more than 30 norovirus outbreaks — an outbreak consists of at least two laboratory-confirmed cases — were reported, while five or fewer outbreaks were reported at the same time in the past four years.

“We’re already experiencing a surge in flu cases, anticipating a challenging RSV season, and still coping with COVID-19,” says Dr. Jyotu Sandhu, a family medicine doctor with Sharp Rees-Stealy Medical Group. “Normally, about 50% of the population receive a flu shot, leaving an additional 50% who don’t get vaccinated, and several people are not up to date on their COVID vaccines. Now, we’re seeing cases of norovirus on top of the respiratory illnesses. It seems people are not taking the illnesses — and the importance of stopping their spread — seriously.”

Vaccines can help prevent three of the illnesses

However, Dr. Sandhu has hope. The good news, he says, is that people age 6 months and older can receive safe and effective vaccines for both the flu and COVID-19 to prevent severe illness, hospitalization and death. Additionally, Beyfortus, an immunization to prevent RSV in all newborns and infants born during or before their first RSV season, is available. Children up to age 24 months who are at risk of severe RSV disease, including premature babies and infants with congenital heart defects, are eligible to receive the drug through their second RSV season.

What's more, the Abrysvo RSV vaccine, developed for pregnant women, can be administered to protect a fetus. One dose of Abrysvo during RSV season is recommended for people who are 32 to 36 weeks pregnant. Their body will produce antibodies against RSV, which are then transferred through the placenta to their fetus, offering protection to an infant once born.

These vaccines offer a solution for lightening the load of illness nationwide if everyone who can get vaccinated does so.

In fact, the CDC reports that the flu vaccine has been shown to reduce the risk of going to the doctor with the flu by 40% to 60%. Flu vaccination among adults was also associated with a 26% lower risk of intensive care unit (ICU) admission and a 31% lower risk of death from flu compared to unvaccinated people.

The COVID-19 vaccines have proven to be extremely safe and effective. The latest vaccines remain highly effective at preventing severe illness, hospitalization or worse.

Beyfortus, a long-acting monoclonal antibody, has been shown to reduce the risk of both RSV-related hospitalizations and doctor appointments by about 80%. And Abrysvo was found to be nearly 82% effective against severe RSV illness within a newborn’s first 90 days. Six months after birth, the vaccine was more than 69% effective.

“It's so important to share the message that vaccination can protect you from severe illness and help local health care systems avoid being overwhelmed,” Dr. Sandhu says. “It's vital that everyone eligible remains up to date on all recommended vaccines to avoid what they're calling a 'quad-demic.’”

How to prevent illness

RSV, COVID and flu are spread when someone with the viruses coughs or sneezes. The viruses can also survive on surfaces, such as doorknobs and handrails, and are shared through direct physical contact. Norovirus is highly contagious and can be spread by direct contact with an infected person; consuming tainted food or water; and touching contaminated surfaces, then putting your hand in your mouth.

You can protect yourself from these illnesses by following precautions:

• Avoid people who are sick.

• Thoroughly wash your hands often with soap and water.

• Avoid touching your eyes, nose or mouth.

• Regularly clean contaminated surfaces and affected clothes and linens.

• Improve ventilation and air filtration in indoor spaces.

• Avoid crowded indoor spaces.

• Consider wearing a face mask in public indoor locations.

Thoroughly washing fruits and vegetables and properly cooking seafood are also essential to avoid norovirus infection. The CDC further recommends other good health habits, including getting plenty of sleep, being physically active, managing stress, drinking plenty of fluids and eating nutritious food.

Treating 'quad-demic' illnesses

If you have cold-like symptoms, which could be due to flu, COVID or RSV, stay home. Consider wearing a high-quality face mask around others and cover your coughs and sneezes with a tissue or your upper shirt sleeve — never use your hands. Avoid close contact with infants and other high-risk people, such as people who are immunocompromised and older adults.

Over-the-counter (OTC) medications, such as acetaminophen or ibuprofen, may help reduce fever, headaches and body aches. OTC medications with pseudoephedrine and oxymetazoline can be excellent options for treating congestion. It is also important to stay hydrated and get plenty of rest.

You should also talk with your doctor about testing for flu and COVID-19. Knowing if you are infected with a virus allows you to take care of yourself, receive treatment when appropriate, and take action to reduce the chance that you will infect others. However, if you or a loved one — especially an infant or older adult — are having severe breathing problems or other serious symptoms, do not hesitate to call 911 or go immediately to an emergency room for care.

The best way to treat norovirus is to rest at home and drink plenty of fluids. But if you have excessive vomiting or diarrhea and are not able to keep up with rehydration, Dr. Sandhu recommends seeking medical care. Other symptoms of serious illness include high fevers, dizziness, severe abdominal pain or bloody stools.

“Hospitals across the country are already seeing numbers of seriously ill patients, so we’re advising people to stay safe and prevent RSV, flu and COVID-19 infection through vaccination and precautions and prevent norovirus with preventive measures before they become a greater problem,” Dr. Sandhu says. “They’re all very real, very active and happening concurrently. We have to take them seriously.”

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For the news media: To talk with Dr. Sandhu about flu, RSV, COVID-19 and norovirus, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.