Colorado’s COVID hospitalizations rise dramatically as flu and RSV spread

Hospitalizations for COVID-19 and flu are rising in Colorado at the same time, while a respiratory virus that primarily harms children is already pushing pediatric hospitals to the brink.

As of Tuesday afternoon, 320 people were hospitalized with COVID-19 in Colorado, which was a “pretty dramatic” increase from 218 at this time last week, state epidemiologist Dr. Rachel Herlihy said. Cases and the percentage of tests coming back positive also have risen, suggesting the virus is spreading more widely, she said.

Since the start of October, 92 people in Colorado have been hospitalized with flu, Herlihy said. That’s still a relatively low level, but more than the state usually sees this early in the season, she said.

On Wednesday, the Colorado Hospital Association announced the state’s hospitals had reactivated the transfer center that helped move patients to areas with available beds during the worst pandemic surges. At the moment, however, they’re trying to manage a flood of children sick with respiratory syncytial virus, or RSV, rather than adults with COVID-19.

“The collaboration between our hospitals and health systems will be one of the keys to addressing this triple-demic we face,” Jeff Tieman, president and CEO of the Colorado Hospital Association, said in a news release. “We are again at a point where we need Coloradans to do their part to help our health care system.”

People can reduce strain on hospitals by washing their hands frequently, getting vaccinated against flu and COVID-19 and considering if a setting other than an emergency room would meet their needs, Tieman said.

It’s “critically important” that people who have respiratory symptoms stay home, even if they think they just have a cold, Herlihy said. Masks also are highly effective in reducing your odds of contracting respiratory viruses, which helps preserve hospital capacity, she said.

“That same virus that is mild for me or you can be life-threatening for a young child … or an immune-compromised person,” she said.

Another COVID-19 wave starting

The Colorado Department of Public Health and Environment reported 6,531 new COVID-19 cases in the week ending Sunday, which was an increase of more than 1,400 compared to the previous week. About 12% of tests came back positive over the last week, continuing a steady rise since mid-October.

Ten wastewater systems showed increasing virus concentrations, while none showed decreases. The rest either held steady or didn’t have recent data.

In late October, the COVID-19 Scenario Modeling Hub released projections that the country could have a wave that’s similar to what it saw over the summer, said Beth Carlton, an associate professor of environmental and occupational health at the Colorado School of Public Health. But hospitalizations are already where they were during the summer peak, and the cases and positivity rate suggest infections aren’t slowing down yet, she said.

“We expect COVID hospital demand to increase. We don’t know how much,” she said. “I don’t think we’re headed toward January 2022 with omicron,” when more than 1,600 people were hospitalized.

While the Centers for Disease Control and Prevention still lists most of Colorado as at low risk from COVID-19, the state’s northwest corner is showing signs of trouble. Moffat, Rio Blanco and Routt counties were listed as high risk, based on their case counts, hospital admissions and the percentage of beds occupied by people who have COVID-19. Eleven counties were listed as at medium risk.

In contrast, all but 10 counties had high or substantial transmission, based on cases and the percentage of tests coming back positive, according to the CDC.

Part of the increase in COVID-19 transmission probably comes from people moving their gatherings indoors, Herlihy said. The proliferation of new variants is likely also a factor, she said.

The most recent data on variants in Colorado is from Oct. 16. That shows BA.5 was still found in about 64% of samples chosen for sequencing, though the BQ.1.1 and BF.7 variants were becoming more common. All of the current variants are in the omicron family.

The CDC estimated that BA.5 now accounts for only about 39% of cases nationwide, while BQ.1.1 and BQ.1 increased their shares to almost 19% and 16.5%, respectively. The new variants appear to be even better at evading immunity than BA.5 is.

One big concern with the new variants is that some drugs won’t work well against them. While the antivirals like Paxlovid and remdesivir seem to be holding up against BQ.1 and BQ.1.1, that’s not the case for the monoclonal antibody bebtelovimab. Evusheld, an antibody cocktail meant to prevent infection in people who can’t produce their own defenses after being vaccinated, also appears to be significantly less effective against the latest versions of omicron.

Nationwide, COVID-19 cases and hospitalizations have increased slightly over the last week, according to data compiled by The New York Times. That doesn’t capture the full picture in harder-hit states, however. In Massachusetts, patients reported waiting up to eight hours for emergency room care, as short-staffed hospitals attempted to deal with a flood of people with conditions made worse by the pandemic, COVID-19, other respiratory viruses like flu and all the ordinary problems that need a quick response, according to The Boston Globe.

“It’s not just COVID now, but this triple threat,” Carlton said.

Flu starting to get traction

As of Friday, the CDC reported Colorado had “moderate” flu activity, based on the percentage of visits to health care providers for influenza-like illness. While flu hospitalizations are still low, they are higher than they were at this point in each of the previous six years, according to data from the state health department.

So far, about 1.3 million people in the state have gotten flu shots, said Scott Bookman, director of the division of disease control and public health response at the state health department. That’s in line with last year’s numbers, but behind 2020, when about 1.6 million people had gotten the shot, he said. The state health department urged people who haven’t gotten the flu shot to do so this week, so they develop some immunity before Thanksgiving.

The flu strain that’s leading nationwide is one that tends to cause more severe illness for young children and older adults, though it’s too early to say how the season will go, Dr. Jose Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases, said on a press call Friday.

Flu is notoriously difficult to predict, because the virus changes so quickly, said Dr. Annette Regan, an epidemiologist at the University of San Francisco. But there are several warning signs this year, including the fast, early start to the season; that the predominant strain tends to cause more severe illness; and that fewer people have gotten vaccinated, she said.

“That’s not really a great combination,” she said.

It’s not clear how two years of minimal flu activity will affect people, but it’s possible that kids who haven’t built up immunity could be at greater risk this season, Regan said. The best thing to do is to get the flu shot as soon as possible and to take precautions like frequently washing your hands, she said.

“If you’re going to that big Thanksgiving event, you want to get (the flu shot) now,” she said.

Dawn O’Connell, assistant secretary for preparedness and response under the U.S. Department of Health and Human Services, said her agency is monitoring capacity and can send staff and supplies from the Strategic National Stockpile if states ask for help. There’s “some confidence” that the health care system can manage surges based on how hospitals got through last winter, though some in the Northeast have already reported strain, she said during a press call Friday.

“RSV and flu are not new, and we have safe and effective vaccines for COVID-19 and the flu,” she said.

It’s not clear what people should expect, with three major respiratory viruses circulating at the same time, said Dr. Rebecca Fischer, an assistant professor at Texas A&M University’s School of Public Health. RSV returned somewhat last year after a hiatus in 2020, but we’ve never seen it spreading widely at the same time that flu and COVID-19 are, she said.

“We don’t really know what it looks like when someone has RSV and SARS-CoV-2 (the virus that causes COVID-19) at the same time,” she said. “This winter in particular is really challenging because of all those unknowns.”

It’s unlikely the country will be totally blindsided by respiratory viruses, but the easiest way to keep them under control is to take some precautions before the situation gets out of hand, Fischer said. Hopefully, states and communities can scale up their response if it’s clear a wave is building, but that may not be the case, particularly in areas without many resources, she said.

“Our personal choices and behaviors influence those waves and can sort of mute them or inflame them,” she said. “I think that people underestimate the role that individuals play and have an opportunity to play.”

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