As the temperature drops and Bay State residents spend more time indoors, public health experts and health care professionals are concerned about an increasing viral mix of COVID-19, RSV, and the flu, while staffing shortages and overflowing emergency rooms continue to stress the state’s medical care system.

Places ranging from movie theaters to the State House made masking optional earlier this year, but COVID-19 variants continue to develop during the holiday season. In recent weeks, other respiratory illnesses — the respiratory syncytial virus, or RSV, and the flu — are also rising nationwide.

“Everything is happening at an accelerated pace,” Dr. Huan Ngo, chief medical officer at Signature Healthcare Brockton, said about an increase in respiratory illness cases. “This is all happening with COVID-19 underlying.”

In Massachusetts, the three-week average RSV positivity rate hit 23.1% in mid-November, according to the latest CDC figures available, a stark increase from just over 3% at the end of August.

The flu has also seen record spikes and hospitalizations throughout the state, according to the Department of Public Health’s recent report. Health officials report flu severity as “very high” as flu-like illness visits at health care facilities more than doubled from last year to almost 6% of visits.

“I’ve been concerned about this for months,” Ngo said. “Everybody is getting [sick]. It is challenging to manage more sick people than you’re used to.”

Ngo said that the flu and RSV historically rise in the winter months, but hospitals faced an inordinary increase in sick patients as early as September.

Although it doesn’t cause severe conditions in most older kids and adults, Ngo said, it can pose a dangerous threat for the elderly, folks with a weakened immune system, and young children. Illnesses like RSV can cause respiratory distress and blockage of the airways.

But public health care experts say that current state trends are only the beginning of what’s to come.

“It’s been a tough recent time with flu and RSV,” said Jonathan Levy, chair of the department of environmental health at Boston University’s School of Public Health. “It’s quite likely that things are going to get worse in the coming months.”

To help mitigate the stress on the health care industry, state medical group leaders say that residents need to take more precautions to protect themselves.

“Our level of concern has been elevated to the point at which we are compelled to share and recommend mitigation measures that can help to prevent illness,” said Massachusetts Medical Society President Ted Calianos, Massachusetts Academy of Family Physicians President Emily Chin, and American Academy of Pediatrics Massachusetts Chapter President Mary Beth Miotto in a joint statement.

They said Massachusetts families should vaccinate all children older than six months against the flu and COVID-19, including boosters, and practice regular hygiene like hand washing. They said that anyone gathered in crowded indoor spaces, including symptomatic children, should consider wearing masks.

“This will not only lessen the burden on our over-stressed health care system, which is especially important as we approach the holiday season,” they said. “[It] will also reduce interruptions to in-person learning and other children’s activities that can result from outbreaks caused by viral infections.”

The early onset of flu and RSV season, has prompted some health care experts to hypothesize why this is a new issue this year. Some say our immune systems are not ready for typical winter respiratory illnesses after more than two years of masking and lockdowns.

Levy said that we could spend time discussing the causes of the “tripledemic,” but it’s more important to act and deal with the impacts.

“There’s been a lot of debate about whether we’re seeing a problem where our bodies haven’t seen these viruses for a while versus the immune system having been depleted from COVID infection and kind of everywhere in between,” he said.

“Regardless of the cause of it, we have to deal with the cost.”

A tired workforce

Ngo wanted to become a health care professional and help people feel better since he was five years old.

For almost 20 years, he has treated community members at Signature Healthcare, first as the chief of the emergency department and now as the hospital’s administrative leader. But the conditions he has seen in the past two years, he said, have been entirely out of the ordinary as hospitals face massive staff shortages and overwhelmed emergency centers.

“The situation that health care is in right now is something that none of us have ever seen, including me,” he said. “It’s exacerbated by the viral illnesses, but a lot of it started with the pandemic.”

He said that at the pandemic’s onset, helping patients initially energized providers. Still, as time went on, the stamina of the industry started to buckle.

“We always thought that there would be light at the end of the tunnels, we always thought, you know, I will get through this, and unfortunately, that’s never happened,” he said. “There’s just an enormous amount of people just leaving the industry. They’re burned out. It’s not right or wrong, that’s just what happened, and now the health care industry is extremely short-staffed.”

In late November, Gov. Charlie Baker said that the industry needs to reimagine care as hospitals in the state have experienced shortages for the past year.

“There’s this giant staffing problem running across the system,” he said at the Massachusetts Association of Health Plans conference. “That staffing problem is doing significant damage to the normal process by which the system works.”

A recent Massachusetts Health and Hospital Association report reveals that about 19,000 full-time positions statewide remain unfilled, putting Massachusetts hospitals on track to pay more than $1 billion for temporary nurses.

Positions offering nursing care had the highest vacancy rate among survey respondents, with a rate of 56%. Home health aides (34%), pulmonary function technicians (35%), mental health workers/technicians (32%), and infection control nurses (26%) also reported high vacancy rates.

“Regionwide, every hospital system is fighting for the same employees,” Ngo said. “The prices get driven up, and that affects every corner of health care from the hospital to the outpatient setting, to the nursing homes and the rehab facilities where they’re struggling with staffing — everything’s interconnected.”

Compared to previous years, the MHA reports that state hospitals paid about $181 million in 2020 and $328 million in 2021.

Shortages have led to increased waiting times and a decreased capacity to treat patients, especially as more sick patients with respiratory illnesses turn to emergency rooms. Some hospitals have had to redirect patients to local facilities due to a lack of resources.

“We are a community hospital,” Ngo said about Signature Healthcare Brockton. “We don’t have a pediatric intensive care unit.”

For many sick young patients with the flu and RSV, he said that the goal for providers in recent weeks is to stabilize them and transfer them to other facilities like Boston Children’s Hospital. At the beginning of November, Boston Children’s representatives told The New York Times they had postponed some elective surgeries to make room for more patients with respiratory illnesses.

But at some points in recent months, Ngo said no more beds were available at these larger hospitals to make a transfer possible. So, they pivoted.

“There were many times where we were trying to transfer these kids out of state to Connecticut, to Maine to Vermont.”

Black, Latino residents

With the trifecta of virus cases on the rise and showing no signs of declining, community leaders are worried about how this will affect communities of color, already significantly impacted by the pandemic in the past two years.

“We still have COVID-19 around. We still have a lot of inequities in our community,” said Paola Martinez, La Colaborativa’s new health equity director, about community preparedness ahead of the winter months.

Over two years of dealing with a pandemic, DPH reports that Latino and Black residents experience the highest case rates at almost 25% and 17% of COVID-19 cases per 100,000 residents, respectively.

Similarly, according to the Department of Public Health, more Latino and Black residents have been hospitalized for flu-related diagnoses so far this year.

Although there isn’t demographic data available for RSV infections, public health experts say that many Black and Latino families with children will likely struggle to deal with the long-term consequences of the disease.

As policymakers continue to take a “laissez-faire” approach to protect residents, Levy said this would affect disadvantaged people the most.

“It’s about the risks of infection,” he said. “What are the consequences? That’s where you see the disparities emerge — what households and families are better able and better equipped to try to weather the storm.”

Getting sick is more than getting over respiratory illness-related symptoms, Levy said. For some families, it can affect their finances as individuals may need to miss work without sick leave to take care of themselves or their family members, and the quality of available health care isn’t the same for everyone statewide.

When many communities have changed perspectives about the pandemic and preventative measures, La Colaborativa, a nonprofit organization based in Chelsea supporting Latino immigrant communities in Greater Boston, has not, particularly as Latino and Black communities continue to report the highest cases of COVID-19 and, this year, the flu.

“People think that COVID is the news of yesterday. For us it continues to be the news of today,” said Gladys Vega, La Colaborativa’s executive director. “Your good reality, that is my sad reality.”

La Colaborativa continues to help families dealing with the aftermath of the pandemic, including helping with issues like unstable housing, unemployment, food insecurity, and immigration status.

Community advocates like Vega and Martinez hope policymakers from the local to the federal level will work together to take more preventive measures regarding respiratory illnesses heading into the colder months.

“The incidence of COVID-19, RSV and influenza in the ‘tripledemic,’ is just serving a purpose of unveiling the challenges that have been undermining our communities for a long time,” said Martinez. “As public servers, authorities should focus on addressing the foundation of these stratifications by developing policies and programs that provide equitable access to basic services, such as housing, to all communities.”

Anna Guaracao writes for the Gazette from the Boston Univesity State House Program.]]>