COVID, Flu, RSV: Hospitalizations Rise as Wave of Viruses Hits New York

NEW YORK — Just in time for colder weather and with other respiratory viruses on the rise, the mix of COVID-19 variants is shifting again in New York City in potentially worrying ways.

The omicron variant that accounted for most infections through the summer, BA.5, is now giving way to a variant soup — a mixture of different omicron subvariants, including BQ.1 and BQ.1.1., which are even more transmissible and better at dodging immunity.

With most testing now done at home, it is hard to get a clear picture of the amount of virus circulating. The city’s official COVID case numbers have been holding steady for two months, at about 2,000 cases reported per day. But hospitalizations have again started to increase. There were about 1,100 people hospitalized with COVID-19 in New York City on Oct. 24, up from 750 in mid-September, according to state data.

The rise in COVID hospitalizations is coinciding with the early arrival of flu season and a nationwide surge in RSV, or respiratory syncytial virus, which can cause breathing difficulty in young children and older adults. The result is a brewing triple threat that is already increasing emergency room visits, and raising concern that hospitals could again be strained this winter.

“There’s nothing to be alarmed about right now, but we are laser focused on the dynamics involved,” said Gov. Kathy Hochul at a virus briefing Wednesday.

Doctors say the pandemic shifted patterns of immunity, by reducing the circulation of regular viruses with masks, and isolation measures. Now that those precautions have been curtailed, familiar viruses are circulating again at high levels, and both the flu and RSV seasons have arrived sooner than expected.

“What we are seeing right now is a combination of many viruses causing a lot of stress on the health care system,” said Dr. Jay Varma, the director of the Cornell Center for Pandemic Prevention and Response.

Some children’s hospitals are already at capacity in Massachusetts, Connecticut and Washington, D.C., as well as in some southern states, due largely to a surge in RSV cases. In New York, Hochul and Mayor Eric Adams both said Wednesday that hospitals overall were still able to handle their patient loads.

Still, in New York City, visits to emergency departments for children under 5 for respiratory issues are now at the highest level since the first omicron surge last winter. And some pediatric facilities are reporting strain.

On the eastern edge of Queens, Cohen Children’s Medical Center is “absolutely packed” with young patients, with about 250 children being seen in the emergency room each day for the past few weeks, up from 175 to 200 normally, said Dr. Charles Schleien, the chair of pediatrics at the hospital.

As many as 30 to 40 children are being admitted to the Northwell-run hospital every day, mostly with RSV, though there is also an occasional COVID case, he said. Patient areas are so full that some children are spending the night in the emergency room and in the operating room recovery area.

“We were not this busy during the first omicron surge; we never got to these proportions,” he added. “It’s been well over 10 years since it’s been like this.”

So far, in the month of October, Northwell Health’s 21 New York hospitals have treated about 300% more patients for RSV than they did in September, according to a spokesperson.

Much remains unknown about what comes next. “We haven’t seen what it’s like to have these three viruses circulating at once,” said Dr. Denis Nash, a public health researcher at the City University of New York, who also noted a similar rise in emergency room visits across age groups. While he didn’t think COVID cases alone would flood hospitals this winter, the combination of diseases might. “It’s also possible there could be co-infections or that one will enhance transmission of another,” he said.

Among the mix of omicron variants circulating in New York, the one that seems most likely to cause a winter wave is known as BQ.1.1, which has already sent cases soaring in Europe. The variant and its close cousin, BQ.1, now account for an estimated 28% of cases in the New York and New Jersey region, up from 11% two weeks ago, according to the Centers for Disease Control and Prevention.

The variants do not appear to be causing more severe illness than BA.5, from which they mutated, but they are more transmissible, said Maria Van Kerkhove, the COVID-19 Technical Lead at the World Health Organization, in a public update Wednesday. Reassuringly, vaccines and tests are working as well in response to BQ.1 as with other variants, she said.

Still, as immunity in the population wanes over time, experts are urging people to get booster shots to keep the winter wave as small as possible. While getting boosted does not eliminate the risk of getting COVID, it can reduce the likelihood, and protect against severe disease.

“The boosting is the thing that has to get buckled down,” said Dr. Eric Topol, a cardiologist and the director of the Scripps Research Translational Institute. “As a nation, we are terribly under-boosted.”

In New York, only 7% of people eligible for the new booster — which is available to anyone older than 5 — have gotten one, Gov. Hochul said Wednesday. Only 3% of children under 5 years old statewide have completed their primary vaccination series, according to the state. Among children 5 to 11 years old, 39% have been fully vaccinated, and only 5% have gotten at least one booster dose.

Flu shots also are lagging, with 3 million doses given across the state, Hochul said. Along with being up-to-date with vaccines, it may also be time to reach for that mask again, experts said.

Hearing the same message again may be exhausting — mask, boost, avoid crowded indoor situations, improve ventilation — but with very few mandates left, changing personal behavior is the only real option left for people to tamp transmission down.

“I wish I had something new to say, and that’s really the problem,” Varma said. “Everything we need people to do are the same things we have been sending messages about since COVID first emerged.” This article originally appeared in The New York Times.