What is driving the ‘perfect storm’ of respiratory illnesses around the world?

The hope that the world had turned its back on the type of medical emergencies brought on by the Covid-19 pandemic has been confounded.

Chief medical officer Prof Breda Smyth has described the situation in Ireland as a “perfect storm of viruses” with record numbers on trolleys. In the United States they call the combination of Covid-19, influenza and respiratory syncytial virus (RSV) the tripledemic.

Hospital services around the world are being overwhelmed. Belgium, Germany and Slovakia are among the European countries that have declared a flu epidemic, the NHS in England is so overexposed that discharged patients are being moved to hotels. In Canada, pharmacies are running out of cold and cough medicines.

What is driving the tripledemic?

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Irish Thoracic Society Council president Dr Marcus Butler said the influenza strain that is so prevalent is the A strain. It is the only one known to cause flu pandemics, can spread easily and is most likely to cause severe disease, especially in older people.

Dr Butler, who works in St Vincent’s hospital, said this flu season has been the worst he has experienced as a respiratory consultant in more than 20 years.

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“It has come through as a stronger problem in many countries for reasons that are not fully understood,” he said. “One of the common reasons can be a more pathogenic strain of the virus.

“We need better quality influenza vaccines than we currently have, but it is better to use them than not to use them.”

He said an “obvious rebound” was to be expected after the pandemic restrictions were lifted and the situation shows the importance of mask wearing and social distancing.

“Why it is higher than pre-Covid is the question. We are seeing record trolley numbers. One of the issues that may be contributing to this is that during the last couple of years there were very low instances of non-Covid respiratory viral illness,” he said.

“Very early in the pandemic paediatric hospitals were reporting a drop-off in bronchiolitis. As a result of this there is a whole generation of kids, and to a lesser extent adults, who did not get exposed to these viruses and did not top up their immunity.

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“Your immunity needs stimulation to prepare for the next time you meet these viruses. It’s an unpaid immunity debt that now has to be paid off by the body with these slightly less familiar virus[es].

“This has the ripple effect of seeding more cases in the community and it is also happening earlier in the calendar year, and all this is conspiring to fill up the hospital system.

“We now know that avoiding respiratory infection through wearing masks is highly effective at reducing influenza rates. We assumed that with weaker data. The pandemic has a wealth of evidence that influenza rates really fell away and it stands to reason that would happen.

“A lot of my respiratory patients are wearing masks for fear of getting a flare-up of their chest through whatever virus is circulating. Covid-19 is a triggering factor for underlying lung conditions.”

Dr Butler said better vaccines for influenza and the development of a vaccine for RSV will ease the situation in the future for healthcare systems.

“A lot of it is seasonal because influenza prefers cool and moist environments. It is a greater phenomenon than ever this year. It is the worst I can remember.”