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Why one expert says the so-called ‘tri-demic’ might actually be a ‘septa-demic’


According to Dr. Peter Hotez of Baylor College of Medicine, there are seven respiratory viruses infecting people in large numbers this season.

Feeling under the weather? For many, it’s certainly understandable that the first thought may be COVID, given all we’ve been through over the past couple of years.

Unfortunately, that’s not the only thing going around these days.

This winter we’re experiencing what some are calling a “tri-demic” or “triple-demic” – that is, three highly infectious respiratory diseases are circulating among the population. Hospitals are under strain from increasing caseloads of COVID, flu and respiratory syncytial virus, also known as RSV.

But according to Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, there are even more respiratory illnesses on doctors’ radar this year. Listen to the story above or read the transcript below.

This transcript has been edited lightly for clarity:

Texas Standard: We all know about COVID and flu, but can you tell us a little bit more about RSV? You know, how serious it is and what exactly it is. 

Dr. Peter Hotez: Yeah, so there’s RSV and actually, although people are calling it the “tri-demic,” in fact, I’m calling it a “septa-epidemic” because there’s about seven respiratory pathogens out there and we can talk about some of the others in a minute.

But RSV, respiratory syncytial virus, is a respiratory virus that peaks in the winter. It tends to strike very young and very old. So premature neonates are very susceptible – graduated out of the neonatal ICU, can have underlying respiratory or cardiovascular illness or neuromuscular illness are especially vulnerable. But even otherwise healthy infants are susceptible. And then the other piece to this that people often forget is the very old. Our seniors are also very susceptible. So it’s an important cause of severe respiratory illness and death among seniors. And there’s a good news story, but not for this year. The good news: there’s about at least two or three RSV, respiratory syncytial virus, vaccines that will come online probably by next year. So in the long run, I have a lot of optimism. The key is getting through this year when we’ve got it on top of influenza and COVID.

And then the others that not many people know about include something called parainfluenza, which is the cause of croup and tracheitis. There’s metapneumovirus. There’s rhinovirus. And then there’s a non-viral pathogen of pneumococcus which can cause severe illness, especially among seniors. So that’s why everybody’s getting so sick. We’re just being inundated with this flood. And what the unusual part is, is that it’s happening much earlier than we usually anticipate. The fact that it’s occurring in the fall, when it usually occurs later in the winter, just that it’s all hitting the wall at once and so that hospitals are getting overwhelmed.

Well, I guess that’s what a lot of people are wondering about. You talked about a septa-demic, and a lot of people using that phrase “tri-demic.” Why are we experiencing this now? Is there a perfect storm that has come together here in November and December? 

Well, there are different theories out there, which neither is mutually exclusive. They could be reinforcing. One is this concept of “immunity debt,” which essentially says that people have been social distancing for so long. Now they’re finally getting together and any type of potential herd immunity that developed over the last two years has withered and therefore people are susceptible. There may be some merit to that. The other is that COVID-19 has the ability to interfere with immune responses to other respiratory viral pathogens. So the fact that so many people have gotten COVID could make people more susceptible, as well. So those are two of the theories out there. And, as I said, we usually see epidemics of all of these virus pathogens around this time of year or typically later. The fact that it’s coming so early.

» SEE MORE: COVID-19, flu and RSV overwhelm hospitals just as pandemic surge briefly subsided

Well, does this outbreak of different viruses and pathogens, does it seem to be hitting certain groups harder than others? It sounds like older folks and kids, no?

That’s it, I think you hit it. But anyone could fall to one of these viruses. So the key that I’ve been recommending is take as many of these virus and bacterial pathogens off the table by doing one simple thing, which is getting vaccinated. So if you haven’t gotten your influenza vaccine, get your influenza vaccine. If you haven’t gotten your new bivalent COVID booster, now’s the time to do it. Because as bad as things are right now, COVID is just getting geared up. So many of us are expecting another big winter wave of COVID-19, just like we saw in the winter of 2021 with the alpha variant and the winter of 2022 with the BA.1 omicron variant. Now we have these new, what I call “Scrabble,” variants like XBB and BQ.1 and BQ 1.1. I call them that because they use high-value Scrabble letters. And so they’re just now picking up here in Texas.

So get your bivalent booster. And then lastly, get your pneumococcal vaccine, especially if you’re a senior and many seniors are not taking advantage of the fact that they get their pneumococcal vaccine. And you can get many of these at the same time. So the point is go make your trip to Kroger, to H-E-B, to CVS or whatever pharmacy you like to use or your doctor and get your vaccines.

» SEE MORE: You can now order free COVID tests again by mail

You know, Doc, I was at the supermarket just last night and I was noticing that it seemed like more people were wearing masks. And I got up this morning and looked at my newsfeed and there was a story about how it was time to mask up and they were specifically citing this tri-demic – or septa-demic as you were calling it there. Is it time to mask up? I mean, should we be wearing masks outside of the home now?

Well, masks. But explaining the reason why for the mask – because COVID now is just taking off. But remember, one of the reasons why people did so well with RSV and flu these last two years is not only were they social distancing, but they were wearing masks. Masks do a great job at also preventing influenza and RSV. If you’ve ever done business in Asia, for instance, this time of year you will see lots of people always wearing masks historically in many Asian countries, and they do that for a reason – because it does have a big positive benefit against influenza and RSV and some of these other viral respiratory pathogens. So for instance, when I go on an airplane now, I wear a mask. And not only do I do that, but if you travel domestically – probably internationally as well recently – they’ll hand you one of those sani-wipes or one of those alcohol swabs. I use them. The first thing I do when I open it up is I wash my hands with it and then I swab down the countertop because it may not help so much for COVID-19 as it does some of these other respiratory virus pathogens.

Of course, this being the holiday season, folks are traveling. You mentioned using those wipes, which maybe a lot of people just stuff in their pocket. But, you know, folks are getting together in small and large groups. Should people be changing their plans for the holidays as a result of all of these respiratory viruses and pathogens out there? Or what would you say to someone who wants to participate in holiday activities? I mean, how do you gauge the severity of what we’re looking at? 

Well, everyone has to make some personal choices, but among them is the fact that, if you are immunocompromised, you may want to reconsider. But again, what you want to do is stack the deck in your favor by maxing out your immunizations. So getting your flu vaccine, getting your bivalent booster. Those things won’t prevent RSV, but they’ll certainly help with some of the other things. And frequent hand washing and, you know, being somewhat cautious. But, you know, it’s tough because everyone’s back to in-person events. People are doing holiday parties again and it’s fun, right? It’s fun to see people in three dimensions again. 

People are hungry for getting back together.

Yeah, but that’s why I say at least, you know, there are things you can do to go to those holiday parties and still keep yourself relatively safe. It’s not perfect, but get your vaccinations and frequent hand washing and maybe do some fist bumps and elbow bumps rather than shaking hands. Maybe a few a few less hugs and kisses and eventually we’ll get on the other side of this. So I’m fairly confident of it, but you know, I was hoping 2022 was going to be the year. Let’s hope for much better things for 2023.

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