Senior man getting coronavirus vaccine at home by a healthcare worker. Healthcare worker disinfecting arm of a senior man before giving a vaccine at home.
(Credit: Luis Alvarez / Getty Images)

As media reports of hospitals being pushed to the brink over the “tripledemic” of respiratory syncytial virus, COVID-19 and influenza dominate, one expert said society will need to “get through the storm” before things will get better.

During a LeadingAge membership call on Monday, Monica Gandhi, MD, MPH, associate chief of the University of California, San Francisco, HIV, Infectious Diseases and Global Medicine Division, placed blame for the increase in RSV and flu cases on viral interference and “immunity debt.”

Individuals typically are not infected with more than one virus at a time, she said. Over the past two years, COVID-19 squeezed out other respiratory viruses, creating so-called viral interference. But COVID-19 is now in a lull due to high rates of immunity — both vaccine-led and through natural immunity — making room for other viruses to bubble up.

Immunity debt is a controversial stance that is defined as the unintended consequence of non-pharmaceutical interventions — think social distancing, masking and isolation during the pandemic. Now that society has reopened, individuals — mostly children — are being exposed to infections that have laid dormant the past two years, leading to an increase in cases.

The difference is there are vaccines for flu and COVID-19, but not for RSV. 

Gandhi said society is going to have to persevere through one more hard season of flu and RSV to give people that immunity. In the meantime, her advice for older adults is to get a bivalent COVID-19 booster — especially those aged 80 and older who are most at risk, as well as the immunocompromised. 

For everyone else, she encourages anyone who is sick to stay home, and she is a proponent of increased ventilation to combat the spread of respiratory illnesses.

“We have to get through the storm,” she said. “Closing down society or putting back masks just delays what we have to go through later. It is a form of immunity.”

Gandhi also had some thoughts about who should get boosted — and who shouldn’t.

Pointing to a Lancet study published last month on the risk of severe disease after two COVID-19 vaccines, Gandhi said only four groups emerged as needing booster shots — adults aged 80 and older, immunocompromised individuals, those with chronic kidney disease and individuals with five or more comorbidities. 

The UK study analyzed the results of 30 individuals who received COVID-19 vaccinations to determine which groups would benefit most from future booster doses. Gandhi added that the World Health Organization recommends prioritizing boosters for older adults annually, with the United States the only nation calling for annual booster shots for everyone.