The Morning Call

Under the weather? The real reasons your family is sick right now

- By Faye Flam

Something is altering the normal seasonal currents of cold and flu viruses. They slowed to a trickle during the early part of the COVID-19 pandemic only to blast through human population­s this year. Some public health experts have called it a “tripledemi­c,” but it might even be described as a quadrupled­emic.

In the Northern Hemisphere, flu began surging in October. This year has also seen a steep, early rise in RSV and adenovirus.

These normally cause colds, but RSV can be dangerous to young children and has recently led to overcrowdi­ng of children’s hospitals.

Adenovirus is usually mild too, but this month there were reports of the virus putting college athletes in the ICU, and it’s been implicated in clusters of dangerous hepatitis cases in children.

Why now? The easy answer is that wearing masks for more than two years drove down the incidence of these viruses, and people subsequent­ly lost immunity.

But that’s unlikely to be the whole story. The circulatio­n patterns of different viruses appear to be influencin­g each other in a way that’s not understood, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy and host of a podcast on COVID-19.

“When multiple respirator­y viruses are circulatin­g in a given season, one of them will dominate for reasons we don’t understand,” he said. “There’s something going on there that can’t be just attributed to personal protection (or) distancing.”

Osterholm points out that the same suppressio­n of other viruses happened in 2009 when the H1N1 flu broke out. He said he also doubts mitigation was all that effective against RSV and flu because it wasn’t terribly effective against COVID-19 — more than 75% of children had been infected as of February.

Viral interferen­ce might offer a more complete explanatio­n.

Our innate immune system includes disease-fighting substances called interferon­s, which may protect people infected with one virus from getting another. That may be why, as a large study from the University of Glasgow published in 2019 showed, cold viruses sink as flu viruses rise.

Others, such as infectious disease specialist Jeremy Luban of Harvard Medical School, said human behavior is still likely playing a role in our shifting viral currents. Lockdowns, though brief in many places, might have been enough to shift seasonal patterns. And many U.S. schools were closed much longer than businesses. If we dodged one or two seasons of flu,

RSV and adenovirus, population­s might have less immunity to them later.

He said that might help explain the mysterious clusters of hepatitis that cropped up in 35 countries around the world starting last spring — in some cases, leading to liver transplant­s. The latest thinking, which came up at a major meeting earlier this month, points to a co-infection of two interactin­g viruses.

One was the adenovirus and the other an adeno-associated virus. This virus, called AAV2, needs the adenovirus to replicate. In several recent studies, nearly all the children with hepatitis were positive for AAV2, but none of the children in a control group were. Similar infections might have happened before the COVID-19 era, but only became noticeable when adenovirus had an unusual surge after COVID-19 mitigation measures were lifted.

That leaves the question of whether all these flu, RSV an adenovirus cases will leave population­s flush with interferon­s that might tamp down the next wave of COVID-19. There is something weird already going on — a new omicron wave called BQ.1.1 has begun, but as physician Eric Topol writes in his newsletter, this is the first new variant that’s become dominant without causing a new wave of cases or hospitaliz­ations.

I’m cautiously optimistic that we won’t see a massive quadrupled­emic this winter, if only because COVID-19 could be crowded out by other viruses.

But as we learned just one year ago, when omicron hit, COVID-19 can always hit us with something from left field.

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