The flu, COVID-19 and respiratory syncytial virus, commonly known as RSV, along with a host of other respiratory viruses, are all circulating in North Carolina.
The viruses all have similar symptoms: fever, chills, headache, nausea or a cough. If someone loses their sense of taste or smell, that’s a telltale sign of COVID-19, but otherwise the illnesses all look the same.
“This is an unusually early year, both for flu and RSV. Classically, we begin seeing cases in mid-November, but they tend to peak in January or February, and then continue to March or April,” said UNC’s Dr. David Weber. “In the last three or four weeks, we've just seen this explosion of influenza.”
Last week, UNC Health had about 400 patients isolated with the flu, another 200 or so with RSV and 150 more with other respiratory viruses, said Weber, a pediatrician and the medical director at the hospital’s department of infection prevention.
“This has been an usually early and severe year,” he said. RSV has mainly hit children, Weber said, but patients with the flu have mainly been adults.
"North Carolina has seen increased levels of influenza (flu) and respiratory syncytial virus (RSV) this year compared to the same time in recent previous years, according to data reported to the department. These trends are similar to what is being seen nationally," said Bailey Allison, spokeswoman with the North Carolina Department of Health and Human Services.
Weber said he expects to see the number of flu cases bump in the week after Thanksgiving and again after Christmas, when family and friends traditionally gather.
In North Carolina, 24 adults and one child have died from the flu since the beginning of October, according to the state DHHS. People are still dying from COVID, too, Weber points out - about 300 in the United States each day.
North Carolina reported at least 27 deaths from COVID in the week leading up to Thanksgiving, according to the latest data available from DHHS.
This is the third holiday season of the COVID-19 pandemic. But it’s also the first since schools dropped widespread mask mandates, which public health researchers say kept flu and RSV at bay along with COVID.
The good news is that COVID levels seem to be remaining low for now, data from N.C. DHHS show.
Wastewater monitoring shows COVID in North Carolina has been relatively steady since September. The number of people hospitalized with COVID is below 500 for the first time since May. But holiday travel and gatherings could lead to another spike in COVID numbers.
Weber said his advice is for everyone to get their flu shot and keep up to date on their COVID boosters. As of last week, about 16% of people in North Carolina with the COVID vaccine had gotten the new booster shot.
While COVID levels remain low in North Carolina, the flu is taking its toll. The latest data from the Centers for Disease Control and Prevention put North Carolina’s flu levels at “very high” along with most of the rest of the South.
It is “almost impossible” to tell the difference between flu, RSV and COVID symptoms, Weber said. He said people with health risks, like the very young or old, or those with compromised immune systems, should get tested for the viruses.
He said they use a 4-plex test, which checks for flu A and B, RSV and COVID. He said the test can be important for some people because there are specific medicines they can give to people with COVID or the flu that can help avoid the worst symptoms. But both medications have to be given within a certain timeframe to be effective.
“You really don't want to wait and say, 'well, let's see how I am in a few days and if I'm getting worse,'” Dr. Weber said.
North Carolina has also been dealing with shortages of two medications to help deal with these viruses, Weber said. Amoxicillin, an antibiotic, and Tamiflu, used to treat people with the flu.
"Currently, NCDHHS is not aware of a statewide Tamiflu shortage impacting NC. While there is also not a national shortage, some companies do have their product on allocation status which means quantities may be limited. This can lead to spot shortages such that people have to use an alternative pharmacy," said DHHS's Allison.
With all of these respiratory viruses, the best way to avoid getting sick is something people have become familiar with: wearing a mask, washing hands and giving each other space.
“Being immunocompromised, such as having an organ transplant or cancer chemotherapy, I would still recommend wearing a mask when you're outside of your household bubble. It will work against all the viral diseases,” Weber said.
For holiday travel, Weber said wearing a good mask will keep people safe.
“It's not the traveling that's at risk. If you were wearing your mask while you were in the airport and traveling by bus. You're really well protected,” he said. “It's what you do when you get to the end of your travels.”
The same guidelines for COVID work to avoid the flu, RSV and other viruses this holiday season: if you’re sick, stay home; wear a mask if you’re at risk; and big gatherings make it more likely to get sick.