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San Diego hospitals brace for holiday surges in COVID-19, flu and RSV

San Diego hospitals are preparing for surges in COVID-19 and the flu after the thanksgiving holiday at a time when emergency rooms are already busy. KPBS Health Reporter Matt Hoffman says it’s not too late to help prevent another winter surge as officials brace for a "tripledemic."

COVID-19, the flu and RSV have San Diego health officials concerned about a "tripledemic" this winter. Local hospitals are preparing for surges in admissions following the Thanksgiving holiday.

"We’re tracking unfortunately at the same rate as last year so we do expect that surge to come right after the holidays," said Dr. Ghazala Sharieff, Scripps Health's chief medical officer.

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Around this time last year is when COVID-19-related hospitalizations started to increase. Sharieff said about a week ago they had 52 COVID-19 positive patients, as of Monday it had risen to 81.

"Rinse and repeat — we’ve done this before," she said. "This is what we see after holidays. Two weeks from now we should see that next surge."

Flu cases were low last year, but this November is seeing the most cases in at least a decade. Data from San Diego County's Health and Human Services Agency shows of the more than 10,000 flu cases this season, about half of them are among those under 18 years old. At Scripps alone, flu-admissions doubled over the last week to 52 patients as of Monday.

"If you think about hospitalizations in general — if you’re going to be seeing that volume of COVID patients and add on the flu patients we have — that could easily overrun the health care system," Sharieff said.

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In years past high COVID-19 admissions meant some surgeries had to be postponed, but Scripps is hoping to avoid that this winter.

"We’re trying to get as many — what we call pre-loading — trying to get as many surgeries as we can done before that wave hits," Sharieff said.

COVID-19 hospitalizations are relatively low but they have doubled in the last month and are trending up. As of Monday there were 286 San Diegans hospitalized. This past January saw 1,300 residents admitted with the virus, compared to more than 1,700 in January of 2021.

"We’re ready for it," said Joshua McCabe, director of emergency services at Sharp Memorial Hospital. "The hospitals at this point are not overwhelmed as we were a year or two years ago."

McCabe said Sharp is also preparing for the worst. Emergency room (ER) visits for influenza-like illness are trending up. McCabe estimates as many as 30% of patients are coming in for that reason, but they do not always have to seek emergency care.

"Essentially most people that are presenting with influenza like illness with fever, aches — they generally don't need an ER," McCabe said. "There’s not much we can do for them."

Mild cases can generally be handled with primary care visits, urgent cares or even tele-health consultations.

"If there’s that level of concern where there is true shortness of breath, fever you cant break, neurologic symptoms — absolutely come to the ER," Sharieff said. "But if you’re just part of what we call the 'Worry-well,' where you worry about exposure — that’s probably not the best place for you to go to at this time given the volume we’re seeing."

Emergency departments are typically busy this time of year and Sharieff said Scripps hospitals are seeing about a 5% month-over-month increase in patients.

RSV is a respiratory virus that typically impacts young children. It was surging last month, but Rady Children’s Hospital officials said cases are trending down, but they are seeing more kids coming in with the flu. Rady's spokesperson Benjamin Metcalf said a large majority of patients are presenting at their emergency room for care, with about 10% of those actually being admitted.

The three virus' circulating at once has health officials worried.

"We’re going to see a winter (COVID-19) surge — we just don’t want it to be that significant," said Dr. Seema Shah, medical director for San Diego County's epidemiology and immunizations department.

Shah said COVID-19 wastewater tests show the viral load has tripled in the last few weeks. Wastewater can be an early indicator of when cases are coming, as infections develop in the gut first. She said San Diegans can help reduce the strain on hospitals by not going to holiday parties if sick, testing regularly and getting vaccinated for flu and COVID-19. Shah said just 16% of eligible San Diegnas have gotten the updated bivalent coronavirus boosters.

"We have a lot of room to go," Shad said of the uptick so far. "We know that the bivalent works, we’re seeing that it actually decreases hospitalizations and death so we want to encourage people to get their booster."

Intensive care unit admissions for COVID-19 were four times higher this time last year. Shah said while good news, they likely tend to lag behind general hospital admissions.