The threat of respiratory viruses has always been with us. Even prior to the COVID-19 pandemic, “flu season” has always had the potent effect of severe illness and death in vulnerable populations. While life before the pandemic saw a fairly mild public reaction to the recurrent presentation of these various respiratory viruses, COVID-19 has now galvanized the medical community to look at them differently.
And although fears regarding SARS-CoV-2 have diminished in the past year and the world hopes for continued milder outbreaks in the upcoming 2023 COVID/Flu/RSV season, it is important to consider viral unpredictability and changing global environments year-to-year. This shifting nature of the flu season can be seen by looking back at the last few years:
2020: An Unexpected Silence
In 2020, the world watched with bated breath as COVID-19 tore through communities around the world. In an interesting turn of events, the year’s “Flu Season” and “RSV Season” were seemingly put on pause - cases for these illness plummeted (in comparison with previous years) while SARS-CoV-2 infections skyrocketed (though, notably, RSV saw a late spike in late summer of 2021). While it’s not perfectly clear why the phenomenon occurred the way it did, many attribute it to COVID-19 suppression measures like lockdowns, face masks, and social distancing.
2021: The Echo of Resurgence
As the planet coped with seemingly endless COVID-19 variants and immunization drives, Flu and RSV reared their heads again in 2021 (though still below pre-pandemic levels). Experts argued as to whether the break in infections in the former year had created an increase in susceptibility. What’s worse, the 2021 Flu Season made diagnoses incredibly challenging due to the overlapping symptomatology associated with all three illnesses. PCR became critical in diagnostic workflows, but most only assessed for the pathogenic presence of SARS-CoV-2 alone.
2022: Anticipating a Tripledemic
Flu and RSV activity was higher this season than last but still below pre-pandemic levels. The COVID-19 resurgence seen in winter of 2021 to spring 2022 was driven by the Omicron variant of COVID-19. To date for 2023, flu and RSV remain low, but this is likely to change in the coming months. The medical community is also still grappling with the implications of BA.2.86 - the new variant come to be known as “Pirola.”
2023 Projections: Divergent Opinions
Medical experts aren’t certain yet just what the 2023 COVID/Flu/RSV season will look like. Milder projections see higher levels of COVID-19 vaccinations and prior infections as playing a significant part in a tamer season. Others are concerned over a sudden increase in the circulating rates of all three illnesses - the dreaded “tripledemic” which could lead to significant strain on healthcare systems.
Dr. Anthony Fauci, who leads the National Institute of Allergy and Infectious Diseases, predicts a “pretty bad flu season” this year based on the 2023 Australian summer (their winter), and advises people to get vaccinated against all three viruses and take precautions like mask-wearing and social distancing in an effort to reduce infection spread.
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, warned that Flu and RSV this season are concerning for two reasons: “The first is that they're both extraordinarily early. The second is that they're both out there spreading very, very rapidly." His take is that the public might see a severe flu season this year.
On the other hand, Dr. Scott Gottlieb, the former commissioner of the Food and Drug Administration, attributes the early RSV peak in children to “the fact that children have been somewhat removed from the circulating pathogen, so you don’t have as much immunity in the population generally. So it’s changed the typical cycle for this virus.”
To anticipate the severity of the Respiratory Season each year, the CDC also tracks nationwide trends through a program called FluView. Their data allows you to see weekly trends, rates of infectivity, and unique virus character traits to help labs prepare for what they’ll be seeing most frequently throughout the season.
While understanding varying projections is important, one principle remains much more critical: early detection. Rapid and accurate testing for COVID-19, Flu, and RSV will be essential for several reasons:
Differential Diagnosis: The crossover in the symptoms of these illnesses makes diagnosing them through clinical methods unreliable. The difficult reality of this truth is reinforced by the Infections Disease Society of America (IDSA), which acknowledges that "the clinical signs and symptoms of acute respiratory tract infections (RTIs) are not pathogen specific.”1 Differentiating between SARS-CoV-2, RSV, and Flu is most effectively performed with early and accurate testing. In this regard, PCR has attained recognition as the gold standard in regards to pathogen sensitivity/specificity, with further benefits associated with its ability to detect many pathogens simultaneously.
Isolation and Treatment: Early detection allows for early quarantine, thus reducing the possibility of spread. It also supports earlier treatment starts, which is itself associated with a better prognosis for patients.
Resource Allocation: Early identification also allows medical infrastructure to direct their assets appropriately. It saves unnecessary hospitalizations, saves medical resources, and allows organizations to staff more effectively.
Public Health Measures: Early detection is crucial for guiding public-health decisions, from the timing of preventive measures to appropriate launch dates for vaccination campaigns.
At Molecular Designs, we understand the urgency of early detection in the 2023 COVID/Flu/RSV season. During the early pandemic, our organization emerged as one of the leaders in providing panels for the detection of SARS-CoV-2.
To help our partners get ready for the season, we’ve just released our Direct PCR (extractionless) panel, which will allow the same broad diagnostic testing, but with even further improvements in the kind efficiency famously associated with PCR. We believe that by providing diagnostic labs with reliable and efficient testing solutions, we can contribute to better patient outcomes and help research laboratories and healthcare providers navigate the challenges of this unique season.
Flu season in the years following the COVID-19 pandemic have proven to be unpredictable, but the medical community aims to brace for a dangerous convergence of COVID, Flu, and RSV. In this time, the importance of PCR cannot be overstated. Early detection is not merely a medical imperative; it is a lifeline that stands to reshape the course of seasonal respiratory illnesses.
Molecular Designs products are for research use only and not for use in diagnostic procedures
1. Hanson K, Azar M, Banerjee R et al. Molecular Testing for Acute Respiratory Tract Infections: Clinical and Diagnostic Recommendations From the IDSA’s Diagnostics Committee. Clinical Infectious Diseases. 2020;71(10):2744-2751. doi:10.1093/cid/ciaa508