COVID-19 transmission is low right now, but the unseasonably early increase in flu cases and other respiratory viruses has health providers concerned.

Influenza rates have been very low the past two years because of pandemic-related safety measures such as masking, social distancing, and remote school and work.

Now, most of those measures have ended, and people have less immunity for the common viruses from two years of not getting them, explains Dr. Lynn Fitzgibbons, an infectious diseases physician at Santa Barbara Cottage Hospital.

“Before the pandemic, in the decade or two before COVID showed up, there was a pretty predictable rhythm with common respiratory viruses. We knew within a few weeks when the flu season would start, we knew when RSV cases would start with children,” Fitzgibbons said. “We were in this routine, this rhythm that we prepared for, vaccinated against … and then the pandemic hit and that entire rhythm was disrupted.”

The secondary benefit of masking and other COVID-19 precautions was that they protected against other respiratory viruses such as the flu, respiratory syncytial virus (RSV) and rhinovirus.

“What that means is, we are now starting this winter season with a population that has had far less influenza in the last couple of years than really ever in our lifetime,” Fitzgibbons said.

Flu activity has been minimal in Santa Barbara County so far, but cases have been unusually high for October in other parts of the country.

The Centers for Disease Control and Prevention said Friday that influenza activity continues to increase and the first influenza-associated pediatric death of the 2022-23 season was reported this week. The southeast and south-central regions of the United States are reporting the highest levels of flu activity.

The number of children sick and hospitalized with RSV is higher than usual, too, “with some regions nearing seasonal peak levels,” according to the CDC.

Orange County declared a health emergency this week due to record levels of pediatric hospitalizations and emergency room visits for patients with RSV, the Los Angeles Times reported.  

“We’re seeing a good amount of RSV right now in our community,” Fitzgibbons said, adding that in October, there were about 45 cases of RSV reported in children up to age 5.

“We are seeing cases of RSV increase at Cottage Health, as well as in community clinics. In the past week, RSV cases have doubled at Cottage.”

Most people who are exposed to RSV have a bad cold and recover, but an infection can be serious for young children under 2 and people with asthma or other lung issues.

“For most adults and older children, RSV causes typical common cold symptoms,” said Dr. Dan Brennan, a Santa Barbara pediatrician. “But for infants, preemies and those with high-risk conditions, RSV can create enough mucus and inflammation in the lungs to result in a need for hospitalization to provide things like breathing treatments, deep suctioning, supplemental oxygen, intravenous fluids and sometimes respiratory support in severe cases.

“The same virus may impact people in different ways. For example, a typical elementary school student may have a very mild viral infection that causes minimal runny nose and a mild cough, but if the friend sitting next to him catches the same virus and has a high-risk condition such as asthma, the same virus could have a much more significant impact on the high-risk friend.”

Santa Barbara Cottage Hospital’s emergency department data show the prevalence of specific respiratory viruses, since some patients are tested for multiple viruses to see why they have a bad respiratory infection.  

Rhinovirus and, increasing, RSV are the most common non-COVID, non-flu respiratory viruses right now, Fitzgibbons said.

At Santa Barbara Cottage Hospital, physicians have been seeing a lot of rhinovirus — the numbers increased the last week of August and have stayed high since then, she said.

“It was very likely the most common cause of our school children having colds in these last few weeks or couple of months since school resumed,” she said. “I think many of us had the experience with our own children or other children we heard about who had a bad cold and had a negative COVID test and a negative flu test.”

RSV activity is higher than usual for this time of year in California and Santa Barbara County, according to the Public Health Department.

Rhinovirus and other common cold-causing viruses typically cause symptoms that can include sore throat, runny nose, coughing, sneezing, headaches and body aches. 

RSV typically causes symptoms that can include runny nose, decrease in appetite or activity, coughing, sneezing, fever and wheezing. 

Influenza viruses typically cause symptoms that can include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue (tiredness) and some people may have vomiting and diarrhea, according to the CDC. 

Novel coronavirus (COVID-19) can cause symptoms including fever or chills, cough, shortness of breath or difficulty breathing, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea. 

Do You Need to Know Which Virus Made You Sick?   

Many respiratory viruses have similar symptoms, so sick people may not know exactly what they’re infected with.

It’s still important for people to get tested for COVID-19 if they have any cold or flu-like symptoms, Fitzgibbons said.

Visit the Public Health Department website here for a list of COVID-19 PCR testing locations and more information on at-home test kits. 

People should seek medical care if they have any concerning symptoms, regardless of the virus causing it. Some such symptoms include difficulty breathing, changes in mental state, headaches and ear pain, Fitzgibbons said.

“It is true that COVID, influenza, RSV, rhinovirus and other respiratory viruses can present with very similar symptoms. The good news is that for most people, viral infections will resolve with supportive care, time and rest,” Brennan said.

There are specific treatments available for COVID-19 and influenza, so for people who have those, there can be a significant benefit to know what virus they have, he added.

“It is not always practical, possible or necessary to identify what virus a person has,” Brennan said. “My advice is to reach out to your doctor if you are feeling symptoms and let him/her help sort out testing and treatment options.”

Noozhawk also asked Brennan when children who are sick and test negative for COVID-19 should be kept home from school, child care and activities.

“This question comes up multiple times every day. We have been so focused on COVID for the last two years that we often forget about other respiratory viruses and how they behave and spread,” he said. “It has always been a good idea to stay home until you are feeling better. This is just a kind thing to do in order to keep your school community, teammates and friends healthy.

“Part of our training as pediatricians includes learning about how certain viruses behave, how they spread and how long our patients may be contagious to others. Reaching out to your pediatrician for advice could be helpful when deciding when to send your child back to school (or other activities) if your goal is to minimize the spread of illness to others.”

Prevention Measures and Vaccination Information

Staying home when sick, handwashing and disinfecting high-touch surfaces, improving air ventilation and wearing high-quality masks are all ways to prevent the spread of respiratory viruses.

Vaccines to prevent infection are available for COVID-19 and influenza, for free in the case of COVID-19 and usually at no cost for influenza for people who have health insurance.

The Santa Barbara County Public Health Department recommends getting a flu shot as soon as possible since the virus is already circulating in the community.

Public Health issues weekly reports throughout the flu season, October through May, and they are available to read online here.

“In these next few months it’s important to remember that if you feel unwell, it’s important to take care of yourself and protect people around you,” Fitzgibbons said.

Find a COVID-19 vaccine provider on the Vaccine Finder search function of vaccines.gov/search/. Search for providers by location, by specific vaccine available (Pfizer-BioNTech, Moderna, Novavax and Johnson & Johnson) and booster shots.

Providers also can be found on the county website, publichealthsbc.org/vaccine, or at myturn.ca.gov. Some facilities offer walk-ups as well as appointments.

Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com. Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.

Giana Magnoli, Noozhawk Managing Editor

Noozhawk managing editor Giana Magnoli can be reached at gmagnoli@noozhawk.com.