We’re Sleepwalking Into a Potentially Nasty Respiratory Season

Hospitalizations for Covid, flu and RSV are rising and vaccination rates are lagging

Dr. Tom Frieden
4 min readDec 16, 2023
Photo: Shutterstock

It’s that time of year.

Yes, that means shopping for gifts, spending time with loved ones, and celebrating the holidays. But for those of us in the Northern Hemisphere, it also means respiratory virus season — when we’re faced with a microbial stew that includes Covid, flu and RSV.

Unfortunately, this year’s respiratory virus season is shaping up to be rough. Hospitalizations among all age groups in the U.S. increased by 200% for influenza, 51% for Covid, and 60% for RSV in the past four weeks, according to CDC.

Historically, viruses tend to circulate primarily in the winter months. Covid is still a relatively new virus and hasn’t yet settled into the same seasonal pattern, but we’re seeing an uptick now in many parts of the United States.

Colder weather, travel, and indoor gatherings contribute to the spread of disease. (The Southern Hemisphere is currently enjoying summer — they won’t have to deal with respiratory virus season for a few months.)

Respiratory viruses may seem like only a nuisance, but they’re way more than that. For young children and the elderly, they cause hospitalizations and kill tens of thousands of people in the U.S. every year. And even for young previously healthy people, an infection can mean lost work and a miserable few days or more.

Will vaccinations eliminate all these problems? No. But they are, by far, our best protection. Unfortunately, we’re lagging badly.

Flu vaccination rates are down a bit from last year.

Source: CDC

Covid vaccination is lagging even more: more than 60% of people over 60 are not vaccinated with this year’s vaccine. And only 16% of people over 60 have gotten the RSV vaccine, a new and effective way to prevent hospitalizations. Unlike flu and Covid vaccinations, RSV is, as of now, recommended for just one shot — one shot and years of protection. (Since it’s new, we won’t know for a few years if boosters are available. We don’t know everything about it, just that it’s safe and that it works. For how long — only time will tell.)

Covid and flu both evolve quickly and our immunity from previous vaccination and infection wanes, which is why updated vaccinations are necessary. New Covid variants such as HV.1 and JN.1 are spreading and may have a greater ability to duck around our immunity. However, the fall vaccine targets the XBB 1.5 variant and is likely to provide protection against these other variants too.

By increasing vaccination coverage, we can reduce severe illness and death this season. This is particularly important for older adults and people with underlying medical issues.

It’s crucial we make sure nursing home residents and staff are vaccinated. Vaccination rates in these facilities are unacceptably low. We must also make sure to close disparities by race, zip code and income and do as well as other countries protecting those who are most vulnerable. These are issues highlighted by Katelyn Jetelina at Your Local Epidemiologist.

The U.S. lags other countries badly in protecting those who are most vulnerable. Seniors in the United Kingdom are twice as likely — and nursing home residents, three times as likely — to be up to date with their Covid vaccination. This means, quite simply, that many American seniors will die preventable deaths in the coming months unless vaccination rates improve.

Each of us can do our part to protect ourselves and reduce the risk we spread a potentially dangerous infection to people around us.

  • Get your updated vaccinations! It’s still not too late. Everyone 6 months and older should receive this season’s flu and Covid vaccinations. Adults 60 years and older are eligible for the RSV vaccination. You can find vaccines at your local pharmacy or by using vaccines.gov, available at no cost to you. Talk to your doctor if you have any concerns.
  • Consider wearing a mask if you’ll be in crowded indoor spaces or traveling in airports. The evidence is clear that masks can reduce the risk of spreading Covid and of being infected with it.
  • If you get sick, do your best to stay away from others. Even though we’re all looking forward to holiday festivities, no one wants to spread an infection to loved ones. Talk to your doctor about testing and treatment options.

Rather than sleepwalk into respiratory virus season and be rudely awakened by a wave of infections dampening our holidays, let’s protect ourselves and others and get vaccinated.



Dr. Tom Frieden

President and CEO, Resolve to Save Lives | Former CDC Director and NYC Health Commissioner | Focused on saving lives. twitter.com/drtomfrieden