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The ongoing "quad-demic" of influenza, norovirus, RSV, and COVID is creating heightened health risks, making prevention through hygiene, masking, and vaccination critical.
In an interview with Pharmacy Times®, Donald Middleton, MD, vice president of family medicine at the University of Pittsburgh, explains how the "quad-demic," which is a term that describes the simultaneous circulation of influenza, norovirus, respiratory syncytial virus (RSV), and COVID-19, puts everyone at a higher risk of illness, especially older adults and individuals with chronic conditions. Middleton advocates for preventive measures, including frequent handwashing, coughing into the elbow, wearing masks in high-risk environments, and staying up to date on vaccinations for influenza, COVID, and RSV.
Pharmacy Times: For those unaware, what is meant by “quad-demic,” and why is it occurring?
1. Older adults, individuals with chronic illnesses, and children are most vulnerable to severe complications of "quad-demic" viruses.
2. Hand hygiene, masking in crowded settings, and vaccinations for flu, RSV, and COVID can significantly reduce transmission risks.
3. Unlike the other viruses in the “quad-demic,” norovirus lacks a vaccine and spreads easily, making avoidance and hydration the only effective countermeasures.
Donald Middleton, MD: Yeah, this is sort of a made-up term, and it concerns the fact that 4 viruses are going around at once, and the 2 viruses that are relatively new and spiking are influenza and norovirus. Influenza, of course, [causes] respiratory issues and norovirus, gastrointestinal issues. The backgrounds of RSV and COVID viruses are relatively constant; RSV is actually now probably going to wane a little bit, as far as these 4 viruses go.
Pharmacy Times: Which groups are at the highest risk of contracting one of these circulating illnesses?
Middleton: Well, people who have underlying chronic illnesses or those who are older are always at the highest risk for these diseases. Norovirus, being gastrointestinal, can hit anybody, and sadly, it often affects children as well and causes them to be somewhat dehydrated, and that's always a risk for mortality or morbidity that's quite severe. The norovirus is typically in the winter and typically strikes older patients with more vigor, and so the key there is to keep people hydrated. Sadly, there's no specific treatment for norovirus, and the only way to prevent getting it is to stay away from those who have it already, and that's a tough thing for all of us to do. The issue with influenza is that it is widely spread by cough, and it can also be spread by touching, but cough is the big thing that leads to influenza spreading. And it is clearly spiking at this point; of the 4 viruses that are going around, influenza is the one that's really the most prevalent and the most dangerous.
Pharmacy Times: As these illnesses converge, how can individuals protect themselves, especially those who are 65 years and older?
Middleton: Your hands are critical to keep clean. It's really funny; when you watch people, they often shake hands or touch other people's faces, particularly children and grandparents touching each other's faces, and so on. It doesn't take many viral particles to transmit a disease, and that's primarily the issue. In the old days, when we had the COVID epidemic, of course, we were all wearing masks. We were staying separate from one another. We weren't having mass gatherings. Those sorts of things, sadly, transmit these viruses from one [person] to another. And none of these viruses respect age; they go through the whole gamut of age, from newborn all the way until people are more than 100 years old. What I would advise people to do is the following: number 1, when you cough or sneeze, do not cough or sneeze on your hands; cough into the crook of your elbow, which people are unlikely to touch. Number 2: When you do touch someone before you touch your face anywhere, wash your hands or carry some sort of cleaner with you to clean your hands off. And if you are in a gathering where individuals, a lot of people, are coughing and so on, I'd probably carry a mask in my pocket. If you get, say, in a temple or church or something like that, or you're at a play and everybody's coughing, I'd probably put the mask on at this point to try to keep yourself as safe as possible. Other than that, the most important thing is vaccination, and vaccination against COVID, RSV, and influenza; all of those viruses can be controlled with vaccination. Sadly, we don't have a norovirus vaccine as yet, and I don't really know whether anybody's actually working on one at this point. But there are multiple companies working on improving the effectiveness of the 3 vaccines we have available to protect us against flu, RSV, and COVID.
