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COVID, Flu and RSV Converge

Last updated: December 9, 2022

Though COVID-19 has been with us for almost three years, case numbers of illnesses including flu and respiratory syncytial virus (RSV) declined sharply in 2020 and 2021 as many people wore masks and avoided large gatherings.

This year, with masking less commonplace and people returning in large numbers to workplaces, schools and day care centers, cases of flu and RSV are on the rise. COVID-19 is still circulating widely as well, and it’s leading to what many have dubbed a “tripledemic,” a situation in which the three illnesses are peaking at the same time.

The seasons for both influenza A and RSV have begun earlier in the year than normal, says Dr. David Brooks, Medical Director of Infectious Disease for ThedaCare. “We’re getting back into our routine where flu and respiratory season starts in the fall and escalates throughout the winter.”

The early season, combined with the continued spread of COVID-19, has led to high case numbers, increased hospitalizations, and more visits to clinics and emergency departments.

Here’s what to know about each of the three illnesses:


  • What’s happening now: The so-called “Scrabble variants” — BF.7, BQ.1, BQ.1.1, BN.1 and XBB — have become the dominant strains circulating now. They’re even more contagious than the highly contagious BA.4 and BA.5 variants that spread widely this fall, Dr. Brooks says.
  • How it spreads: Through sneezing, coughing and expelling respiratory droplets into the air.
  • Who’s high risk: Older adults, immunocompromised individuals, and those with underlying health conditions.
  • Symptoms: Symptoms typically appear 2 to 14 days after infection. Common symptoms for the variants circulating now include cough, congestion, sneezing and sore throat, Dr. Brooks says. View more symptoms.
  • Testing: Home tests are widely available. Wisconsinites can order another round of five free tests. Many health insurance plans also cover the cost of a certain number of home tests each month. Check your plan for coverage. For more testing resources, visit the Wisconsin Department of Health Services.
  • What to do if you test positive: For mild symptoms, stay home, follow the isolation guidelines, and take self-care measures, including taking over-the-counter pain and fever-reducing medications as needed. For moderate symptoms or symptoms that concern you, log in to MyThedaCare and use the COVID-19 Symptom Checker to get further guidance on care. If you’re considered high risk (see categories above), seek treatment within the first five days of symptom onset. You can connect with a ThedaCare provider in person or virtually. A free option also is available to people via the Wisconsin telehealth line.
  • When to seek emergency care: Call 911 or go to the emergency department for severe symptoms including difficulty breathing, a pulse oximeter reading of 90% or lower, severe headache and chest pain.


  • What’s happening now: The week of Dec. 4, the Centers for Disease Control and Prevention announced the United States is experiencing decade-high levels of hospitalizations from flu for this time of year. The CDC map for flu shows much of the country at very high or high levels.
  • How it spreads: Through respiratory droplets and aerosols as well as through contaminated surfaces.
  • Who’s high risk: Adults 65 and older, people of any age with certain chronic medical conditions (such as asthma, diabetes or heart disease), pregnant people, and children younger than 5, but especially those younger than 2.
  • Symptoms: Symptoms typically appear 1 to 4 days after exposure. Symptoms are similar to those of COVID-19 and include fever, cough, sore throat, runny nose, fatigue and body aches.  
  • Testing and care: Testing is needed to confirm diagnosis. However, most people with flu can stay home and take self-care steps, including taking over-the-counter pain and fever-reducing medications as needed. The Centers for Disease Control and Prevention recommends staying home for at least 24 hours after your fever is gone. Contact your primary care provider if you suspect you have flu and are at high risk for becoming seriously ill or if you have symptoms that concern you. Antiviral medication is available but is recommended only for high-risk individuals (see categories above).
  • When to seek emergency care: Call 911 or go to the emergency department for severe symptoms including difficulty breathing, persistent chest or abdominal pain, and dizziness/confusion/extreme lethargy.


  • What’s happening now: Throughout the fall, there was a dramatic increase in the number of cases in small children. In recent weeks, however, case numbers have started to decline.
  • How it spreads: Through contaminated surfaces, which can be problematic for children younger than 2, who often put objects in their mouths and who are more likely to get severely ill from RSV. Thus, handwashing and cleaning surfaces are important prevention steps for RSV.
  • Who’s high risk: Infants and children 2 and younger, adults 65 and older, adults with chronic heart or lung disease, and adults with weakened immune systems.
  • Symptoms: Fever, cough, fatigue, stuffy nose, sneezing, shortness of breath and wheezing.
  • Testing and care: Testing is needed to confirm diagnosis. However, most people recover from RSV with home care. Contact your primary care provider if you or your child are experiencing symptoms that concern you.
  • When to seek emergency care: Call 911 or go to the emergency department for symptoms including difficulty breathing, a high fever, or a blue color to the skin, particularly on the lips and in the nail beds.

Bottom Line

No matter the respiratory illness, most people recover with rest and home care measures, Dr. Brooks says. Seek virtual or in-person care for symptoms that concern you, and don’t delay care if you or a loved one are experiencing an emergency.

Vaccination remains a vital step in preventing serious illness and hospitalization for both flu and COVID-19, Dr. Brooks says. It’s not too late to get your flu vaccine and COVID-19 vaccine or booster.

“These new COVID-19 vaccines cover both the original strains and the new variants, so they’re much more effective than the original version,” Dr. Brooks says of the bivalent COVID-19 boosters that are now available for those 5 and older.

Beyond that, continue to follow the steps of frequent handwashing and sanitizing of high-touch surfaces. Finally, avoid contact with others when you’re sick.

“Don’t go to work, school or social gatherings on those days when you’re sick. Stay home until your fever and symptoms have resolved,” Dr. Brooks says.

ThedaCare offers both in-person and virtual care options.

Tags: Covid Dr. David Brooks fall flu illness influenza primary care RSV sickness tripledemic urgent care vaccines walk-in care winter

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