There are 3 main viruses of concern heading into Winter and the holidays: COVID-19, Influenza, and RSV.
The Health Department is seeing an average of 25-30 COVID cases per month since September, but these numbers do not reflect positive home tests that were not confirmed by laboratory testing. Hospitalizations have been increasing over the last month or so, as nationally, uptake on the new bivalent boosters is only around 6%. Pediatric boosters for kiddos < 6 years should be introduced in the next few weeks, and boosters for both the Janssen and Novavax vaccines have been approved. Patients are encouraged to receive the bivalent booster if it has been more than 2 mo. since their last dose. The current COVID variants in circulation, especially the BQ.1.1 and XBB, have demonstrated significant ability to evade monoclonal antibodies. At this time, the antiviral therapeutics, such as Paxlovid, remain effective. However, monoclonal antibody treatments are no longer an option to avoid hospitalization. We continue to monitor COVID testing levels in local wastewater facilities to anticipate cases surges, which can give us 1-2 weeks warning before a surge. At this time, levels are in the lower half of the national samples.
We are seeing a national surge in RSV cases, including here in the community, that is seriously straining the healthcare infrastructure. As of 11/4, Maine Health in Portland released a notice that 100% of their pediatric ICU beds were occupied due to RSV cases. EMMC followed with a release not long after that their own pediatric ICU beds were at 97% of capacity for the same reason. Hospitals in lower New England have been so overrun with pediatric RSV cases that patients are being transferred up to Southern Maine from Vermont and New Hampshire. There is currently a treatment option for RSV, however, its use is severely limited. At this time, it is really only prescribed for pre-term infants.
Recent surveillance reporting from the Maine CDC indicate that Influenza is on the rise in Maine. The most prevalent strain in circulation right now is the H3N2 strain of Influenza A. We are currently averaging 1 case per day in December at the Health Department. While early genotyping from Maine’s HETL laboratory indicates that the flu shot components for this season are a good match for the influenza currently in circulation, H3N2 strains are notoriously resistant to flu vaccinations. A recent update from the Chief Medical Officer at IHS stated that national agencies are predicting the worst flu season in two decades. H3N2 strains also tend to disproportionately affect the lower age range of elders (50-60 yo) rather than the oldest patients as would generally be expected. The reason for this is rather complicated and can be traced to the first influenza strains each generation is exposed to as children. I can answer any questions about this as-needed.
Current Public Health guidance suggests encouraging people to choose to mask in social settings and to suggest they introduce some social distancing as we head into the holiday season. But these are now suggestions only, of course.