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Posted on: November 8, 2022

Health Advisory: Increased Respiratory Virus Activity Impacting Children and Healthcare System

Health Advisory: Increased Respiratory Virus Activity Impacting Children and Healthcare System

November 8, 2022

Action Requested 

  • Be aware of increased respiratory virus activity, particularly among pediatric patients.
    • This includes increased influenza activity, respiratory syncytial virus (RSV), and anticipated increases in COVID-19 activity this fall and winter.
  • Emphasize preventive measures with all patients, including prompt vaccination against influenza and COVID-19 for all patients 6 months and older who are not up-to-date on their vaccinations and booster doses.
  • Eligible children under 2 years old at high risk for serious complications if they contract RSV should receive palivizumab treatment in accordance with AAP guidelines to prevent RSV-associated hospitalizations. 
  • Treat high-risk COVID-19 patients who meet requirements and clinical criteria with COVID-19 antiviral medications and high-risk influenza patients who meet requirements and clinical criteria with influenza antivirals to prevent severe illness.
    • Use diagnostic testing to guide treatment and clinical management of patients. 
    • Administer antiviral medications as early as possible after symptom onset.
  • Prepare for stress on the healthcare system from increased hospitalizations related to respiratory infections, exacerbated by the limited number of pediatric beds in Snohomish County.

For full list of specific considerations for healthcare providers from the CDC, please review the recent Health Alert Network (HAN) Health Advisory.


In Snohomish County and regionally in western Washington we are seeing significant stress on the healthcare system, particularly around pediatric care. We are also seeing increases in RSV and influenza rates as is being described nationally. It is likely these trends will continue into the coming weeks. And we expect to see COVID-19 incidence increase in the near future. It is important for all eligible individuals to receive influenza and COVID vaccinations as soon as possible for their own safety, the safety of the community, and to mitigate the impact on the healthcare system.

The Centers for Disease Control and Prevention (CDC) has issued an advisory about early, elevated respiratory disease incidence caused by multiple viruses occurring especially among children and placing strain on healthcare systems. It is crucial to optimize respiratory virus prevention and treatment measures, including prompt vaccination and antiviral treatment. 

Many respiratory viruses with similar clinical presentations circulate year-round in the United States and at higher levels in fall and winter. In the past 2 years, respiratory disease activity has been dominated by SARS-CoV-2, and seasonal circulation of other respiratory viruses has been atypical. Currently, the U.S. is experiencing a surge and co-circulation of respiratory viruses. CDC is tracking higher levels than are typical for RSV, influenza, and rhinovirus/enterovirus (RV/EV), especially among children, though RV/EV levels may have plateaued in recent weeks. Meanwhile, SARS-CoV-2 also continues to circulate in all U.S. states and is anticipated to increase in the coming months. 


CDC surveillance has shown an increase in RSV detections and RSV-associated emergency department visits and hospitalizations in all but two U.S. Department of Health and Human Services (HHS) regions. While RSV activity appears to be plateauing in some places, the timing, intensity, and severity of the current RSV season are uncertain.


CDC has been tracking early and increasing influenza activity in recent weeks. The most common viruses identified to date have been influenza A(H3N2) viruses, with most infections occurring in children and young adults. Cumulative influenza-associated hospitalization rates are notably higher compared to the same time periods during previous seasons since 2010–2011. CDC anticipates continued high-level circulation of influenza viruses this fall and winter. 


SARS-CoV-2 activity is expected to increase in the winter as has been observed in previous years. Rates of COVID-19-associated hospitalizations among all age groups including children have decreased since August, but rates in infants younger than 6 months remain higher than in other pediatric age groups and higher than in all adult age groups except those 65 years and older. CDC expects continued high-level circulation of SARS-CoV-2 this fall and winter.

Additional Resources 




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