With respiratory illness case rates sure to increase this coming fall and winter, it’s important to take a look at lessons learned from last year in order to reduce severe outcomes for patients and unnecessary strain on health systems.
Numerous studies demonstrate the dangerous effects of respiratory illnesses in patients. One study, published in the Journal of the American Geriatrics Society in July of this year, sought to quantify the increased risk of cardiovascular events in older patients hospitalized with RSV compared to other common causes of hospitalization in that age cohort, like flu, UTI, or fracture. Researchers took a look at about 2,500 patients hospitalized with RSV from 2011 to 2020 and found that 18.5% of them subsequently had a cardiovascular event, compared to 17.7% from flu, 12.1% from UTI, and 8.4% from a fracture. Matched analyses then showed an association between RSV hospitalization and greater risk of subsequent heart failure events relative to all other patient groups.
Practically every outcome analyzed in patients hospitalized in the study was found to be more prevalent in patients with RSV compared to other conditions. In addition to cardiovascular events, higher rates of 30-day mortality and ICU admission were observed, as well as longer lengths of stay for RSV patients compared to other patient groups. The odds for intensive care were higher for RSV patients “regardless of whether pre-existing cardiovascular conditions were present.” The authors of the study characterized the risk of ICU transfer as “substantial” in RSV patients compared to those with UTI or fracture.1
Frightening revelations about the impacts of respiratory illness after acute infection don’t end there. Another study, published in Nature, found that “infection with [COVID-19] is linked with a nearly twofold increase in cancer-related death.” Researchers set out to test whether or not dormant cancer cells could be reawakened by a respiratory illness; they seeded breast tumors in mice and then infected them with either COVID or flu and found that the dormant cancer cells “kicked into high gear, proliferated, and formed metastatic lesions” in the animals within days of infection. Evidently, the culprit was an immune molecule called interleukin-6, as the removal of that molecule slowed the multiplication of the cancer cells down drastically.2
The study helps to explain a marked increase in metastatic lung disease among breast cancer survivors following infection with COVID. The dormant cancer cells may be catalyzed by an infection with a respiratory illness, which only further goes to show the importance of effective, affordable, and widely available interventions against diseases like COVID.
While the safety of patients is obviously of paramount importance, hospitals and health systems find themselves under strain during respiratory illness season as well, and that strain can lead to negative impacts on patient care. In January of 2024, the CDC posted an update on hospital capacity as respiratory illnesses began their seasonal annual increase, which acts as an effective microcosm for how these diseases progress every year and impact hospital systems. The agency warned specifically that “low vaccination uptake…could lead to more disease and potentially more severe disease, straining healthcare capacity.” They mentioned that strain on healthcare systems has been associated with delays in treatment and elective procedures, increased medical errors and lower quality of care, longer patient stays, increased rates of healthcare-associated infections, and poorer outcomes.3
HPN spoke with Dr. Rodney Rohde, PhD, MS, SM(ASCP)CM, SVCM, MBCM, FACSc, Regents’ Professor at Texas State University System, about lessons learned from last year’s respiratory illness season and what hospitals and health systems can implement and think about this year to try to assuage this issue before it begins to worsen, as it does each year.
What are some lessons learned from last year’s respiratory illness season?
Last year’s respiratory illness season reinforced the importance of early surveillance, rapid diagnostics, and clear communication. We saw how co-circulating viruses—COVID-19, influenza, and RSV—can strain healthcare systems. It highlighted the need for higher vaccination rates, public trust in science, and the critical role of medical laboratory professionals in outbreak response.
What do you expect to see this fall and winter?
This fall and winter, I expect another complex respiratory season with overlapping waves of COVID-19, influenza, and RSV. We may also see emerging variants or viral shifts. Continued vigilance, updated vaccinations, and strong public health messaging will be essential—as will the behind-the-scenes work of medical laboratories guiding early detection and response. While influenza, RSV, and COVID-19 are the primary concerns for severe illness, other respiratory viruses circulate during the season as well, including adenovirus, rhinovirus/enterovirus (common cold), pertussis, and parainfluenza. Human metapneumovirus (HMPV) is also on the radar and is expected to follow a similar late season peak as observed in the previous year.
What should clinicians and health systems keep in mind as the season draws nearer?
Clinicians and health systems should prepare for simultaneous surges of respiratory viruses by ensuring vaccine access, staffing support, and diagnostic capacity. Early testing, public education, and collaboration with laboratories will be key. Proactive planning—not reactive response—will make the difference in managing this season effectively.
What can hospitals do before respiratory illness season gets underway to minimize adverse outcomes?
Hospitals can get ahead by ensuring vaccine availability, reinforcing infection prevention protocols, checking on supply chains, and optimizing lab testing workflows. Cross-training staff, reviewing surge capacity plans, and engaging in public outreach can also reduce strain. Early action is critical to minimize hospitalizations and protect vulnerable populations.
What advice would you give people to follow this fall and winter to stay healthy and avoid becoming severely ill?
Stay up to date on vaccinations for COVID-19, flu, and RSV if eligible. Practice good hand hygiene, stay home when sick, and wear a mask in high-risk settings. Test early if you have symptoms, especially if you're at higher risk. Prevention and early action are your best defenses.
Are there any new technologies you’re aware of that are helping infection prevention teams prevent severe outcomes?
Yes—syndromic multiplex PCR panels, real-time wastewater surveillance, and AI-driven predictive analytics are transforming how we detect and track respiratory viruses. These tools help infection prevention teams respond faster, allocate resources more efficiently, and intervene earlier to prevent severe outcomes, especially in high-risk settings like hospitals and long-term care. In my professional opinion, now more than ever it's important to utilize diagnostic management teams [DMT] composed of clinicians, medical laboratory professionals (including Doctor of Clinical Laboratory Science, DCLS), pharm, infection prevention, EVS, nursing, and others involved in tracking infections. Personally, I would also recommend IT who could help create a dashboard or other handy tools to track real-time respiratory (or other) infections.
How can clinicians keep other patients safe from contracting a respiratory infection?
Clinicians can protect others by promptly identifying and isolating symptomatic patients, following strict hand hygiene and PPE protocols, and promoting vaccination. Ensuring proper ventilation, cohorting patients when needed, and using rapid diagnostics also help limit spread within healthcare settings.
Anything else you’d like to share with our readers?
Respiratory illness season is no longer predictable—it’s dynamic and evolving. We must stay vigilant, trust the science, and support the professionals working behind the scenes in labs and public health. The U.S. is in a healthcare workforce crisis and we must support building new academic programs, scholarships, and stronger recruitment and retention strategies. Together, through prevention, preparedness, and compassion, we can protect our communities and save lives. More than ever, it's critical that everyone in healthcare work diligently to share accurate science communication and help fight misinformation, disinformation, and outright falsehoods surrounding vaccines, infection prevention and control, and clinical research.
