As we enter the winter season, you might have seen the term “tripledemic" in the headlines, referring to a simultaneous rise in respiratory syncytial virus (or RSV), influenza and Covid-19. But how concerned should you be?

Dr. Manuel Gordillo, an infectious disease specialist with Sarasota Memorial Health Care System, recently fielded questions about a “tripledemic” in a pre-recorded Zoom call.

What is the “tripledemic” we're hearing about?

“Every winter season, there are a lot of viruses that circuluate. They produce flu-like symptoms, like colds, but not all of them have the potential to kill people. These three [RSV, Covid-19 and influenza] can, especially at the extremes of life.

"We were wondering when these three viruses were going to coincide and cause this triple threat. It looks like it's finally going to materialize. Influenza has been very quiet in the last couple years; we are only now starting to see the flu in Sarasota. Sarasota Memorial Hospital is low with Covid patients—30-40 right now—and very few are in the ICU, and they are mostly older and immunocompromised. Many of them are unvaccinated.”

With RSV, influenza and Covid on the rise throughout the country, what can we expect here?

“Florida may not have a lot [of infections] right now, but snowbirds bring cases here locally and they can start to spread. Again, it’s hard to predict what is going to happen.

“Here’s my educated opinion: Covid rates are low, but the immunity from the previous infection is going to wane. The virus mutates and becomes more transmissible, so rates rise. I don’t know when it is going to happen. It could happen later in the winter with different rates and magnitudes throughout the U.S.

“Same thing for influenza. Some states have it more than others. Tennessee, Georgia  and South Carolina have a lot right now. It hasn’t gotten here yet, but we will see it rise in the coming weeks.”

Why might these viruses be on the rise?

“You get Covid and you get immunity, but with RSV, it doesn’t happen that way. You can get it this month and get it again in two months and again in three months.”

We still don’t know the long-term consequences of Covid. Does having or having had Covid make you more susceptible to other viruses?

"I don’t know. It’s a great research question. We see it with measles in poor countries. People who get infected with measles are less immune to fighting other viruses and bacteria, especially children. There are some similarities with Covid, perhaps, but it’s too early to say.

"There is a lot of speculation, however, and people are making strong claims that are totally unproven. One example is the term 'immunity debt.' It doesn’t exist in the medical world. It was made up by non-physicians two to three years ago, but it gets spread and people think it’s something that is real. Your immune system is not like a muscle where if you don’t use it, it atrophies. It is constantly fighting trillions of viruses and bacteria every day. It’s not that it’s not being trained; it works more like a photo collection. Your immune system recognizes foreign cells and goes back to its photo collection and finds a mugshot of virus X. It will recognize it even if it hasn’t seen it in two years.”

Can you simultaneously receive the flu and Covid vaccines?

“Yes, you can. I did myself. And I was surprised, because normally I do get body aches, but this time, even though I got both, I had none.

“The traditional model of virus etiquette is still one of the best ways for prevention of these illnesses. Stay home when you’re sick. Cough on your sleeve or elbow. All the things we used to tell people to do to deal with the classic winter virus.

"I encourage everyone to get vaccinated. Our hospitals are at maximum capacity. All of us will be very grateful. So I encourage everyone to do their best to prevent these diseases."