How to avoid the 'tripledemic' of RSV, COVID-19, flu

ByJonny Harvey WABC logo
Friday, January 5, 2024
Respiratory illnesses on the rise throughout the US
Respiratory illnesses are on the rise throughout the U.S.

Respiratory illnesses are on the rise throughout the United States, and health officials are warning of a tripledemic. They recommend taking action to mitigate the spread of airborne illnesses.

Here's what we know about the tripledemic and healthy habits to avoid catching respiratory illnesses this season.

What is a tripledemic?

Though it's not an official scientific term, a "tripledemic" represents the spread of three major viruses during this respiratory illness season: flu, COVID-19 and RSV. The medical community refers to the season of respiratory illnesses as "respiratory illness season."

How serious is this respiratory illness season?

Public health experts say it's difficult to compare this respiratory illness season to previous years as COVID-19 emerged as a new threat over the last three years. During the height of the COVID pandemic in the 2020-2021 flu season, there was limited to no flu activity.

Now, the U.S. is beginning to return to seasonal trends with all three of the viruses circulating. Last year was an unprecedented early season.

"A steady increase in respiratory illnesses is a common annual trend, typically fueled by holiday gatherings and travel. This year is no exception," said Dr. John Brownstein, an epidemiologist at Boston Children's Hospital and ABC News medical contributor. "With January and February often marking the peak of such illnesses, it's crucial to exercise heightened vigilance now."

Risks of each tripledemic illness

Everyone is at risk of getting any of theses illnesses. Some areas are dealing with more flu, others with more COVID, others with more RSV.

Adults over 65 have the highest rates of flu and COVID hospitalizations, while kids under 4 have the highest rates of RSV hospitalizations. Adults over 65 continue to have the highest rates of death due to any respiratory virus. COVID remains the main driver of all viral respiratory deaths.

What are the symptoms of each illness?

Each virus has very similar symptoms. There is no real way to tell what you have unless you get tested. There are COVID at-home tests readily available. Some over the counter flu/COVID tests are also available. RSV is typically tested for at the hospital or medical clinic.

Symptoms of COVID-19, RSV, and Flu
Symptoms of COVID-19, RSV, and Flu
ABC News Photo Illustration, CDC, Mayo Clinic

COVID-19 symptoms include:

  • Cough
  • Brief fever
  • Shortness of breath
  • Abdominal pain
  • Loss of taste or smell
  • Congestion
  • Fatigue
  • Sore Throat
  • Nausea or vomiting
  • Diarrhea
  • Muscle or body aches
  • Headache

Flu symptoms include:

  • Fever
  • Chills
  • Headache
  • Runny nose
  • Nausea
  • Fatigue
  • Loss of appetite
  • Sore throat

RSV symptoms include:

  • Runny nose
  • Decreased appetite
  • Coughing
  • Sneezing
  • Fever
  • Wheezing

MORE: Everything you need to know about RSV symptoms, treatments, shots

Health workers are preparing for a possible "tripledemic" of flu, COVID-19, and RSV this winter. Here's how to tell the difference.

How respiratory illnesses spread

Healthy habits like avoiding those who are sick, covering your cough and washing hands can also help limit the spread of germs.

Respiratory illnesses mainly spread by droplets made when people cough, sneeze or talk. Sometimes, viruses can be spread by touching a surface and then touching your own mouth, nose or possibly eyes.

Respiratory illness activity generally tends to begin in the South and migrates West and North across the U.S. The Centers for Disease control updates data for what states are dealing with high/very high activity. You can check out the latest data here.

How to prevent catching respiratory illnesses

"My advice is to prioritize health safety measures like staying home when sick, get vaccinated if you haven't already and practice good hygiene to prevent the spread of illnesses," Dr. Brownstein said.

Healthy habits

  • Avoid close contact with those who are sick
  • Stay home when you are sick
  • Cover your mouth and nose when coughing or sneezing
  • Clean your hands with soap and water or use an alcohol-based hand sanitizer
  • Avoid touching your eyes, nose, or mouth
  • Clean and disinfect frequently touched surfaces

Maintain a health lifestyle

  • Get plenty of sleep
  • Be physically active
  • Manage your stress
  • Drink plenty of fluids
  • Eat nutritious food

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Vaccination remains the best way to reduce the risk of severe illness including hospitalization and death from respiratory illnesses, experts say.

Everyone over the age of 6 months is recommended to get an updated COVID and flu vaccine.

Adults over 60 years old and pregnant women may receive an RSV vaccine. Infants under 8 months may also receive an RSV monoclonal antibody shot. The CDC has asked doctors to prioritize at-risk infants due to limited supply.

Vaccines should be free to most with insurance. Adults without insurance can still receive a COVID vaccine at no cost, via a federal program. Most children can get vaccines for free, via a federal program.

Flu, COVID, RSV vaccines may be given at the same visit. Visit to find locations for flu vaccines and COVID vaccines. Talk to a health care provider for RSV shots.

Vaccine information, eligibility and benefits


What: Updated flu shots and nasal spray flu vaccine.

Who: Everyone over 6 months old, those over 65 may get a higher dose.

Benefits: Reduce risk of severe illness, hospitalization, and death.


What: Vaccine for adults and monoclonal antibody for infants.

Who: Adults over 60 years old, pregnant women within 32-36 weeks and infants under 8 months old.

Benefits: Reduce risk of severe illness, hospitalization and death for those most at-risk.


What: Updated COVID vaccines targeting current variants.

Who: Everyone over 6 months old, younger kids and immunocompromised people may need multiple vaccines.

Benefits: Reduce risk of severe illness, hospitalization, death and long COVID.

MORE | Who gets long COVID and why? Here's what new research reveals

Steps to take when you start to feel symptomatic

Testing is an important first step. If you know what you have, you can get treated.

For those most at risk, antiviral medication is available to help treat both influenza and COVID. That treatment should be started as soon as possible. Antivirals are not routinely recommended to treat RSV.

Talk to your health care provider or pharmacist about your treatment options if you are sick with a respiratory illness.

Every household can order four free COVID tests shipped directly home, at Check if your at-home test expiration dates have been extended here. Find COVID treatments here.

Youri Benadjaoud contributed to this report.