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COVID, flu and RSV could make for a 'triple whammy' this winter. Here’s what you need to know

How worried should we be about COVID this holiday season?
How worried should we be about COVID this holiday season? Copyright Canva
Copyright Canva
By Nicole Lin Chang
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Experts warn that a triple threat of COVID, flu and RSV could combine to put even more pressure on public health systems this winter.


Winter is coming - and with it, the potential for a perfect storm of infectious respiratory diseases.

Shorter days and chilly weather, coupled with Christmas and New Year festivities, make it all the more appealing to gather together snugly indoors, creating the ideal conditions for germs to spread.

To make matters worse, experts are warning of a triple threat of COVID-19, flu, and respiratory syncytial virus (RSV) this winter, a combination that could put even more pressure on our public health systems in the lead-up to the holidays.

As we head into our third winter of the pandemic, here’s what you need to know to stay safe.

What’s the COVID outlook for winter?

Overall, COVID-19 cases and death rates continued to decrease in the European Union in the week up to November 20, and were at low levels compared to the peak of the pandemic, according to the latest weekly update from the European Centre for Disease Prevention and Control (ECDC).

Hospital and ICU admissions continued to decrease, while occupancy currently remains stable, it added.

There have not been major increases in COVID-19 case rates in recent weeks, Marco Cavaleri, the European Medicines Agency’s head of health threats and vaccines strategy, told a news briefing last week.

This could however change during the colder winter months, he added.

However, it’s not so much COVID-19 in itself that is worrying, but rather a combination of different respiratory infections that together could further strain our healthcare systems, experts tell Euronews Next.

Europe as a whole isn’t currently seeing huge surges in coronavirus cases, says Sheena Cruickshank, an immunologist at the University of Manchester.

"It doesn't seem to be in the ascendance; it sort of seems to be in a bit of a kind of plateau," she told Euronews Next.

Predicting what’s going to happen with COVID-19 over winter however is complex, she adds.

Over September and October, we saw what Cruickshank calls an "Omicron variant soup"; essentially lots of variants that are “sort of descendants of Omicron, sons and daughters and grandchildren of it” but nothing seemed to be taking over.

Now, certain variants with a lineage from the Omicron variant - such as BQ.1 and BQ.1.1 - are starting to dominate, she says.

Proportions of the BQ.1 variant of concern have continued to increase, and it’s important to continue monitoring the epidemiological situation, says the ECDC.

Brace yourself for a 'triple whammy' of infections

Meanwhile, cases of RSV and influenza are seeing an upsurge.

"What we are seeing is a real uptick in RSV infections, causing a lot of hospitalisations, particularly in young children," said Cruickshank.

"We're also seeing a really early spike in influenza - flu. I think the latest data I saw from Europe was suggesting that it's going to be a bit of a flu epidemic this year".


"So, those three things together are a kind of triple whammy for our health services, which have already been pushed and stretched by the preceding years with COVID".

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. However it can also cause bronchiolitis (inflammation of the small airways in the lung) or pneumonia, especially in infants.

Nearly all children are infected by RSV by the age of two, but toddlers who have not encountered the virus during the pandemic would be at an increased risk of infection, says the ECDC.

Cases are particularly high this year, and already at levels not normally expected until later in the season.

Meanwhile, ten times more patients were in hospital with flu in England compared to this time last year, according to the NHS’ first weekly winter update released last week.


ECDC figures have also shown that flu is on the rise in Europe.

[COVID-19, flu and RSV] together are a kind of triple whammy for our health services, which have already been pushed and stretched by the preceding years with COVID.
Sheena Cruickshank
Immunologist at the University of Manchester

"Basically, high rates of COVID vaccination have essentially significantly reduced any impact COVID could have on the health services, but people are still going to catch COVID, they’re still going to go into hospital with COVID and other things," Keith Neal, Emeritus Professor in the epidemiology of infectious diseases at the University of Nottingham, said.

This mainly poses a worry in terms of bed management for hospitals, he says, as COVID-19 patients have to be isolated from others.

“The one that worries me most of all is flu,” he told Euronews Next.

“We’ve not had much flu immunity in the last two years, because it’s not been around due to COVID restrictions. So, we could well end up with a flu epidemic”.


He points out that flu, in particular, can be deadly for children - unlike what we’ve seen so far with coronavirus.

Do I need to get vaccinated this winter?

The main takeaway from all this? Get your flu vaccine as well as your COVID-19 booster if you’re eligible, especially if you’re living with vulnerable people.

The uptake of COVID-19 vaccine booster doses has been low so far, prompting concern that protection against severe cases of the disease could weaken this winter.

"I think people have quite honestly got a bit bored of COVID, and they're bored of restrictions and they're bored of thinking about things," said Cruickshank.

"But this is a genuinely scary infection with long term implications for many people".


For one thing, getting boosted will reduce the likelihood of you getting long COVID, she says.

"We still don't understand why people get it, we still don't understand necessarily the best way to treat it, but what we do know is for each time you get COVID, your risk of this happening is a little bit higher," she added.

Getting boosted when you can also help protect those around you, she explains, because if a virus can't thrive inside you, you won't transmit as much.

"If you’ve been offered the vaccine, take it, and if you live with vulnerable people, certainly get it," said Neal.

Both experts also agree that it’s important to get the flu vaccine, not least because this year’s flu vaccine formulations are proving to be a pretty good match for the strain of flu circulating this season.


"That's really good news because we don't always get the perfect match. But this one is looking pretty good," Cruickshank said.

Should we still be wearing masks?

Although nationwide mask mandates have mostly expired, it’s still a good idea to mask up on public transport or in crowded spaces.

We still don't understand why people get it, we still don't understand necessarily the best way to treat it, but what we do know is for each time you get COVID, your risk of this happening is a little bit higher.
Sheena Cruickshank
Immunologist at the University of Manchester

People seem to be masking up less, with a UK Office for National Statistics (ONS) survey out last week finding that only around 2 in 10 adults in Great Britain said they had used a face covering when outside their home in the past week.

But COVID-19 is still mainly spread through aerosol transmission, says Cruickshank, and so this means you are most at risk in areas that are crowded and poorly ventilated.

“It really is about the air that we breathe, much more so than the surfaces that we touch,” she said.


So, if you’re on public transport or other crowded public spaces, it’s ​​worth putting on a well-fitting mask, because that will reduce the likelihood of you getting the infection, or giving it to others if you are ill.

What about Christmas parties and gatherings?

Similarly, be strategic when it comes to socialising during this festive period.

"Basically, don’t go out if you’ve got symptoms. Just avoid people if you’ve got symptoms," Neal advised.

"It’s probably better mixing with the same people day after day, instead of mixing with different people," he added.

When planning social gatherings, Cruickshank recommends thinking about things like how big and well-ventilated the space is and how crowded it will be.


"Have people done COVID tests before they've gone [out], so that they've reduced the likelihood that they're infected?" she said. "These are all things that you can do that don't mean that you're not going to have a lovely time, but you're just thinking, 'is this going to be safe for me?'"

What to know about travel this winter

Vaccinated tourists can now mostly travel with ease, and many top destinations in Europe such as France, Italy, and the UK, are fully open for tourism.

However, it’s still worth checking on the latest restrictions for your destination, as well as whether it might be experiencing a COVID-19 surge.

Travellers should continue to practise "barrier measures" such as wearing masks, washing hands regularly, and practising safe distancing, recommends Philippe Guibert a global medical director from International SOS, a health and security risk management firm.

Think about isolating before travelling abroad, as well as boosting your health by eating a diet high in vitamins and fibre, he said. According to the firm's data, take-up rates for the COVID-19 vaccine booster remain low - so getting vaccinated is something that travellers should consider staying up to date on, he added.


Consider doing a COVID-19 test before you travel, and have your companions do the same, advises Cruickshank.

Also, take along some N95 or FFP2 masks to wear on the plane or train, as well as when you’re at your destination. Some countries have retained mask requirements for spaces like public transport or medical settings.

"We've got to try and live with this condition now, but we can live safely and we can make choices that keep us as safe as possible," said Cruickshank.

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