Covid-19 struck Beth Green just in time for Christmas, upending her annual holiday gatherings.

She planned on hosting her extended family at her Derry Township home on Dec. 23. She was especially excited because it’s difficult to get two of her adult sons together with their hectic schedules.

Green, an administrator at a long-term care facility, said her covid symptoms weren’t serious. She went ahead with altered plans to host. She wore an N95 mask. She told family to attend at their own risk. Some did. Some didn’t.

She also was set to eat Christmas dinner at her in-laws but dashed those plans. Instead, her in-laws held an outdoor bonfire later that Green visited while wearing a mask.

The holiday season means travel, gatherings and merriment. Unfortunately for people like Green and others in Western Pennsylvania, that also means more people are getting sick with respiratory viruses.

“Five years ago, no one would have thought twice about being around me,” Green said. “I understand we need to take covid seriously in my line of work, and I have seen how it can be devastating. But I’m trying to look at the positive. It wasn’t the holiday I envisioned, but my husband made me smile, and the family I could enjoy from a distance.”

Cases of covid, flu and respiratory syncytial virus (RSV) have been on the rise regionally and nationally over the past several weeks. Experts say that is expected, but it still takes some management.

Dr. Amesh Adalja, a Pittsburgh-based infectious disease specialist for Johns Hopkins Center for Health Security, said the local and national increase means it is a good time to remind people to vaccinate and take preventive measures such as masking when necessary.

He said it’s typical to see a rise in respiratory illnesses during this time of year. The addition of covid has made it more noticeable.

“We traditionally see many respiratory pathogens increase their prevalence, and that is what is occurring,” Adalja said. “This is what the norm is, but with covid added into the mix. … This is what the season was like in 2018, minus covid. It is sort of what we expect. People didn’t pay attention as much to it pre-covid.”

Case comparison

Hospital groups including UPMC have reinstituted mask mandates at their facilities as covid, influenza and RSV cases are rising. Others, such as Allegheny Health Network and Independence Health, have held off.

Dr. Graham Snyder, medical director of Infection Prevention and Hospital Epidemiology at UPMC, said comparing this year to prior years can be difficult. Data is not as complete as it was earlier in the pandemic. He said it appears cases are high but in line with previous seasons.

“The number of covid-19-related hospitalizations is up significantly since the summer and comparable to the frequency of hospitalizations seen at the beginning of the last two winter seasons,” Snyder said. “We are seeing substantial frequencies of RSV infections and hospitalizations. And influenza hospitalizations are rising — it is still early in the season.”

Pennsylvania has a moderate level for respiratory illness activity, according to the Centers for Disease Control and Prevention. More than a dozen states are experiencing a very high or high level of respiratory illness activity.

Allegheny County covid cases jumped to 822 for the week starting Dec. 10, the most recent data available. That’s an increase of more than 200 cases from the month before. But cases in the county are lower compared with last year. For the week starting Dec. 11, 2022, there were 1,008 covid cases, according to data from the Allegheny County Health Department.

Information for Westmoreland County was unavailable. The state stopped requiring mandatory covid infection reporting, but Allegheny County still reports such data, the county health department told TribLive last month.

Nationally, new weekly covid hospitalizations totaled 25,577 for the week starting Dec. 10. While increasing compared with previous weeks, those figures are still well below early December 2022 weekly peaks, which reached above 34,000 new hospitalizations.

Flu cases in Allegheny County reached nearly 700 for the week starting Dec. 10, but that rate is still well below last year. In 2022, flu cases in the county peaked at close to 2,000 in one week in December.

Last year, flu cases across the U.S. were more than four times as prevalent compared with this time this year, according to data from the World Health Organization.

RSV cases in Allegheny County have averaged above 250 a week during December and are just behind November 2022’s peak.

These trends are similar to what is occurring statewide and nationally, Adalja said. And local hospitals appear to be better prepared for the winter increase than last year, he said.

“There were much harsher RSV impacts on pediatric hospitals last season,” he said.

According to the CDC, emergency department visits because of influenza are increasing nationally, especially among school-age children, as of Dec. 22.

Covid visits remained elevated across the country as of last week, while RSV visits continued to increase in some areas but are decreasing in Southeastern states, the CDC reports.

Dr. Nathan R. Shively is the medical director of the Tele-Antimicrobial Stewardship Program of Allegheny Health Network’s Division of Infectious Disease. He said he wouldn’t be surprised if Pittsburgh-area respiratory virus cases increase into January following all of the holiday gatherings.

“There is some lag in the reporting data, so we may be peaking or have peaked for RSV, but it still seems pretty clear that covid and influenza are on the rise,” Shively said.

‘Not merry Christmas’

Jessica Greenawald of Elizabeth Township said she tested positive for covid on Dec. 21. It ended all of her social Christmas plans.

She had planned to visit family in Mercer County but canceled. She said her father and in-laws are in their 70s, and she didn’t want to risk getting them sick.

Greenawald usually prepares Christmas dinner, so she said the family scrambled to get their own meals this year. She said they didn’t exchange gifts.

Instead, she said, she made a quarantine zone in her basement and spent the next six days on the couch.

“My vacation from work was spent shivering, sneezing and being entirely miserable,” Greenawald said. “Christmas Day, Santa dropped off a covid migraine. … All around, a very stressful, not merry Christmas.”

Best way to avoid getting sick

Vaccinations are the best way to avoid serious complications from respiratory illnesses, local health care experts said.

Snyder encourages patients 6 months and older to get covid and flu vaccines. Covid and flu vaccines generally take about two weeks to become effective, according to Johns Hopkins Medicine.

The most up-to-date covid vaccine is not just a booster but a new vaccine, Snyder said.

“It adds protection against the newer forms of the virus,” he said.

For RSV, people 60 and older should consider receiving the new, one-time vaccine known by brand names Arexvy and Abrysvo, Snyder said. Pregnant patients also can take vaccines to prevent complications in newborns.

“Vaccines won’t prevent you from getting exposed to the virus, but they will prepare your body to fight the infection,” Snyder said. “Vaccination is a safe and effective way to reduce the risk of serious complications of infection if you are exposed.”

People also might be keen to take over-the-counter “immunity boosters” such as Emergen-C or Airborne to stave off viruses, but experts said their effectiveness has not been proved medically.

Shively said he is not aware of any convincing evidence for the general use of immunity booster products, except for those with known vitamin or nutritional deficiencies.

He said this is the time of year for increased viral transmission, so well-worn advice applies: Stay up to date on vaccines, avoid others who are sick, wash your hands and wear masks if comfortable doing so. Shively said there is always going to be a risk of transmission when gathering, especially at this time of year.

“Depending on their level of comfort and underlying health conditions, people can choose to accept this risk but can also mitigate it by practicing good hand hygiene and wearing a high-quality mask,” he said.

Dr. Michael Ben-Aderet, an infectious disease specialist at Cedars-Sinai Medical Center in Los Angeles, told CNBC the best way to boost one’s immune system is to eat a balanced and healthy diet, exercise, get plenty of sleep, practice good hand hygiene and get vaccinated against circulating respiratory viruses.

Adalja advises people who have contracted a respiratory illness to stay home if possible and to wear masks if they have to travel outside the home.

Synder agreed and said a mask also can help people avoid being exposed to potential viruses. He said masks are still the best tool to slow the spread of respiratory illnesses.

There is no one-size-fits-all approach to slowing the spread of respiratory illnesses, Adalja said. But vulnerable populations should consider wearing masks to protect themselves, he said.

“Many of these respiratory viruses are unavoidable over time,” he said. “You are not going to be impervious to them.

“It is sort of the price you pay for social interaction.”

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