Sonoma County doctors concerned about spike in local flu, RSV rates

The feared viral “tripledemic” of COVID-19, influenza and respiratory syncytial virus (or RSV) isn’t at a dire stage locally. But all three pathogens are on the rise, pushing Sonoma County’s hospital emergency rooms toward capacity and sparking worried parents to overload pediatric offices and appointment phone lines.

That was the message Tuesday afternoon as two local physicians joined county health officials in an online public health briefing.

“I think all of us have kind of forgotten what it’s like to have all these viral illnesses during the wintertime,” said Dr. Jenny Fish of Santa Rosa Community Health Center.

The reminders are back — and some local families describe suffering through periods of extensive illness.

While COVID rates have generally been trending downward for months, there has been a recent uptick in Sonoma County, measured both in test positivity and in wastewater surveillance. That positivity is currently at 5.3% in the county, with about 6.3 new cases per 100,000 residents per day, according to Kate Pack, Sonoma County’s health program manager.

As of Tuesday, 23 people were hospitalized with COVID in the county.

Those numbers likely wouldn’t be cause for great concern if it weren’t for much more dramatic spikes in both influenza and RSV.

During the briefing, Pack displayed two slides to demonstrate those trends. The first showed side-by-side graphs of flu and RSV rates from the state’s clinical laboratories, overlaid with lines from other years. Both revealed a rise in cases much earlier in the 2022-23 season than in previous years.

The second slide also included side-by-side graphs. These showed concentrations of RSV and influenza A in wastewater samples taken in Santa Rosa and Petaluma. They both showed recent upward arcs, confirming the lab rates. The Petaluma graph lines, in particular, had shot nearly straight up since late October.

“Influenza’s really taken a step,” said Dr. Gary Green, an infectious disease specialist with Sutter Santa Rosa Medical Center. “In the Sutter footprint, Santa Rosa has the highest numbers. So right now, out of hundreds and hundreds of flu swabs we sent in, 43% are positive for influenza. That’s an extraordinary number.”

Usually, Green said, doctors mark the beginning of flu season when swabs clock in at more than 10% positive.

“We’ve been at that level for about three to four weeks,” he said. “Right now we’re at 43%, and it doesn’t look like it’s peaked yet.”

RSV is looking even more prevalent, Green said, with 16% of swabs coming back positive. He called that “an extraordinary number” as well.

The bloom of viral transmission in Sonoma County hasn’t resulted in emergency-level conditions, but hospitals and doctors’ offices are being impacted.

Sutter Santa Rosa effectively doubled its emergency room capacity with a recent building addition, Green said, but still has resorted to using a tent for overflow patients at times recently. Kaiser Permanente Santa Rosa Medical Center also has erected a tent for ER overflow, said Sonoma County Health Officer Dr. Sundari Mase.

“I think the big issue is when kids have to be hospitalized, often times they’re transferred out,” Fish said. “I spoke with a physician who is working at the Children’s Hospital of Oakland, and they had nowhere to transfer kids to. Their beds are totally full. And so they’re basically like running an inpatient pediatric unit in the ER. … I’ve also heard from other pediatric hospitalists across the country that I know personally who are describing this as a surge.”

Fish described a similar strain on clinics and pediatricians’ offices.

“The calls coming in are overwhelming,” she said. “It represents a lot of parents whose kids are sick and they don’t know what to do.”

The experts provided some guidance on that Tuesday.

Parents should strongly consider taking their children to a hospital emergency room if three factors are evident, Fish said. The first is respiratory distress, for example a child needed to use their chest or neck muscles to breathe. The second is dehydration. The third sign is a fever of 104 degrees or higher that persists even when the young person has been taking ibuprofen or Tylenol.

In the absence of those factors, doctors and public health staff are strongly discouraging emergency room visits for adults and kids alike, simply because demand is outstripping availability, leading to multi-hour waits in some cases.

“The truth is, you can care for yourself at home for the most part,” Fish said. “People that are having respiratory distress, or babies who aren’t doing well, those should be the ones going to the ER. I wouldn’t suggest going to the ER just to get a diagnosis. … A lot of clinics are trying to do telephone assessments.”

Classroom absences are on the rise, though parents, public health officials and school leaders have been offering differing perspectives on the magnitude.

“As many of you are aware, schoolchildren are staying home sick at a very high rate,” county spokesperson Paul Gullixson said to kick off Tuesday’s briefing.

That squares with anecdotal information from local parents who describe a debilitating start to the colder months.

“Emotionally, I’m exhausted,” said Valerie George, a single mother of two girls in Rohnert Park. “Drained. I’m waking up every 45 minutes to take temperatures and make sure they’re not getting worse.”

George’s daughters — 10-year-old Mariah and 5-year-old Kaleiah — have missed five days of school in the past week and a half, both of them with influenza A. They went back to class at one point, only to relapse.

Mariah’s highest temperature reading was 105.3. Kaleiah’s was 106.2.

“They have this horrible cough, too,” George said. “It sounds like bronchitis, but it’s not. They sound like they’ve been smoking for years. And that will probably linger 4-6 weeks, the doctor says.”

As if on cue, one of the girls fought with a raspy cough in the background.

When George’s daughters were diagnosed, their pediatrician prescribed Tamiflu. George searched CVS and Walgreens pharmacies all over the region, but couldn’t find the antiviral drug. By the time she located the Tamiflu at a smaller pharmacy, the girls were out of the 48-hour window and, their mother was told, the side effects now outweighed the benefits.

Both Mariah and Kaleiah had COVID-19 last February. This flu, Valerie said, is far worse.

“I posted on my personal page on Facebook, ‘This feels like Day 1,754 of this flu, but it’s only Day 9. It doesn’t go away,” George said. “And when you think it’s getting better, the fever comes back, like, ‘Hey, I’m still here.’”

George said nearly half of Mariah’s class at University Elementary School has missed time with an illness lately. But school district representatives around Sonoma County told The Press Democrat that absences are roughly in line with typical cold-and-flu seasons.

“There are absences,” said Mayra Perez, superintendent of the Cotati-Rohnert Park School District. “Maybe in a classroom, you might see four or five absences. Which is significant. But it’s not a giant red flag.”

Prior to the COVID pandemic, Perez said, the district’s attendance rate usually hit about 96%. Currently, Cotati-Rohnert Park is at 93.4%.

“This is flu season, cold season, so a lot more people are out,” Perez said. “COVID is still impacting our attendance, too, though not like it was. We’ll have to see after winter break. Last year it really impacted us.”

A Santa Rosa City Schools representative said Sonoma County’s largest school district also was seeing a normal rise in November absences.

The five campuses that make up Old Adobe Union School District in Petaluma, meanwhile, are showing attendance rates of between 81% and 92% since Nov. 1. That compares with rates of 92%-95% overall since the start of school.

If a child does become ill with the flu or with RSV, Fish recommended a return to school when that boy or girl has been without fever, with no medication, for at least 24 hours, and when symptoms are dissipating. The exception is a cough, which can persist for four to six weeks, Fish added.

Health professionals are particularly concerned about gatherings for Thanksgiving and Christmas. Last winter, they resulted in COVID spikes. This year, all three of these transmissible diseases are in play.

The message hasn’t changed much since the beginning of the COVID-19 pandemic, in that regard. Mase still recommends masking in large indoor gatherings, getting tested if you become symptomatic or are exposed to someone who is infected and, most of all, staying up to date on your COVID and influenza vaccines.

This year’s flu shot appears to be a strong match for the strains of influenza A going around, Green said. And he and Mase both pointed out that outcomes for COVID — and especially the prospects of long COVID — are much better for the vaccinated.

They also understand that, as we approach Year 3 of the pandemic, it has become a harder sell.

“I think there are three types of people when it comes to vaccination,” Green said. “Those who support it, those who don’t and those on the fence. And I think pandemic fatigue has affected those on the fence. They’re kind of done with it, and want to move on in their life.”

That feeling is less pervasive in the medical community, he noted.

“For those of us in hospitals, when we see people die every day, or if you’re a pediatrician and you see a pediatric death from flu, it kind of changes you,” Green said.

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.