Respiratory illnesses such as flu, colds and RSV are on the rise in Arizona. What you need to know

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An increasing number of Arizonans are feeling sick with symptoms such as a cough, sore throat and fever and medical experts say it's not too late to get COVID-19, flu or RSV shots for added protection.

"It's that time of year," said Samia Kadri, a family nurse practitioner lead at Banner Urgent Care, which has seen an uptick in flu cases over the past month. Banner Health is Arizona's largest health care delivery system. "Our urgent cares are very busy."

Flu and RSV cases are on the rise in Arizona, state data shows, and providers say they're seeing a steady number of patients with other respiratory illnesses, too, including pneumonia, COVID-19 and cold viruses. The U.S. Centers for Disease Control and Prevention's latest county snapshot categorizes overall respiratory illness activity in Arizona as "high."

The addition of COVID-19 into the annual seasonal surge of flu and RSV has created what some providers call a "tripledemic" where the three different viruses are all hitting at once.

Officials with Valleywise Health, which is the public health system for Maricopa County, say they are seeing an uptick in patients with respiratory symptoms "across the board" both in emergency departments and outpatient settings compared with December.

"Impact in the ED is that they are seeing more patients and volumes are higher," Valleywise chief medical officer Dr. Michael White said. "It has been a combination of flu, RSV and COVID."

Reported cases of both flu and RSV (respiratory syncytial virus) in Arizona are elevated and above the five-season average, and COVID-19 case levels are stable, according to the latest respiratory illness report from the Arizona Department of Health Services for the week ending Dec. 30.

"We are starting to see a pretty steep rise in influenza and this is usually when we see flu in Arizona, it's earlier − January or February. So this is not uncommon," said Dr. Andrew Carroll, a family physician in Chandler. "We are seeing this other non-flu, non-COVID respiratory illness and I'm not sure what it is. It's kind of like a really bad cold. I had it around Christmastime."

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Carroll has been regularly seeing COVID-19 cases since November, too.

"It's not a huge surge like we've seen in the past where a whole bunch of people have it. It's kind of here and there," he said of COVID-19 cases. "It's nothing to be alarmed about, but the issue is that we have COVID, in addition to flu. Flu always overloaded our hospitals and with the addition of COVID, patients are ending up in ICUs, not as many as before, but that is using up hospital beds."

For most people, the common respiratory illnesses of flu, RSV and COVID-19 are not life-threatening, but that's not true for people who are elderly, pregnant and have underlying conditions, including compromised immune systems. Severe illness, hospitalization and deaths are still a risk with respiratory illness and Long COVID is still a risk with COVID-19.

In the flu season that began Oct. 1, one Arizona child has died because of the flu, and nationally that number is 20 infants and children, state and CDC data shows.

Here are seven things Arizonans need to know about this respiratory illness season:

Flu cases in Arizona jumped by 25% during the week ending Dec. 30

There were 4,280 flu cases reported in Arizona for the week ending Dec. 30, which was a 25% increase over the prior week, the state's latest data says. The season total of 21,570 flu cases through Dec. 30 is a 173% increase over the five-season average for the same time period, state data shows.

The state's case numbers are not a reflection of the true number of flu cases in the state, since many people do not visit the doctor when they have symptoms and even if they do, not all patients exhibiting respiratory symptoms are tested for the flu.

The worst of respiratory season in Arizona may be yet to come

"We're definitely expecting flu cases to kind of climb," Carroll said. "When kids go back to school here in Chandler District on the 9th, I bet you will see a spike in kids soon after that. That's usually what happens − people are all mixed together during Christmas and New Year's, and they get sick from one another, bring it home and then the kids bring it into the classrooms of their schools."

It's not too late to get a flu shot, Carroll said.

"It's actually a really good time for it," he said. "Now that we're starting to see our influenza surge, if we issue the flu shot now your immune system should be ready for it."

In addition to influenza vaccines, which are available at doctor's offices, clinics and major pharmacies, there are RSV prevention shots available for babies younger than 8 months; for pregnant people; and for adults ages 60 and older based on shared decision-making with their provider.

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Most Arizonans haven't received the latest COVID-19 vaccine

The CDC maintains a "Respiratory Vax View" that tracks vaccine coverage for flu, COVID-19 and RSV. The dashboard says that as of Dec. 23, just 17.3% of Arizona adults over the age of 18 had received the new COVID-19 vaccine since Sept. 14, which is lower than the national adult level of nearly 19%.

More Americans and Arizonans have received a flu vaccine, though evidence suggests COVID-19 spreads more quickly than the flu, can cause more severe illness in some people and people with COVID-19 may be contagious for longer periods of time.

"If you haven't had a vaccine and you haven't been ill in like the last year, your immunity to COVID is probably way down," Carroll said. "If you have a history of respiratory illnesses, maybe you are a senior, or you just haven't seen COVID in a while, it would be time (to get a COVID vaccine)."

The JN.1 variant of COVID-19 is dominant in the U.S. and Western states

As of Jan. 6, the JN.1 variant of COVID-19 comprised nearly two-thirds of COVID-19 cases in the U.S. and in the federal region of the U.S. that includes Arizona.

While JN.1 appears to be either highly transmissible or better at evading the immune system, there's no evidence it causes any more severe illness than other subvariants of COVID-19, the CDC says.

Officials at Valleywise Health in Phoenix say they are no longer genotyping positive COVID-19 tests, so they can't be sure of the strain that they are seeing among an increasing number of patients with COVID-19, but White suspects it's mostly JN.1.

Respiratory symptoms may not be COVID-19, RSV or the flu

"The best thing to do, if you do have a respiratory illness, see your family physician and have them help you figure out which one it might be," said Carroll, the Chandler family physician.

Some people with respiratory symptoms may forego getting medical care, only to later discover they have a serious respiratory illness like pneumonia, Kadri said. Kadri recently saw a female patient in her 30s who had asthma and pneumonia, and the pneumonia was aggravating her asthma.

"We just have to make the public aware if they are having pain in their chest when they are coughing, if they are having fevers, night sweats and feeling fatigued, they really need to come in and get checked out, especially this time of year" Kadri said. "We're seeing a fair amount of influenza, COVID-19, common colds. I would say the pneumonia patients are much fewer, but there has been an increase in pneumonia as well."

Respiratory symptoms can be caused by common colds or strep. And providers in Arizona need to be on the lookout for valley fever, a potentially deadly and often misdiagnosed upper-respiratory infection, Kadri said. Valley fever, which goes by the clinical name coccidioidomycosis, is a fungal disease and an estimated two-thirds of cases nationwide happen in Arizona.

Symptoms of valley fever often include fatigue, cough, fever, shortness of breath, headache, night sweats, muscle aches or joint pain and rash on upper body or legs. The bone and joint pain can be so bad that Valley fever has been known as "desert rheumatism."

Treatments for respiratory illnesses are available, but early intervention is important

For the very young and very old who test positive for influenza, Banner Health prescribes Tamiflu, but the Tamiflu needs to be started within 48 hours to 72 hours after the onset of symptoms to be effective.

"It can be very helpful for very at-risk infants, or an elderly person," Kadri said.

People who test positive for COVID-19 may be treated with the antivirals Paxlovid or Molnupiravir, but treatment must begin within five days of symptom onset for best results, providers say.

Many respiratory illnesses, such as common colds and mild cases of COVID-19 and flu may be treated at home. Kadri said the key is to drink plenty of fluids, stay warm and if you are contagious, wear a mask.

High-quality masks work

High-quality masks, like N95 and KN95 masks, can help reduce the amount of germs one breathes in, according to the CDC.

"Masks still work. They have not stopped working," Carroll said. "If you absolutely do not want to get a shot and you know a lot of people around you are sick, wear an N95 mask. It does work."

Some medical experts are recommending so-called "strategic masking" for protection, which means wearing a mask in only the highest-risk situations, such as traveling and going into busy or crowded public spaces, like a concert.

"I have a lot of people who say they flew in on an airplane two days ago and they have flu, COVID, or some kind of cold," Kadri said.

Masks help protect others if you are sick. Anyone who is symptomatic with a respiratory illness should wear a mask to protect those around them.

"During the pandemic, people were so much better about not going to the grocery store without a mask, or not getting on a plane when they are ill and I feel that's kind of fallen by the wayside," Kadri said. "The next couple of months are busy. There are a lot of illnesses, so just be mindful and take extra care."

Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on X, formerly Twitter: @stephanieinnes.

This article originally appeared on Arizona Republic: Flu, RSV cases are rising in Arizona