Tripledemic 2023: preparing today for tomorrow’s respiratory illness surge

In fall of 2022, COVID-19, Respiratory Syncytial Virus (RSV), and influenza reached overlapping peak infection rates, creating what is referred to as a “tripledemic.” Hospitals strained to accommodate the influx of patients as infections surged and both supplies and hospital capacity were depleted. As the weather cools, we potentially face another collision of these viruses and a repeated “tripledemic.”  

How might this year’s tripledemic compare to last year’s? Who stands to be most impacted? And how can we use lessons learned to prepare for the year ahead? 

Then and now: exposure and immunity

Part of what made the 2022 tripledemic possible was a lack of immunity to these respiratory infections. Social distancing practices and face masks used to prevent exposure to COVID-19 during the pandemic also kept people from building immunity to more common viruses, such as influenza for over a year. This practice also prevented children, who are usually exposed to RSV before their second birthday, from contracting the disease and developing a degree of immunity that could lessen the severity of future infections. Since many children born in 2020 spent most of 2021 in social isolation, when in-person school and work resumed in fall 2022, the virus spread rapidly and led to more severe symptoms.  

This year, experts are predicting that RSV and flu will occur in typical seasonal patterns, which could help mitigate surges. Additionally, exposures from last year should provide some degree of immunity for otherwise healthy patients. Many patients are likely to be able to manage care at home, preserving hospital beds and emergency resources for sicker patients. 

Persistent drug shortages will still be a challenge

In 2022, the tripledemic impacted the healthcare supply chain and depleted stores of vital medications. For example, Amoxicillin, commonly prescribed for illnesses such as pneumonia and other respiratory illnesses, was already in shortage in 2022. This was due in part to the unexpected rise in RSV and COVID-19 infections. The drug remains in short supply today and drugstores like CVS are reporting that there is an “industrywide supplier shortage of certain doses of amoxicillin.”  

Other reasons for current drug shortages involve upstream manufacturing issues, over-prescribing by doctors and supply chain disruptions. The implications of drug shortages could be that cases may be more severe because there is not guaranteed access to the medications. This might prompt patients to turn to hospitals for care and overwhelm these health systems.  

Inequalities will drive outcomes

Systemic racial and economic inequities impact patient and community health outcomes in general and in extreme events like a tripledemic. Underserved and marginalized individuals and communities, such as communities of color, older adults, those who live in rural areas, unhoused individuals and low-income communities experience greater barriers to care and suffer worse health outcomes because of inequitable access and disparate distribution of healthcare resources.  

Much of the population of medically underserved communities rely on Medicaid for health insurance coverage. The end of the COVID-19 public health emergency triggered a Medicaid unwinding, resulting in at least 5.3 million Americans completely losing coverage since April 2023. Because of this lack of insurance, a higher percentage of patients may delay seeking care for mild symptoms and ultimately seek care at hospitals at a more severe stage of illness.  

Infants are extremely vulnerable to severe RSV infections, and along with children face additional challenges in obtaining access to healthcare. This is likely to be exacerbated as children account for over 1 million of those disenrolled from Medicaid. Managing illnesses in children and infants requires specialized staffing and equipment. In regions without access to sufficient pediatric providers and pediatric healthcare equipment, illness surges in infants and children may become more common and be harder to manage.  

“During a tripledemic, children face heightened infection risks, potential healthcare resource shortages, disrupted routine care and psychosocial challenges,” says Julie Abrams, associate director of programs and response at Healthcare Ready. “Preparedness means prioritizing vaccinations, expanding telehealth and ensuring mental health support is accessible so we emerge stronger and more resilient. Preparedness also involves surge capacity planning, stockpiling pediatric supplies and fostering interagency collaboration to protect the most vulnerable patients in challenging times.” 

Though three new vaccines that protect against respiratory illnesses will be available this year, deep mistrust around medical interventions like vaccinations persist. For historically medically underserved communities and communities of color, mistrust is the result of painful histories of unethical experimentation and systemic bias in the medical system — two issues our current healthcare system must make restitution for to begin rebuilding trust.  

Preparing today for tomorrow's tripledemic

We cannot predict the severity of the potential tripledemic this year, but adequate preparations now will help protect individuals, communities, and the healthcare system through this season: 

  1. Get vaccinated – Getting vaccinated is one of the best ways to protect yourself and your community. Many vaccines are available free of charge at clinics, hospitals, pharmacies, and other locations. Even without insurance, some vaccines may be free or available at reduced cost. 
  1. Educate your community – For healthcare professionals and others on the front lines of community care, consider providing free community education to address concerns and vaccine hesitancy.  
  1. Create your plan now – Hospitals and other points of care cannot afford to wait for the worst of a crisis to develop a response strategy. It is critical to prepare today and establish coordination channels between emergency departments, health systems, and community organizations to help providers and community members navigate surges in respiratory illness.  
  1. Stay up to date – Keep up to date on these situations as they unfold. It is key to successfully navigating them. Sign up for Healthcare Ready’s situation reports and alerts to have all the latest updates delivered right to your inbox. 



Sign up for updates and alerts