Epidemiologists advise use of masks due to “Tripledemia”

Health experts are once again recommending the use of masks due to the increasing incidence of the three major viruses this season: flu, Covid-19 and respiratory syncytial virus (RSV).

At the end of November, the United States entered a tripledemia due to the coincidence of the flu, Covid-19 and RSV. These viruses are inevitable, and just a few days ago Europe was already warning of the significant increases already being seen.

“Currently, the region is experiencing an increasing circulation of influenza and respiratory syncytial virus. Along with Covid-19, these viruses are expected to have a high impact on our health services and populations this winter,” the European Commissioner for Health and Food Safety, Stella Kyriakides, the regional director for Europe, warned in a statement with the World Health Organisation (WHO), as experts, Dr. Henri P. Kluge, and the director of the European Centre for Disease Prevention and Control (ECDC), Dr. Andrea Ammon, echoed the concerns.

In this context, the incidence of influenza has already exceeded the usual levels for this time in Spain and in the rest of Europe. But, it is not the only virus that this cold season has arrived earlier than usual. RSV has also emerged earlier this year, saturating paediatric emergencies. Added to this is the increase in cases in the European region due to COVID-19. It is therefore expected that these viruses will have a high impact on health services and populations this winter as new variants emerge.

The data shows that influenza viruses (A and B) are circulating in different parts of the European region. Although it circulates among all age groups, and particularly among school-age children, influenza A viruses generally cause severe illness, primarily in the elderly and those with chronic conditions. In addition, it is observed that an increasing number of people are admitted to hospitals due to influenza, with hospital admissions increasing since October. Specifically, 23 of the countries that reported data on severe acute respiratory infections (SARIs), hospitalised patients have been diagnosed mainly with type A virus (87%), with children four years of age or younger being the most affected.

“This represents a 7-fold increase in detections compared to the 2021-2022 season, despite only a modest increase (3%) in the number of samples tested,” the ECDC detailed. “Although there were clear indications of an influenza epidemic in 2021-2022, with the epidemic threshold of 10% positivity in sentinel samples exceeded for 17 weeks, following an approximate two-year period of low influenza virus circulation due to the Covid-19 pandemic, the signs point to an early start to the 2022-2023 season and a more intense epidemic than in 2021-2022”.

RSV has also been on the rise since October, with some 20 countries and areas experiencing intensified activity. Countries like France and Spain have already meant that, in some cases, paediatric emergencies are being pushed to the limit.

Given this, in the statement issued, the experts recall that the use of masks in closed spaces, with crowds and where ventilation is not remote is one of the ways to prevent infections and increase the risk in people over 60 years of age and immunosuppressed. It is true that the obligation to wear a mask outdoors and in closed spaces disappeared months ago. Little by little, European countries were eliminating the face mask according to its incidence. Currently, no country uses the mask in closed spaces, with the exception of public transport, despite the fact that health leaders continue to recommend it due to the current situation.

“We have to continue protecting ourselves with masks. We have the risk of spreading the virus and if we don’t pay attention, we can end up infecting more people”

Belgium, Denmark, Hungary, Latvia and Poland removed the rule on wearing a mask on public transport before this summer. The Danish country was one of the first to suppress this use; then both Hungary and Poland followed. Belgium, Latvia, Austria, Bulgaria, Finland, Italy, Luxembourg, Malta and the Netherlands are other European countries where it is not mandatory to wear a mask on public transport.

On the other hand, eight countries recommend its use. Croatia, Slovenia, Ireland, Lithuania, and Sweden are currently committed to the recommendation to wear a mask on public transport. With this, the Lithuanian country advocates that this protection method only be used during peak hours when there is a greater influx of people. This group is completed by our neighbours from Portugal and France, although the latter is already considering re-imposing it in closed spaces due to the high numbers of infections that they are reporting.

As for the countries where it is mandatory to carry it, such as Spain, Germany, the Czech Republic, Cyprus, Slovakia, Estonia and Greece, they are the ones in which the most debate has been generated around whether or not it is essential to carry it in this situation after two and a half years since the pertinent regulations were decreed. Now more than ever Spanish epidemiologists advocate continuing to carry it. As explained by Dr. María del Mar Tomás, spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), “this could get worse because the peak of the flu was expected to be these weeks, but now we ourselves don’t have a clear pattern of what can happen. We come from living with two years of pandemic and we are seeing that viruses are having a different behaviour. Right now we cannot guarantee how long these incidents will last due to the situation.

In addition, he defends that, “we have to continue protecting ourselves with masks if we see that we have symptoms, avoid social contact and take tests. We have to be careful with the children, because they are now the ones who are being affected. We have the risk of spreading the virus and if we do not pay attention, we can end up infecting more people.”