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PHOENIX — Arizona lags behind in policies that prevent and reduce tobacco use, according to the American Lung Association’s annual “State of Tobacco Control” report. The state received failing grades in three of five categories and did not improve on any of its grades from last year. Read moreArizona gets failing grades in annual Lung Association tobacco report card

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If you’re a virus that infects the lungs, life’s good right now.

If you’re a human being – well, not so much.

Epidemiologists say it’s looking like a bad year for the flu and the RSV virus – all on top of the stubborn persistence of COVID.

So they’ve redoubled their efforts to convince people to get their COVID booster as well as their flu shots as soon as possible.

The flu and RSV in a normal year cause tens of thousands of deaths. Both respiratory viruses all but disappeared last winter – probably due to the precautions people took to avoid spreading COVID.

This year, people have resumed traveling and gathering in large groups without wearing masks – so the flu and RSV have made a comeback – months sooner than normal.

And get this: Turns out the flu and RSV can actually merge into a single hybrid virus, according to recent research.

The good news for Arizona – the flu and RSV have just started to circulate.

The bad news – COVID’s still widespread, especially in Apache and Navajo counties.

Unfortunately, the politicization of the COVID vaccines appears to have spilled over into other vaccines – especially for kids, with already low vaccination rates on the decline.

Unfortunately, the US senate has balked at providing more money for vaccination campaigns, local county health departments have curtailed their outreach efforts and people have grown weary of the public health warnings.

That’s all very unsettling – especially when combined with a study showing that the flu and RSV virus can actually merge – making the hybrid virus immune to the flu shot. No vaccine yet exists for RSV. The fused virus was shaped like a palm tree, with RSV forming the trunk and influenza the leaves, according to a study based on cells in the laboratory published in the journal Nature Microbiology.

The study demonstrated how much we still don’t know about viruses and how they interact with the immune system.

For instance, we’re still not sure why the 1918 flu pandemic proved so lethal, killing more than 50 million people worldwide. The disruptions of World War I probably played a role, together with a global breakdown of healthcare systems. That flu strain may have caused a fierce over-reaction by the immune system that triggered a “cytokine storm.” This might also contribute to the lethality of the COVID virus.

All of which underscores the urgent advice of doctors this winter: Get the COVID booster shot and the flu shot as soon as possible. You can get the shots at most pharmacies and can get both shots in one visit.

So here’s a rundown on the prospects for a “tripledemic” this year – with rising rates of COVID, flu and RSV all at the same time.

COVID still simmering:

Nationally, the decline in COVID cases has apparently bottomed out, with 38,000 new cases daily. That works out to about 11 cases per 100,000. People are still dying at the rate of about 360 per day.

Arizona’s infection rate is about the same as the national average, with 777 cases and 9 deaths per day.

Apache County’s reporting a daily infection rate of 42 per 1000,000, about four times the statewide average and the highest rate in the state.

Navajo County’s reporting 12 cases per 100,000 daily.

The death rate remains lower than in the early stages of the pandemic, thanks to the vaccines and the number people who have recovered from an earlier infection. In addition, the new COVID strains are so far much easier to catch – but less likely to kill you.

The vaccine followed by a booster shot every four to six months will still reduce the odds of infection significantly – and the odds of serious illness dramatically. Nonetheless, vaccination rates in Gila County and the non-reservation portions of Apache and Navajo counties remain among the lowest in the state.

Europe’s already reporting a fresh surge in COVID cases, driven by new, faster-spreading, more immune-system-evading strains of omicron – leading some epidemiologists to predict a winter surge in COVID cases here.

Flu season may prove deadly

A fierce, early flu season in Australia and New Zealand serves as a storm warming for the US and Europe. Arizona’s already reporting a handful of flu cases, although the flu season doesn’t normally get started until December.

But then, the flu’s been acting weird for the past two years – with only a fraction of the normal cases last winter followed by a strange, unexpected spike in cases last spring

Last winter, Apache County had two or three cases in January where it would normally have peaked at about 80 per week. Instead, cases peaked at about 40 per week in early June – when the county normally has no cases at all.

The same pattern held in Navajo county, with 11 cases per week in January compared to the five-year average of 78 for the same week. Instead, the peak came in late April at 32, about eight times the long-term average for that week.

The unusual patterns probably reflect the measures people took to avoid COVID, like improving indoor ventilation in schools, staying home when they felt sick, wearing masks, reducing travel, quarantining kids with symptoms and reducing big gatherings. It’s also possible the COVID virus somehow inhibited the flu virus, which is called “viral interference.”

The federal Centers for Disease Control notes that the flu causes between 140,000 and 710,000 hospitalizations annually in the US in a normal year as well as roughly 25,000 to 40,000 deaths.

The CDC is already reporting the start of the flu season in Texas and many southern states, but only a scattering of cases in Arizona.

Doctors develop a new flu vaccine every year, based on the flu strains circulating in the Southern hemisphere. Fortunately, the flu shot looks like a good match this year.

RSV complicates the picture

RSV looks like it’s following the same script as the flu virus. RSV causes about 14,000 deaths per year among adults older than 65 and about 500 deaths among children under five. The virus hospitalizes about 58,000 children and 177,000 older adults in a normal year.

Last winter in Navajo County, RSV peaked at about 23 reported cases in late November, when there are normally no cases at all. Cases then dropped to near zero in January and February when they’re normally peaking. In Apache County, doctors reported 10 cases in late November – but few cases during the normal peak months of winter.

Already, the CDC’s reporting about 7,000 cases of RSV weekly, sign of an early, potentially more severe RSV season.

No vaccine exists, partly because the virus is especially adept at evolving ways to evade the immune system’s antibody-based defenses. Two new vaccines against RSV are in clinical trials. Read moreSevere flu, RSV season predicted

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