COVID-19 remains a dominant respiratory threat in the United States, causing more illness and death than either influenza or respiratory syncytial virus (RSV), according to a comprehensive study published January 27 in JAMA Internal Medicine.
Researchers from the Veterans Affairs Portland Health Care System analyzed medical records of 72,939 veterans treated for respiratory illnesses between August 2023 and March 2024. Their findings reveal that COVID-19 represented 60% of all respiratory infections during this period, while influenza accounted for 26% and RSV for 13%.
"SARS-CoV-2 was far more common than influenza or RSV and resulted in more severe disease outcomes, including short-term hospitalization and mortality," reported the research team led by Dr. Kristina Bajema, medical director of antimicrobial stewardship with the VA Portland Health Care System.
Comparative Disease Burden and Outcomes
The study found similar hospitalization rates for COVID-19 and influenza patients (16%), slightly higher than for RSV patients (14%). While short-term mortality risk (within one month of infection) was comparable between COVID-19 and influenza, COVID-19 was associated with significantly higher long-term mortality within six months of infection.
"COVID-19 was associated with more severe disease outcomes, including long-term mortality, compared with influenza or RSV," the researchers wrote.
These findings align with public perception. A recent HealthDay/Harris Poll found that nearly three-quarters of Americans (72%) still consider COVID-19 a serious public health threat, despite the official end of the pandemic in 2023.
Vaccination Impact
The study highlighted the critical role of vaccination in reducing severe outcomes. Unvaccinated COVID-19 patients were more likely to die than unvaccinated influenza patients. However, among vaccinated individuals, there were no significant mortality differences between COVID-19 and influenza at any time point.
"Vaccination remains an important strategy for minimizing the impact of respiratory viral illnesses and particularly Omicron variants," the researchers emphasized.
Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, commented on the findings: "I think this virus will be with us for decades, if not longer," comparing COVID-19's current status to that of seasonal influenza, which emerged as a pandemic in 1918 and has remained an endemic threat.
Testing and Prevention Behaviors
The HealthDay/Harris Poll also revealed that 73% of people would seek testing if they developed COVID-19 symptoms, either through at-home tests or at medical facilities. Additionally, 85% of respondents indicated they would quarantine and wear a mask if they tested positive.
Dr. Offit emphasized that high-risk individuals should particularly prioritize testing to enable timely treatment with antivirals like Paxlovid to limit infection severity.
Evolving Guidance
The CDC currently recommends that people with COVID-19 isolate until at least 24 hours after their fever subsides and symptoms improve, followed by five days of masking and distancing when around others.
However, the poll found that more than half (56%) of respondents were unaware of the current recommended quarantine period, suggesting ongoing challenges in public health communication.
Future Outlook
As COVID-19 transitions from pandemic to endemic status, health experts emphasize the importance of maintaining vigilance, particularly for vulnerable populations. The virus continues to evolve, and vaccination strategies may need adjustment to target those at highest risk.
"Although the pandemic is over, I think we have to understand that this is a serious infection," Dr. Offit noted, adding that similar attention should be given to influenza, which also causes significant morbidity and mortality annually.
The study's findings underscore that while public health emergency measures have been lifted, COVID-19 remains a significant health threat requiring ongoing monitoring, prevention strategies, and targeted interventions to protect vulnerable populations.
