We are at the beginning of a new pandemic year. This is the fourth year that humanity has faced the COVID-19 pandemic. The virus creates new strains, adapts to humans and the process is far from complete. It also brings new uncertainties, especially those caused by the intersection of pathways in the circulation of several types of viruses.

Much has been written about the possible intersection of influenza and COVID-19 viruses last winter. But at the time, COVID-19 was still strong and dominated throughout the whole season.

This winter season is special

We have the COVID-19 virus, with the whole family of descendants of the first generation of BA and with the descendants of the second generation of BB. These strains are highly contagious, spreading very quickly, but causing milder forms of the disease in the general population, especially for those who have already been vaccinated or have gone through the disease.

We have flu viruses that are quite active and some of them have created epidemics in the past. WHO has recommended vaccination in the 2022–2023 season against H1N1 viruses; H3N2; and two types of B. It should be noted that both H1N1 and H3N2 were the causes of recent influenza epidemics in the twenty-first century.

We also have syncytial respiratory viruses, called RSV, that were somehow cannibalized by COVID-19 last season, but they've become quite active this season.

We can say that now in Moldova we are faced with a triple epidemic.

The positive side is that the experience of the pandemic can help us prevent the domino effect of these viruses now, which can lead to a temporary collapse of the health care system.

Imagine that the symptoms in all three of these infections are absolutely similar. And patients with these symptoms will end up in primary care, after which they will flood hospitals that have already slightly weakened the mechanisms activated during the pandemic.

This can be an unpredictable short-term impact on the health care system, disruptive in some places, for chronic patients.

What can be done?

Prevention

During the pandemic, we've learned that the most important thing is not to get sick.

The flu is prevented with the flu vaccine. We're looking for options, and we're being vaccinated. It's not too late. 

COVID-19 is prevented by vaccination or revaccination against COVID-19. I assume that in Moldova there are doses for primary vaccination and doses of bivalent booster.

If vaccination is not taken, you can wear a protective mask and apply other methods of prevention and protection.

Increased attention would be helpful to the topic of "individual protection of medical workers", since this season they are in a permanent red zone.

Testing

If there are already symptoms, then testing is the decisive element. There are already PCR tests that allow you to examine 5 viruses from one sample. That is, instead of a test for SARS Cov2, a PCR test for a combination of viruses is done, which will make it clear which virus is the cause of the infection.

Treatment

For all three types of infection mentioned above, there is currently a cure.

For influenza, there are antiviral drugs in the pharmacy, respectively, treatment can also be carried out at home, if it can be started within the first 48 hours after the onset of symptoms. 

For COVID-19, there is also a valid established protocol that helps alleviate symptoms, at least. 

The main thing is to have a clear diagnosis and the correct testing will surely help in this, so that then the doctor can choose the appropriate treatment for each patient.

The danger of influenza infections colliding with COVID-19 has gone from predictable to real. A large number of sick people in the country confirm this to us.

Pandemic fatigue and a reluctance to take simple protective measures increase the risks of a domino effect from current viruses on the health care system caused by this season's triple epidemic.

It's probably helpful to talk about these risks and try to bring the community together to stop this domino effect before it's too late.