By Donald Gilpin

In December, as winter approached, health officials braced for a harrowing combination of spiking COVID-19 variants, an early flu season, and more patients with RSV and other respiratory illnesses than they had seen in recent memory. Media and others warned that the three years of the COVID-19 pandemic would be followed by a “tripledemic.”

But no such surge has come to pass. COVID-19 numbers continue to decline. The flu season seems to have peaked. And the early RSV wave has abated.

“Good news,” said Penn Medicine Princeton Health (PMPH) Chief Medical Officer Dr. Craig Gronczewski in a February 6 phone conversation. “New Jersey was hit particularly hard with a COVID uptick in December, but in the past four weeks hospitalizations and ER visits have gone down significantly.”

He continued, “It also looks like influenza as a disease peaked in early December in New Jersey, and serious illnesses and hospitalizations from RSV have trended down as well. From a respiratory illness standpoint things have been tracking very well in the past four weeks as far as the emergency department is concerned.”

But the news is not all good at PMPH. “We had many fewer COVID cases and hospitalizations than in the previous year, but the number of patients coming to the ER requiring hospitalization actually increased,” said Gronczewski. “I was surprised by the volume of ER visits. The number of patients requiring admission and hospitalization with non-respiratory illnesses was much higher than in years past. It has been a busier winter than ever. We had to use more hallways for patients than ever before.”

Gronczewski suggested that one reason for the influx of hospital patients might be “deferred care,” perhaps an unanticipated consequence of the pandemic. “That’s a lot of what I’m hearing from patients and staff — difficulty in getting access to care or getting diagnostic tests or getting appointments with primary care physicians or with specialists,” he said.

“It seems that patients are having more challenges with that, and it’s often leading to a decline in their overall condition, and they’re ending up in the emergency department.”

Preparations for a tripledemic, however, did not go to waste at Penn Medicine Princeton Health. “I feel very fortunate and grateful that our organization really had a proactive plan for the winter surge,” said Gronczewski. “We definitely needed it.”

“Deferral of routine maintenance” is how Dr. George DiFerdinando, internist and chair of the Princeton Board of Health, described the situation. “Seems like people have done that —put it off,” he said. “There are a lot of treatments, screenings and others, that have been missed.”

DiFerdinando noted that the Princeton Health Department is catching up on scheduled maintenance, still keeping a focus on COVID-19 while working with Princeton school administrators and nurses on vaccine audits, seeking to fill any vaccine gaps in the school-age population.

DiFerdinando was not willing to declare the end of the pandemic. “Out of the woods? We don’t know what out of the woods would look like,” he said. 

Though COVID-19 was the third leading cause of death from 2020 through mid-2022, and there are still more than 500 deaths attributed to COVID-19 per day, it is now no longer among the top five killers in the United States, according to last week’s New York Times.

“The trends look good,” said DiFerdinando, “but the numbers are unreliable.” He went on to note that many people remain unvaccinated and the booster uptake is only about 33 percent. “There are deaths that can still be prevented, and while that’s true, there’s still work to do,” he noted.

He went on to voice his concerns about the severe attrition in the health care work force since the beginning of the pandemic, with fewer health care workers and fewer hospital beds than there were before the pandemic.

Gronczewski expressed some optimism that the worst of the pandemic and its strains on all health services was over, but he was not willing to declare a transition from pandemic to endemic. “I’d leave that up to epidemiologists,” he said. “Whether it’s referred to as a pandemic or endemic, our mission is just to be prepared.”