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Positive outlook for 2023 as RSV cases fall, although more COVID is incoming

RSV hospitalizations have been dropping quickly, but flu levels remain high and the arrival of the XBB.1.5 strain in Oregon is expected to lead to more COVID cases.

PORTLAND, Ore. — Oregon's hospitals are still under pressure from multiple respiratory viruses, and a short-term rise in COVID cases is likely on the way thanks to the new XBB.1.5 strain, but state health officials say the overall forecast for 2023 is encouraging.

"As we move into 2023, the trends look much better, that we will not be having the same conversations and seeing the same heights of surges that we saw in previous years," state health officer and epidemiologist Dr. Dean Sidelinger said at a Thursday news conference.

Oregon hospitals are still operating at near-capacity, Sidelinger said, but hospitalizations for RSV (respiratory syncytial virus) have decreased substantially and Oregon is now well past the peak for RSV cases in children. 

That milestone is important because surging pediatric RSV cases became the biggest cause of pressure on the state's hospital system back in November, forcing multiple Portland-area hospitals to temporarily implement crisis standards of care in their pediatric departments.

Flu activity has remained high until now, Sidelinger said — Oregon passed the peak case level for adults in early December, but case levels for children have essentially plateaued — but it's expected to drop in the coming weeks.

A second wave of flu infection is possible later in the season, he added, so it's still important for any Oregonians who have not yet received a flu shot to make an effort to get one. 

Flu vaccine effectiveness can be a bit inconsistent from year to year because scientists have to predict in advance which version of the virus will spread each winter, but Sidelinger said this year's formula has proven to be very-well matched to the version that's currently circulating.

COVID hospitalizations have declined in the past week, Sidelinger said, but Oregon could see a small increase in February as the XBB.1.5 strain of the omicron variant expands its foothold in the state.

The subvariant the most transmissible version yet, and it has rapidly become dominant in the northeastern United States and other parts of the world. It only accounted for about 5% of cases Oregon as of mid-December, Sidelinger said, but it's predicted to spread fast now that it's here.

A Jan. 6 forecast from Peter Graven with Oregon Heath and Science University predicted that 367 people will be hospitalized with COVID in Oregon as of Feb. 4, up from 261 hospitalizations in the Oregon Health Authority's most recent COVID update on Wednesday.

Although the new strain is highly contagious, Sidelinger said, it does not appear to cause more severe illness than past versions.

"In general, we are not seeing a significant cause for concern about XBB.1.5 right now," he said.

The updated bivalent boosters do still provide protection against XBB.1.5 as well as other omicron strains, Sidelinger added, and he urged Oregonians to get their COVID booster shots if they haven't already.

Oregon was also dealing with an outbreak of monkeypox last year, but Sidelinger said those case numbers have dropped substantially, with fewer than 5 new cases in the past month.

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