Acute Respiratory Illness on the Cape & Islands
Update prepared by Lea Hamner, Contract Epidemiologist for Barnstable County Department of Health and Environment.
Introduction
If you’ve navigated to this page, you’re likely wondering how to understand the current climate of respiratory disease transmission in our communities here on Cape Cod. Perhaps you’re worried about COVID-19, RSV, the flu, or all three; the trifecta of what are now referred to as “acute respiratory illnesses”.
Previously, we provided COVID-19 Case Data in Barnstable County as verified by healthcare providers and reporting of targeted diagnostic testing to state and local public health agencies. Now, with the changing landscape of at-home COVID testing along with the co-occurrence of flu and RSV—two viruses which present with similar symptoms to COVID-19—we need a broader perspective to look at viral transmission in our region.
Summary
April 22, 2024
Statewide, acute respiratory illness activity in emergency department (ED) visits has stabilized over the past 3 weeks. In this stable period, of all ED visits statewide, 12 to 13% are for acute respiratory illness. Nantucket County still continues to have the highest proportion of ED visits for acute respiratory illness (22.3%). However, compared to peak season (Dec 2023-Jan 2024), this burden is still lower. Last week Dukes County was on the upswing but this week it has come back down. Barnstable has remained relatively stable.
Influenza
Out of the 3 major viruses tracked by public health (influenza, COVID-19, and RSV), influenza is the leading contributor to healthcare visits in the state. In the Cape & Islands, influenza-like illness activity remains high and influenza severity is moderate. Other areas of the state are seeing decreases to moderate or low influenza-like activity.
COVID-19
Most key indicators, including wastewater, case counts, hospitalizations, and deaths, are showing decreasing and low levels of activity in the state. Nearby in Wareham, there have been 2 samples in a row showing increasing COVID-19 viral concentrations in wastewater.
RSV
Most key indicators, including emergency department visits and hospitalizations are showing low levels of activity in the state.
Vaccination
Local, state and national vaccination coverage for COVID-19 and influenza are lower this year compared to years prior.
Guidance
On March 25, 2024, MA DPH released new guidance for what to do if you have symptoms of a viral respiratory illness or test positive. CDC updated respiratory virus guidance can also be found below and recommends a symptom-based strategy to exiting self-isolation, as well as taking measures to improve indoor air, masking, testing, physical distancing and practicing good hand hygiene.
This Week’s Primary Concerns
Influenza is the main concern for viral respiratory illness. Influenza-like illness activity (fever plus cough or sore throat) remains HIGH in southeastern MA including the Cape & Islands. Influenza severity, shown by emergency department visits and hospitalizations, is MODERATE. There has been a 1-week increase in influenza-related ED visits and hospitalizations in the island hospitals.
Most Affected Geographies: ED visits for acute respiratory disease remain highest in Nantucket County. After an uptick, Dukes has come back down this week though higher than state average. Barnstable had a similar ED visit burden compared to the statewide average. Hospitalizations for acute respiratory illnesses have been higher on the Cape & Islands throughout the season, likely due to the older demographic.
Most Affected Populations: While trends are decreasing across all age, race, and ethnicity population groups, the youngest and oldest age groups continue to be disproportionately seen in the ED for acute respiratory illnesses. The oldest age groups are most likely to have severe disease and be hospitalized for acute respiratory disease, COVID-19, influenza, and RSV. Across the state, Hispanic and Black/African American residents are disproportionately seen in the emergency department. White and Black/African American residents are most likely to be hospitalized for any acute respiratory illness, influenza, COVID-19 or RSV.
Massachusetts Statewide Trends
| Metric | This Update | Prior Update | Trend | Trend (Accessible) |
Metric note |
| Acute respiratory illness burden in Emergency Departments |
11.4% |
13.4% |
 |
Decreasing |
Using syndromic surveillance data, uses the percent of ED visits that are for acute respiratory illness diagnoses and/or symptoms. Source: MA DPH. Most recent week for this update is 4/7–4/13.
—– |
| Influenza Activity (Southeastern MA) |
High |
High |
 |
Stable |
Using syndromic surveillance data, uses the percent of ED visits that are for Influenza-like illness (ILI), defined as fever plus cough and/or sore throat. Classified as minimal, low, moderate, high, or very high. Source: MA DPH. Most recent week for this update is 4/7–4/13.
—– |
| Influenza Severity |
Moderate |
Moderate |
|
Stable |
A combination metric which looks at ED visits for influenza-like illness, hospital admissions, and influenza positive test results. Classified as low, moderate, high, or very high. Source: MA DPH. Most recent week for this update is 4/7–4/13.
—– |
| COVID-19 Activity: Wastewater |
Low |
Low |
|
Stable |
Viral concentration in wastewater, averaged statewide for the week. Classified as minimal, low, moderate, high, and very high. Source: CDC. Most recent week for this update is 4/7–4/13.
—– |
| COVID-19 Severity: ED Visits
|
Minimal |
Minimal |
|
Stable |
Using syndromic surveillance data, uses the percent of all ED visits that are related to COVID-19. Source: MA DPH. Most recent week for this update is 4/7–4/13.
—– |
| COVID-19 Severity: Hospitalizations |
Low |
Low |
|
Stable |
Using syndromic surveillance data, uses the percent of all hospitalizations that are related to COVID-19. Source: MA DPH. Most recent week for this update is 4/7–4/13. |
Dashboards:
Respiratory Illness Dashboard
This dashboard provides data on hospital admission and emergency department (ED) visits related to acute respiratory diseases, including COVID-19, influenza (the flu), and RSV. Dashboard maintained by MA DPH, updated on Thursdays.
