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The U.S. is currently going through a wave of four separate viruses at once, prompting experts to label the situation a “quad-demic.”
Recent data from the CDC shows that COVID-19, influenza, RSV, and norovirus are circulating at high levels. Positive testing for Influenza has reportedly increased to 29.4% nationally, while 7.6% of reported RSV tests and 5.4% of reported COVID-19 came back positive. For norovirus, 23.1% of tests returned positive in the most recent weekly data.
While the spread of viruses isn’t necessarily abnormal for this time of year, it’s crucial for families to stay informed and prepared.
Tis’ the Sick Season
“These are all common viruses that circulate during the fall and winter months, but things become particularly intense when all four start to spike at similar times,” says Shazma Mithani, MD, FRCPC, emergency physician.
“It’s important to get vaccinated against the viruses that have vaccines available. This significantly reduces the risk of getting infected,” she advises. “It’s also important to be prepared at home with things like tissues, a thermometer, nasal saline, a nasal aspirator (if you have infants at home), pain and fever medications like acetaminophen and ibuprofen and a humidifier.”
So, why do these viruses tend to always pop up during winter months? Tasia Isbell, MD, MPH, a pediatrician and author, explains that winter itself doesn’t make you sick, but it can impair your body’s defenses.
“People tend to spend more time indoors during colder months, often in close proximity to others, which increases the likelihood of viral transmission,” she notes. “Many respiratory viruses, like influenza and RSV, thrive in cold, dry conditions, and are more stable on surfaces in these environments. Dry winter air can also dry out the mucous membranes in the respiratory tract, which makes it easier for viruses to invade.”
Is Norovirus a Type of Flu?
Norovirus is commonly called the “stomach flu,” but it isn’t caused by the influenza virus, says Dr. Isbell. “Norovirus is unique because it primarily affects the stomach and intestines (gastrointestinal system), causing vomiting, diarrhea, and stomach cramps, while the other viruses tend to cause respiratory symptoms,” she says. “However, norovirus outbreaks can occur alongside flu season and often in similar environments like schools or daycare centers. It’s included in broader flu-related data because it often circulates at the same time and can contribute to the overall viral burden in communities.”
Spotting ‘Quad-Demic’ Symptoms
“These viruses can be differentiated based on certain clinical features,” continues Dr. Isbell. “RSV, for example, is more common in young children and often leads to wheezing, congestion, and breathing difficulties, with symptoms typically worsening between days three to five.
“Norovirus, on the other hand, is known for its hallmark symptoms of vomiting, diarrhea, and stomach cramps. When testing is conducted, healthcare providers may use PCR or antigen tests for COVID-19 and influenza, rapid tests for RSV, and stool tests for norovirus.”
Dr. Mithani says that while symptoms can be mild in many cases, there are complications that can occur in children and in adults.
“The highest risk groups are very young children, immunocompromised children/adults and elderly people. All four viruses are spread by contact and droplet, meaning they can spread by touch as well as respiratory droplets (from coughs, sneezes and runny noses),” she explains.
She also notes COVID-19, influenza and RSV all tend to cause respiratory symptoms like cough, sore throat, runny/stuffy nose, and sneezing. Norovirus, on the other hand, tends to cause mainly abdominal pain, vomiting, and diarrhea.
You can get a fever with all four viruses. It’s important to seek medical attention if your child has any of the following:
- a fever in any child who is immunocompromised or under 3 months old
- a fever lasting more than three days
- difficulty breathing
- chest pain
- shortness of breath
- confusion or abnormal sleepiness
- ongoing vomiting or diarrhea
- signs of dehydration (sunken eyes, less than 4 wet diapers or pees over 24 hours, no tears, dry mouth)
- severe abdominal pain
- blood in the stool or vomit
Treatment and Prevention
Dr. Isbell adds that while there’s no vaccine for norovirus, good hygiene practices—like frequent handwashing, avoiding contaminated food or water, and disinfecting surfaces—can help prevent infection.
“Supportive care—such as rest, hydration, and using a humidifier—can help ease symptoms,” she advises. And treatment tends to be the same regardless of the specific virus.
Soothing Coughs in Young Kids
“The cough associated with many viruses can be especially distressing to parents, particularly when it lingers for days to weeks,” says Dr. Isbell. “It’s important to note that the American Academy of Pediatrics (AAP) does not recommend cough medications for children under 4 and advises caution with children ages 4-6, always consulting a pediatrician. For kids over 1-year-old, honey is a natural and effective remedy for soothing a persistent cough.”
Dr. Isbell notes that the diagnosis of a viral illness is typically made clinically and usually does not require confirmatory testing. As a result, she says that testing may not always be necessary, unless the diagnosis is important for public health purposes or if the patient is at higher risk.
“One of the most common questions I get from parents in the ER is why their child is always sick,” Dr. Mithani says. “With so many viruses circulating (plus many other viruses that we don’t test for), children are very prone to getting back-to-back viruses that can give the appearance of ‘always’ being sick. The first year of daycare, in particular, is the most challenging, as studies have shown that kids can get [up to 12] illnesses in that first year.”