Risk of severe pressure on healthcare systems due to RSV, flu and COVID-19 co-circulation

Press release

Since the end of October 2022 and as of week 47, several EU/EEA countries have indicated an increase in paediatric hospitalisations due to RSV infections causing bronchiolitis, amidst concurrent circulation of other respiratory pathogens, such as influenza and SARS-CoV-2 viruses. As a result, there is a high risk of significant pressure on the EU/EEA healthcare systems in the coming weeks and months, warns the European Centre for Disease Prevention and Control (ECDC) according to a Risk Assessment published today.

Several EU/EEA countries are experiencing high respiratory syncytial virus (RSV) circulation, and the number of severe acute respiratory infections (SARI) due to RSV infection is also increasing. RSV infections at this time of the year are not unusual, but higher and earlier this year than in the pre-pandemic period, also proportionately affecting more children. The EU/EEA countries are also experiencing an early influenza season and a possible resurgence of COVID-19 after weeks of decline in cases and hospitalisations.

ECDC Director Dr. Andrea Ammon stated:

The end-of-year festive season is associated with activities such as social gatherings, shopping and travelling, which pose significant additional risks for transmission of RSV and other respiratory viruses. Reinforcement of healthcare systems and support of healthcare workers should be prioritised due to the risk of severe pressure on our healthcare systems in the coming weeks and months. Vaccination against influenza and COVID-19 should also be a priority among risk groups.

In addition to an increased number of hospitalisations, the co-circulation of RSV, influenza virus, SARS-CoV-2 and other respiratory viruses may lead to staff shortages due to sick leave. Maintaining an adequate ratio of staff to patients, especially in ICUs, is critical to maintaining patient safety and quality of care. In order to manage the expected higher number of cases, an increase in capacity should be considered and re-assessed frequently according to the epidemiological situation.

ECDC presents EU/EEA Member States with the following options for response:

  • Implement risk communication activities for the public including active promotion of vaccinations against seasonal influenza and COVID-19;
  • Increase awareness among healthcare professionals to timely diagnose cases and enhance hospital preparedness to manage increased patient load in outpatient and inpatient settings. This is particularly important for paediatric hospitals and intensive care units, and long-term care facilities (LTCFs);
  • Ensure RSV prophylaxis to high-risk infants in accordance with national guidelines;
  • Implement appropriate infection prevention and control (IPC) measures based on the local epidemiological situation, particularly for vulnerable groups within healthcare facilities, including LTCFs;
  • Promote good hygienic practices in the community and consider appropriate non-pharmaceutical interventions (NPIs), such as staying home when ill, good hand and respiratory hygiene including appropriate use of face masks, appropriate ventilation of indoor spaces, use of teleworking where possible, and avoiding crowded public spaces;
  • Where possible, implement and improve surveillance of RSV and testing for respiratory pathogens.



RSV is a major contributor to lower respiratory tract infections (LRTI) worldwide. By the age of two years, almost all children have been infected, but natural infection does not provide long-lasting immunity. Reinfection is common but usually affects only the upper respiratory tract. RSV clinical manifestations vary among different age groups. Symptoms range from mild influenza-like presentations to severe LRTIs, including bronchiolitis and pneumonia, that might require acute care admissions and mechanical ventilation.

Children below five years of age (particularly infants below six months), and adults over 65 years of age are the most affected by RSV-associated severe disease. An average of 213 000 children under five are admitted to hospital each year with RSV in the EU, Norway and United Kingdom.

RSV is a leading cause of acute LRTIs in infants and young children, but it is also considered an important cause of morbidity and mortality in older adults and high-risk individuals. RSV outbreaks in long-term care facilities (LTCFs) have significant case-fatality ratios.