While the daily average of COVID-19 cases in Hawaii has become less of a concern, health officials are now keeping an eye on the rise of influenza and respiratory syncytial virus infections approaching winter.

These three have at times been referred to as a “tripledemic,” posing a triple threat the week before Thanksgiving.

Caitlin Rivers, an infectious disease epidemiologist, notes in her “Force of Infection” update that this year’s flu season continues to accelerate, putting the season on track to be “one of the worst in the last dec­ade, and well ahead of the usual winter timeline.”

Rivers, also a professor at Johns Hopkins Bloomberg School of Public Health, said the surge in RSV across the U.S. has been the highest since at least 2018, posing the most danger to younger children and older adults.

And then there are the new omicron subvariants — more than 300 now, with more sublineages continually emerging — that epidemiologists are keeping an eye on.

Omicron subvariant BA.5, which the new bivalent booster targets along with the ancestral strain, is now on its way out, according to the latest data from the Centers for Disease Control and Prevention.

BA.5 only makes up roughly 30%, while the more immune-evasive subvariants, BQ.1 and BQ.1.1, now make up about 44% of new cases in the U.S.

CDC on Friday added another subvariant of concern, BN.1 — a descendent of BA.2.75.5 — to its list.

How these play out in case counts and hospitalizations remains to be seen this winter.

Some experts, such as Eric Topol, professor of molecular medicine at Scripps Research, expressed cautious optimism that the BQ.1.1 wave in France did not lead to more hospitalizations.

In addition, the new bivalent booster helps protect against BQ.1.1, he said in a daily update, which is a good reason to get it.

“With Thanksgiving and the holidays around the corner, the outlook is far better than what we’ve been through for the past two years,” he wrote. “The immunity wall built by vaccines, boosters and infections, appears to be holding up to substantial evolution of the virus (at least in France). And the virus is having a harder time to find new hosts to replicate within and spread, its primary mission.”

Slow booster uptake

But the booster uptake in the U.S. is a far cry from what health officials had hoped when they were rolled out over Labor Day weekend.

So far, only 10.1% of eligible Americans have received the bivalent booster, prompting federal officials to kick off a “Countdown to Thanksgiving Vax Up America Tour” offering pop-up vaccine sites.

In Hawaii, bivalent booster uptake is higher, with 197,118 residents having received the shot, representing 17.8% of the eligible state population.

A new study by Moderna suggests its updated booster increases antibodies against BA.5 and BQ.1.1.

Enthusiasm for boosters has waned, and even those who are receptive to vaccinations are in no rush to run out and get the updated one.

The Queen’s Health System is once again offering COVID-19 vaccinations this Saturday, 9 a.m. to 2 p.m., at Palama Settlement in Kalihi.

Kaiser Permanente continues to host community vaccination events around Oahu, including one from 10 a.m. to noon today at the Filipino Community Center in Waipahu, and one from 10 a.m. to noon Sunday at the Mililani YMCA.

Hawaii’s seven-day average of new COVID-19 cases was at 142, the state Department of Health reported Wednesday, down from 154 reported on Nov. 9.

The state’s average positivity rate also inched down to 5.1% compared with 5.3% the previous week.

Hospitalizations of COVID-19 patients remained steady, with a seven-day average of 66 compared to 68 the previous week, according to the Healthcare Association Hawaii.

HAH, however, reported that the number of patients filling state hospitals is currently at a record high, at times spilling over 2,500 per day. The state is at the same time coping with a growing shortage of health care workers, including registered specialty nurses and nurse aides, in particular.

DOH also reported six more deaths, bringing the state’s COVID-19 death toll to 1,722.