Q&A: Dr. Varun Shetty, Acting Chief State Epidemiologist on public health in the midst of respiratory illness in Texas


Boram Kim


Varun Shetty, MD, served at the Texas DSHS before being promoted to Acting Chief State Epidemiologist in October. On Sunday, Dr. Anthony Fauci said cases of respiratory syncytial virus (RSV) among children across the country were at a critical juncture as hospital systems monitor the threat of a “tripledemic” this holiday season. Shetty spoke to State of Reform about the current public health picture in Texas as the holiday season begins.  


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State of Reform: What is the current public health situation in Texas? Are we seeing a “tripledemic”?

Varun Shetty: “Typically, we see respiratory viruses that circulate commonly in our population. These include influenza, RSV, rhino and enterovirus, the viruses that cause the common cold. We typically see increased activity in the fall and winter months. I definitely wouldn’t use those types of alarming terms. But I think that we are seeing high activity earlier than usual and I think it warrants our attention and it warrants some action that we can all take to improve the situation.

We have a really effective surveillance system in place so that we can monitor for example, influenza activity, COVID activity, [and] RSV activity across the state. At this time, there’s not any one particular area that is in need of a higher level of concern than others. We are following this really closely. I think it’s really good that this is an issue that we’re giving attention to. We want to make sure that everyone is able to move through this holiday and winter season in a way that’s really healthy and safe.”

SOR: Why is RSV more widespread this season than in the past? 

VS: “During the pandemic, there were some changes due to a number of things, a lot of behavior change, a lot of decrease in interaction, getting together, and gatherings. There were historically low years during the pandemic of influenza and some of these other viruses. I think now as we are emerging from that, one of the things that’s different about this season is that we’re seeing increased activity much earlier in the season than we typically do and have in recent years.

RSV is a virus that we always watch closely. It’s a virus that can cause severe illness, particularly in very young children or in older adults. It’s also one of the most common causes of a common pediatric condition called bronchiolitis as well as pneumonias. As a result, it can cause a strain on hospital resources when there are increases in activity in communities. Those are the reasons that we monitor it very closely and again, we had seen high activity earlier than expected this year. But in Texas and elsewhere, we’re starting to see some encouraging trends that that rise is starting to slow and maybe even be trending down now.”

SOR: What is the department’s strategy against respiratory infections as we head into winter?

VS: “The good news is that we have several tools available to us and several strategies that I think that everyone in our communities can take advantage of to prevent bad outcomes and to make sure that we’re staying healthy during the winter season.

The first one and the most important one is to get vaccinated for the viruses that we can vaccinate against. Everyone six months and older is currently eligible for a COVID or flu vaccine. And so we want to encourage individuals to go ahead and get vaccinated. It’s one of the most effective tools that we have to prevent infection and severe outcomes from infection.

We’re seeing that the vaccine products for influenza that are available today are a really good match for the influenza that is circulating in our communities. And so that’s really encouraging that we have a good tool available. With COVID as well, we’ve seen over many months the impact that those products have had at keeping people out of the hospital, keeping people safe and able to survive and thrive after infection.

The second piece is really just the everyday, common-sense approaches that we recommend every year heading into the winter season. Those are things like making sure that you’re staying away from people who are sick, making sure when you are sick that you’re staying away from others, covering your coughs and sneezes, and then making thoughtful choices about the activities that you choose to participate in going into the holiday season and winter activities.

Then the third, if you are unfortunate [enough] to become sick, know that we have a lot of really great tools that weren’t always available that you can take advantage of to reduce your risk of getting sicker. First of all, there are ample testing choices available for COVID. Even at home tests that are very convenient. There are rapid tests for influenza. We have therapeutics that are available that can reduce the impact that these diseases have on you.

For COVID-19, there’s a medication Paxlovid that a recent study from CDC has shown in the real world to be highly effective at dramatically reducing the risk of becoming hospitalized for COVID-19. And then for influenza, the product oseltamivir can shorten the course of the disease. It’s really important that people start on those treatments early. They’re only effective if they’re started within the first few days of illness. So the moment that you are concerned that you’re sick, seek out testing, get tested, and then get treated early.”

SOR: What’s the guidance to those seeking out hospital or emergency care when they or a loved one feels sick this winter?

VS: “One of the things that we want to be mindful of is not overburdening hospital systems during this time. We’ve seen in other parts of the country and other parts of the world that there are some situations where emergency systems [and] hospital systems can get overwhelmed very quickly.

Most of the steps that I laid out are things that people can do either from home or from their primary care provider’s office. I really want to encourage people to take advantage of those options that will hopefully keep you away from hospitals or systems that are limited in their resources and you want to make sure that we’re preserving those for the people who are most sick.”

This interview was edited for clarity and length.