Severe outbreaks of the flu, COVID-19, RSV and norovirus are occurring throughout the United States, especially in areas where there are lower vaccination rates.
In Virginia, flu vaccination rates vary based on age, with ranges for the 2024-25 season from 24 percent (ages 5 to 17) to 45 percent (ages 50+), according to Department of Health data. COVID vaccination percentages are much lower statewide with a low of six percent (ages 5 to 17) to a high of 45 percent (ages 50+).
“Areas with lower vaccination rates, colder weather and higher population density are seeing higher infection rates,” said Dr. Ryan Fulton, a faculty member at the Virginia Tech Carilion School of Medicine. “These factors make it easier for respiratory viruses to spread.
“This year, we’ve seen earlier and more intense surges of RSV and the flu compared to what we’re used to,” Fulton, section chief of general pediatrics at Carilion Children’s, said. “COVID-19 emergency visits are less frequent than during earlier stages of the pandemic, but the virus remains a factor.”
The push for routine vaccines is still a priority for most doctors, including Fulton.
RFK Jr.: A ‘danger to the nation’s health’
Donald Trump’s controversial nominee for Secretary of Health and Human Services, Robert F. Kennedy Jr., has shown skepticism toward vaccination and shared conspiracy theories including a false claim that vaccines are linked to autism in children.
Through the nonprofit Children’s Health Defense, RFK Jr. also filed a petition with the Food and Drug Administration during the most deadly phase of the COVID-19 pandemic to stop the use of vaccines to treat the virus pointing to alternative choices that were proven to be ineffective. An estimated 14.4 million deaths were prevented worldwide with the rollout of vaccines, according to the National Institutes of Health.
The nonprofit organization Public Citizen released a statement asserting RFK Jr. is a “clear and present danger to the nation’s health.
“He shouldn’t be allowed in the building at the Department of Health and Human Services (HHS), let alone be placed in charge of the nation’s public health agency.
“Donald Trump’s bungling of public health policy during the COVID pandemic cost hundreds of thousands of lives. By appointing Kennedy as his secretary of HHS, Trump is courting another, policy-driven public health catastrophe,” said Robert Weissman, co-president of Public Citizen.
Despite strong opposition, the Senate Finance Committee, along party lines, voted to send RFK Jr.’s nomination to lead HHS to the full Senate. No date has been set to confirm him although the vote is expected in coming days.
‘Greater risk of severe outcomes’ in kids if unvaccinated
Children are presenting co-infections simultaneously, which increases the risk of complications and hospitalizations, Fulton said.
Infants and young children are at the highest risk for severe illness from the four viruses.
“Children with underlying conditions like asthma, heart disease or immune system deficiencies are especially vulnerable,” said Fulton. “Unvaccinated children and families face a greater risk of severe outcomes from flu and COVID-19 due to the lack of vaccine protection.”
In Virginia, two pediatric deaths have been reported in 2025.
Fulton said children who are ill should stay home from school or daycare to prevent the spread of the virus.
“Frequent handwashing with soap and water is of the most effective ways to protect children,” he said.
Symptoms of the four viruses
The flu, COVID-19 and RSV share many symptoms. Norovirus is unlike others in that it primarily targets the gastrointestinal system, according to Fulton.
- Influenza or flu: Symptoms often include high fever, cough, sore throat, congestion, muscle aches and fatigue. Vomiting or diarrhea is also possible, especially in children.
- Respiratory Syncytial Virus or RSV: Symptoms include a runny nose, cough, sneezing, fever and wheezing. Symptoms can be more subtle in infants, Fulton advises, and may include poor feeding, irritability or pauses in breathing.
- COVID-19: Symptoms vary but may include fever, cough, sore throat, fatigue, congestion, and in some cases, loss of taste or smell.
- Norovirus: Primarily causes gastrointestinal distress including vomiting, diarrhea, nausea and stomach pain, sometimes includes a fever or body aches
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Crystal Graham
