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The worst of the respiratory virus season is likely coming in Minnesota, infectious disease experts predicted Thursday, despite a recent decline in hospitalizations of children with respiratory syncytial virus, or RSV.

The 355 influenza-related hospitalizations in Minnesota in the week ending Nov. 26 was an increase from 319 a week earlier, according to the state's update on Thursday. That trajectory means Minnesota, at best, is a month or two ahead of typical flu patterns or, at worst, is on the precipice of a severe viral season.

"Things are going to get worse before they get better," said Patsy Stinchfield, a Children's Minnesota nurse practitioner and president of the National Foundation for Infectious Diseases.

Stinchfield was unconvinced by a decline in RSV-related hospitalizations. The state's weekly report showed 120 such hospitalizations last week in the seven-county Twin Cities area, mostly among infants. While it's a decline from 200 hospitalizations two weeks ago, Stinchfield said that remains high.

"RSV can go up, it can come down, and then it can go even higher than the first peak," she said. "It's impossible to predict, as its coming down now, if it's over."

Respiratory diseases are challenging Minnesota's hospitals. More than 8,000 inpatient beds were filled on eight days in November — a crude marker for when the state's hospitals are at capacity, according to Thursday's weekly pandemic update.

RSV has consumed pediatric intensive care beds. Only six of 144 such beds were available on Monday.

"The surge that we're seeing now, I've never seen this in my 20-plus years of working in pediatrics," said Dr. Sameer Gupta, vice president of medical affairs for M Health Fairview's Masonic Children's Hospital in Minneapolis.

The concern is that all of this occurred before the holidays — when travelers gather and spread germs. Flu levels usually heat up after Christmas in Minnesota.

The dominant A strain of influenza is associated with severe seasons, but that same strain produced a weak flu season last winter amid surges in COVID-19, said Melissa McMahon, a senior epidemiologist with the Minnesota Department of Health.

"We had an ability to guess what flu was going to do before the pandemic and now that pattern has been a little bit thrown out the window," she said. "We've had flu seasons that didn't make any sense with the knowledge we had the last couple of years."

COVID-19 levels have remained steady, but are contributing to hospital pressures. The 573 COVID-19 hospitalizations in Minnesota on Tuesday represented the highest total since Feb. 24 — although it was below the 1,533 hospitalizations on the same date in 2021.

COVID-19 deaths rates have declined among all age groups since then, but remain elevated among the elderly. Among 75 COVID-19 deaths that occurred over the past three weeks, 72 were seniors.

Theories abound on why RSV and influenza spread so early this year, after spreading at low levels during COVID-19 waves. Social distancing and mask-wearing measures might have shielded people in 2020 and 2021.

Minnesota saw an expected decline over Thanksgiving break in flu-like outbreaks in schools, which are reported when 5% of children in one school or three children in the same elementary classroom are absent with flu-like symptoms. The 142 outbreaks last week compared to 240 the week before.

Flu-related hospitalizations early in the season typically involve children and younger adults, whose mobility increases their infection risks. With time, the virus spreads to more elderly people at greater risk of severe illness, McMahon said. The median age of flu hospitalizations was just over 30 in Minnesota three weeks ago, but it's 58 now.

Health officials urged people to take basic precautions, including staying home when sick, washing hands, covering coughs and receiving recommended vaccinations. Social distancing and mask-wearing offer protection against viral threats as well, McMahon said.

"That is good advice," she said, "for flu, for RSV and for COVID."