THL: Respiratory tract infections are common in the winter and increase hospital burden

Publication date 14 Nov 2023

Several viruses that cause respiratory tract infections are currently circulating in Finland. In the winter, infections are caused by coronavirus, influenza, rhinovirus, adenovirus and RSV. Coronavirus is circulating in the population throughout the year. In addition to viruses, bacteria, such as pneumococcus, also cause respiratory tract infections.

"The overall burden on hospitals caused by respiratory tract infections is currently normal for this season. However, the situation at the end of the year and the timing of epidemic peaks in coronavirus and other viruses cannot be assessed with certainty", says Tuija Leino, Chief Physician at the Finnish Institute for Health and Welfare (THL).

The number of coronavirus infections is rising. The most prevalent variant for this autumn is the Omicron XBB sub-variant EG.5 The circulating coronavirus variants are very similar to each other and, according to current information, they do not differ from each other in terms of symptoms.

The RSV and influenza epidemics have not yet started, even though individual cases have been reported to THL’s National Infectious Diseases Register. It is expected that RSV and influenza infections will increase by the turn of the year. The peak of the influenza epidemic often occurs only after the turn of the year.

Tuija Leino says that a mild flu-like disease can be treated at home, regardless of the virus that caused it.

"Please stay home when you’re ill. However, it is difficult to avoid the spread of respiratory tract viruses, as they can be contagious even if there are no symptoms yet,” Leino explains.

A small number of patients need hospital care.

"The majority of respiratory tract infection cases that lead to hospitalisation are not confirmed through microbiological testing, or they are caused by a virus other than coronavirus, influenza or RSV", Leino adds.

Currently, the number of patients in need of hospitalisation is rising due to coronavirus. In most cases, the patients are older and have multiple illnesses. 

Risk levels vary – old age is the most significant risk factor for a serious respiratory tract infection

All high-fever infections can be fatal to older people or to those with very serious underlying conditions. They are also more likely to end up in specialised medical care or the inpatient wards of primary healthcare. Some people with a severe underlying disease may need treatment at an intensive care unit due to a normal respiratory tract infection. Respiratory tract infections increase the mortality rates of the most fragile older people every winter.  

Old age is the most significant risk factor for a severe coronavirus disease. Even serious infections do not always cause a fever in older people, but the symptoms may include fatigue and a deterioration in overall condition. 

Although 65 years is the lower age limit at which age-based influenza and coronavirus vaccinations are offered in Finland and many other countries, people over the age of 85 are at the most significant risk of developing a serious respiratory tract infection and being hospitalised.

"People with underlying conditions who are part of the vaccination target groups have a higher risk of needing inpatient care due to a respiratory tract infection than a healthy person of the same age. However, the risk is usually low compared to the risk for older people. Only diseases and treatments that clearly damage the immune system definitely increase the risk for people of all ages," says Leino.  

Vaccinations for at-risk groups are under way

In September, THL recommended that the late autumn booster vaccines against coronavirus be given at the same time as influenza vaccines. However, wellbeing services counties may, at their own discretion, bring forward the vaccination schedule for the most fragile people in at-risk groups. The wellbeing services counties are responsible for organising vaccinations.

The aim of coronavirus vaccinations is to maintain the continuous protection of the population against severe coronavirus disease, as there may be several epidemics during the year. For the time being, it has been necessary to improve the protection of at-risk groups annually. The booster doses were scheduled for the autumn this year and last year because a fresh variant-tailored vaccine has been introduced, and the burden caused by respiratory tract infections, such as coronavirus, is particularly heavy in the winter.

At-risk groups will also receive influenza vaccinations in late autumn. This is largely the same target group as for coronavirus vaccinations. The influenza vaccine is preferably not administered very early in the autumn, as its protective effect, especially in older people, will rapidly decline in less than six months. 

Be cautious about home test results

Influenza, the common cold and the coronavirus disease are respiratory tract infections that cannot be distinguished based on symptoms. Symptoms may include a sore throat, runny or stuffy nose, cough and fever. The symptoms may range from mild to severe.

The cause of the infection can be confirmed by a laboratory test. The coronavirus antigen test, i.e., the home test, makes it possible to identify an acute coronavirus infection. There are also home tests available to identify not only coronavirus but also influenza A and B and, in some tests, RSV virus.

You can take a home test if you wish, but you should be cautious about the result. The tests are most reliable during epidemics, when the levels of the disease in question are high in the population.

Niina Ikonen, Chief Specialist at THL, says that the antigen test best identifies a virus infection when only a few days have passed since the start of the symptoms.

"A negative test result does not indicate with certainty that the cause is not the virus you tested for. It is essential that, if you have symptoms, you stay at home and avoid contacts outside your household, if possible," says Ikonen.

Further information

Preventing respiratory tract infections

Tuija Leino
Chief Physician, THL
[email protected]

Niina Ikonen
Chief Specialist, THL 
[email protected]

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