There's been an alarming increase of respiratory and gastrointestinal viruses in the United States lately, causing anxiety about a so-called "quad-demic". According to surveillance reports, influenza, COVID-19, RSV and norovirus are at very high levels everywhere. While the surge aligns with patterns typical for this season, several epidemiologists view simultaneous infections of such proportions to pose risks not only to individual healthcare but public health.

The incidence of the quad-demic should vary with seasonal patterns, vaccination rates, and public health interventions. Each virus alone is relatively easy to manage; however, the effect of all together could lead to overburdening of health care facilities and increase risks for those at higher risk. Continuing surveillance, early testing, and proactive prevention measures will play an important role in the control of these infections going forward.

While the term "quad-demic" sounds daunting, it must be taken into perspective. For years, we have had all these viruses together, and we have the capabilities to mitigate some of the risk. Vaccination, proper hygiene and using common sense helps individuals get through the season unscathed. Is the quad-demic a permanent fixture or just another seasonal wave? Let's break this down.

What is the Quad-demic?

Typically, flu, COVID-19, and RSV have been the primary culprits behind seasonal respiratory infections. However, norovirus, a highly contagious stomach bug, has emerged as a fourth significant player, inducing fears of a more severe and widespread viral outbreak. According to the Centers for Disease Control and Prevention (CDC), the U.S. recorded nearly 500 norovirus outbreaks between August and December 2023, a substantial rise from the previous year’s numbers.

While the term "quad-demic" may sound ominous, the seriousness and consequences of such infections should be weighed in light of the U.S. healthcare system's experience with managing viral surges since the start of the COVID-19 pandemic.

1. Influenza (Flu)

Flu continues to be one of the most common and alarming seasonal illnesses. In the period spanning from 2023 to 2024, there were approximately 40 million cases of flu, and thousands of hospitalizations along with reported 47 deaths have been reported this season. Flu symptoms include fever, chills, cough, sore throat, muscle pain, and fatigue, with most recovering within a week or two but risky factors for severe illness effects occur in young children, elderly, and people with chronic conditions.

2. Covid-19

Despite its reduction from the first pandemic peak, COVID-19 is still rampant. The CDC estimates that alone between October and December 2023, there were between 2.7 and 5 million cases in the U.S. Hospitalization has increased by cities such as Los Angeles, Chicago, and New York. Symptoms are closely similar to the flu, fever, cough, and fatigue but uniquely presents in some cases as loss of taste and smell.

3. RSV

RSV is the most common cause of lower respiratory infections in infants, older adults, and immunocompromised individuals. While RSV peaked late in 2023 and early 2024, it continues to be a threat because it can lead to bronchiolitis and pneumonia. It is very similar to the common cold, presenting with symptoms such as congestion, runny nose, coughing, and fever, which can make it difficult to differentiate from flu or COVID-19 without testing.

4. Norovirus

Norovirus, also called the "stomach flu," is a highly contagious infection of the gastrointestinal tract, not a respiratory virus. It transmits quickly from contaminated food and water and contact with contaminated surfaces, causing such symptoms as diarrhea, vomiting, nausea, and stomach pain. Cases have shot up, the CDC said Monday, with reports of outbreaks surging compared with last year.

Is There a Challenge In Diagnosis Due to Overlapping Symptoms?

The greatest challenge during the quad-demic is how the four viruses are alike and thus make identification very hard with no testing applied. Most cases present symptoms common to all viruses: fever, tiredness, body pains, and respiratory, which includes coughing and congestions for influenza, COVID-19, and RSV; the other would be norovirus symptoms as nausea and vomiting can appear even in extreme influenza and COVID-19. This overlap increases the risk of misdiagnosis and delayed treatment, hence the need for early testing and proper medical guidance.

Also Read: Is US Preparing For A Quad- demic 2025?

Effective Prevention Strategies That Work

The best defense against these viruses is a combination of vaccines, hygiene, and lifestyle precautions. While lifestyle modifications are highlighted as part of the constant need to eat healthy, ensure daily movement and drinking adequate amount of fluids. There is a sure short two preventive strategies that are effective:

Vaccination

• Flu vaccine: Annual flu shots reduce the severity of infection, allergic flare ups and hospitalizations.
• COVID-19 vaccine: Though COVID-19 cases have declined, vaccination remains critical in preventing severe outcomes.
• RSV vaccine: Available for those aged 60 years and older, especially those with underlying conditions.
• Norovirus vaccine: No vaccine is yet available, but mRNA vaccine research is in progress.

Hygiene and Sanitation

• Washing hands frequently with soap and water for at least 20 seconds, especially after public exposure.
• Disinfect frequently touched surfaces regularly, use sanitiser when outside.
• Avoid close contact with infected people and wear masks.

Do You Need To Wear A Mask All The Time?

While debates on masked wear continue on, experts on mask-wear affirm that this does not only have a historical precedent but works towards reducing airborne viruses spreading within the environments. Hospitals, though, ensure masking in key sections of themselves. Publicized mask-wear remains a discretion, though massing indoors still goes a longer way in cases like peak flu seasons.

If you notice the symptoms of these viruses, then it's best to be confined at home and avoid having face-to-face interaction with others and seek immediate attention from your physician if your condition worsens. Quarantining for some days can decrease the spread of infection.

As we move into the first half of 2025 and beyond, staying informed and proactive is the best strategy for maintaining health and avoiding unnecessary panic. The key takeaway? Stay vigilant, but don’t be alarmed—these viruses are here, but so are the means to fight them.

The U.S. Centers for Disease Control and Prevention on Tuesday withdrew its decades-old guidance that all newborns in the country should be vaccinated against hepatitis B at birth. Instead, the decision has now been shifted to parents, who are advised to consult a healthcare provider when deciding whether babies born to hepatitis B-negative mothers should receive the vaccine, including the birth dose.

The change follows a recommendation made by Health Secretary Robert F. Kennedy Jr.’s vaccine advisory panel, marking a significant shift in public health policy. Earlier this month, the panel suggested that the birth dose be limited to newborns whose mothers test positive for hepatitis B or whose infection status is unknown. The CDC approved this recommendation as official policy on Tuesday. Here is what this change means for newborns moving forward:

Also Read: Indoor Air In Delhi Is More Toxic Than Outdoor Smog, Pulmonologist Warns

CDC Ends Guidance That All Newborns Should Get Hepatitis B Vaccine

Under the updated guidance, if parents decide against vaccinating their baby at birth but later believe the shot is necessary, the CDC now advises waiting until the child is at least two months old before administering the first dose. Since 1991, U.S. health authorities have supported universal infant vaccination against hepatitis B, with the first of three doses typically given shortly after birth. CDC recommendations influence health insurance coverage decisions and serve as a key reference point for doctors when determining vaccine schedules.

Public health experts have raised concerns that the shift toward what the CDC calls “individual-based decision-making” may leave more children vulnerable to the virus and could encourage families to skip vaccination without a strong federal directive. Kennedy, who has long opposed vaccines, has already introduced sweeping changes to the country’s vaccination policies.

CDC New Guidance On Hepatitis B Vaccine: What Does This Mean For Newborns?

Rather than advising hepatitis B vaccination for every newborn, the CDC now formally recommends that women who test negative for the virus discuss with their healthcare providers whether their babies should receive the first dose within 24 hours of birth. According to NBC News, the agency is also evaluating another proposal from the advisory panel, which suggests parents consult doctors about testing children for hepatitis B antibodies before deciding on second doses of the vaccine. Typically, the hepatitis B vaccine is administered as a three-dose series during infancy.

Also Read: ‘Fix Your Handwriting’: Indian Doctors Told to Write Clear, Legible Prescriptions Under New Rules

This policy shift stands out as one of the clearest departures from established medical consensus reflected in current CDC guidance. During discussions, the advisory committee relied on selective data and misinformation, while overlooking decades of research showing that hepatitis B vaccines are both safe and highly effective when given soon after birth.

“Removing the recommendation for newborns increases the likelihood that case numbers will rise again. This makes America sicker,” Senator Bill Cassidy, R-La., a liver specialist who has treated hepatitis B patients, wrote on X earlier this month. Despite the change, pediatricians are still expected to encourage parents to vaccinate their newborns.

The Department of Health and Human Services has stated that the updated guidance will not change insurance coverage for the vaccine. The shots will also remain available to newborns through the Vaccines for Children Program, which provides vaccines at no cost to uninsured or underinsured families.

Last month, the CDC also revised a webpage that had previously stated clearly that vaccines do not cause autism. The updated language now says studies have not ruled out a link, despite decades of scientific evidence showing no connection between vaccines and autism.

No more scribbling, notes a BBC report from October 1, 2025, where the Punjab and Haryana court tells doctors to fix their handwriting. Now, the National Medical Commission or NMC has issued nationwide order to the doctors to ensure their prescriptions are written in a clear and legible manner.

While jokes around the notoriously bad handwriting of many doctors that only can be read by pharmacist are common in India, but after the High Court's ruling, this joke is taken seriously. The High Court noted that "legible medical prescription is a fundamental right" as it can make a difference between life and death.

Also Read: Delhi Sees Rising Cancer Burden With Sharp Increase in Oral and Lung Cancers; Breast Cancer Remains Most Common

What Are The New NMC Guidelines On Doctor's Handwriting?

Under the new directive, the NMC ordered that doctors must:

• Write prescriptions in clear, legible handwriting, avoiding ambiguity.
• Arbitrary or unclear prescription writing will no longer be acceptable, as it compromises patient safety.
• Subcommittees will be formed in all medical colleges to monitor prescription practices and ensure compliance.
• Medical students will be taught the importance of clear prescription writing, making it a core part of clinical training.

The Background Of NMC Guidelines

The Punjab and Haryana High Court ordered doctors to fix their handwritings while it was looking at a case that involved allegations of rape. While checking a medico-legal report written by a government doctor who examined the woman, the court found it incomprehensible.

Also Read: Delhi Is a Gas Chamber Where Nothing Comes In or Goes Out, Says Expert; Neighboring States Not to Blame for AQI

Justice Jasgurpreet Singh Puri said, "It shook the conscience of this court as not even a word or a letter was legible".

"At a time when technology and computers are easily accessible, it is shocking that government doctors are still writing prescriptions by hand which cannot be read by anybody except perhaps some chemists," said Justice Puri.

Importance Of Clear Prescriptions

The World Health Organization (WHO) identifies medication errors as a major global patient safety challenge, contributing to avoidable injuries and deaths worldwide. Illegible prescriptions are a well-recognised cause of such errors.

A clear and readable prescription also:

Prevents misinterpretation

Poor handwriting leads to misinterpretation of the intended drug name, dosage, or instructions. Many drugs have names that look or sound alike, making clarity critical.

Ensures the right dosage

Unclear instructions when it comes to dosing result in giving out doses that are ten or one hundred times the correct amount, leading to toxicity or therapeutic failure.

Empowers patient understanding

When the patients are able to clearly read and understand the prescriptions and medication labels, they are more likely to take their medications correctly, reducing the margin for errors.

Reduces healthcare costs

Medication errors resulting from unclear prescriptions lead to increased hospital admissions, prolonged lengths of stay, and additional costs, placing a significant burden on the patient and the healthcare system.

Oral cancer cases recorded the sharpest in Delhi in 2025, as per the Union Health Ministry data presented in the Parliament. While there is no definitive explanation provided by the report by the Union Health Ministry, previous reports show that widespread use of tobacco has increased, and accounted for about 30% of all oral cancer cases in India alone.

As per the report shared by the Union Health Ministry, a 5.1% increase was scene in the reported increase of oral cancer, while lung cancer rose by 4.9% between the period 2023 and 2025.

Also Read: ‘Fix Your Handwriting’: Indian Doctors Told to Write Clear, Legible Prescriptions Under New Rules

The data showed that lung cancer increased among women, and it rose to 6.5%. In numbers, this would make 686 cases in 2025, which is up from the 644 cases recorded in 2024, and 604 in 2023. Among men, oral cancer had the highest growth, with a 5.8% increase. This led to 2,717 cases in 2025, compared to 2,569 cases in 2024 and 2,429 cases in 2023.

However, breast cancer remained the most prevalent cancer in the city. Data from the National Cancer Registry Programme indicate a steady rise in reported breast cancer cases, increasing from 3,198 in 2023 to 3,260 in 2024 and 3,321 in 2025. Oral cancer ranked as the second most common cancer overall, with combined cases among men and women reaching 3,208 in 2025.

A closer look at the data shows that oral cancer continued to rise in the city over the past three years. In 2023, Delhi reported 2,901 cases, including 2,429 among men and 472 among women. The number rose to 3,051 cases in 2024, with 2,569 cases in men and 482 in women. Among women, cases increased slightly further to 491 in 2025.

The International Journal of Research in Medical Sciences provide the tobacco use, betel quid chewing has seen a rising trend in India. Tobacco use includes chewing gutka and khaini in rural areas as well as smoking cigarettes in urban area, which continues to be the nation's leading preventable cause of cancer.

Cervical Cancer Shows a Decline

Cervical cancer followed a different pattern. Cases among women fell from 741 in 2023 to 716 in 2024, and then to 692 in 2025. This reflects a year-on-year decline of around 3.4 percent over both periods.

Rising Trends in Other Cancers Among Men

Among men, oral cancer showed the sharpest increase. Lung cancer cases also rose, climbing from 1,668 in 2023 to 1,814 in 2025. Prostate cancer followed a similar upward trend, with reported cases increasing from 1,168 in 2023 to 1,301 in 2025.

Delhi’s High Cancer Incidence Rate

The health ministry has pointed to Delhi’s relatively high Age-Adjusted Incidence Rate of cancer. Between 2015 and 2019, the AAIR stood at 146.7 per one lakh population among men and 132.5 among women. These figures are higher than those reported in cities such as Mumbai, Kolkata, Pune and Ahmedabad. The AAIR allows cancer rates to be compared fairly across regions with different age profiles.

Treatment Burden Extends Beyond Delhi

It is also important to note that Delhi attracts a large number of cancer patients from across north India and other parts of the country. Major tertiary care centres, including AIIMS and the Rajiv Gandhi Cancer Institute and Research Centre, contribute to a higher treatment load in the city.