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.

India’s Union Ministry of Health and Family Welfare has introduced "healthy lifestyle and mental wellness" as two key priority areas at the First Health Working Group (HWG) Meeting under the BRICS framework for the year 2026 in New Delhi.

HWG is a key platform for advancing cooperation in public health, said Punya Salila Srivastava, the Union Health Secretary while chairing the meeting.

She noted that as the BRICS Chair for 2026, India is guided by the overarching theme “Building for Resilience, Innovation, Cooperation and Sustainability”, reflecting a people-centric and humanity-first approach.

The theme underscores India’s commitment to strengthening collaborative frameworks that are responsive, inclusive, and future-ready.

India’s 2026 Chairship

While reaffirming commitment to existing priorities, the Union Health Secretary also proposed two new priority areas under India’s Chairship:

• BRICS Mission for Healthy Lifestyles: Aimed at promoting healthy behaviors and addressing key risk factors such as unhealthy diets, physical inactivity, tobacco use, and harmful use of alcohol
• Promotion of Mental Health and Wellness: Focusing on strengthening mental health services, addressing stigma, and integrating mental health into broader public health frameworks.

In addition, under the country’s Chairship, Srivastava said that the HWG aims to:

• Foster inclusive, sustainable, and evidence-driven health cooperation,
• Recognize the diverse health systems and socio-economic contexts of BRICS nations.
• Integrating traditional, complementary, and integrative medicine into health systems.

The BRICS Health Working Group

Srivastava hailed the BRICS Health Working Group meetings for having paved the way for collaboration on pressing health challenges in the recent year. She said that the HWG made efforts towards tackle communicable and non-communicable diseases, enhancing health systems, as improving access to affordable medicines.

“These efforts have further strengthened cooperation in pandemic preparedness, health technology innovation, and the promotion of Universal Health Coverage,” Srivastava said.

The meeting also deliberated on the nine priority areas, which include:

1. BRICS TB Research Network;
2. collaboration among BRICS Medical Products Regulatory Authorities;
3. BRICS Integrated Early Warning System for prevention and response to mass infectious diseases;
4. Digital Health Architecture for continuum of care, including specialised healthcare in remote areas;
5. BRICS Mission for Healthy Lifestyles;
6. promotion of mental health and wellness;
7. Traditional, Complementary and Integrative Medicine (TCIM);
8. fight against diseases driven by social determinants of health (DDSDH);
9. BRICS Network of National Public Health Institutes.

The meeting brought together senior health officials, technical experts, and delegates from BRICS member countries—Brazil, Russia, India, China, South Africa, Egypt, Ethiopia, the United Arab Emirates, and Indonesia to deliberate on priority areas of cooperation in public health.

The global experts welcomed India’s leadership and the shared theme of building resilience through innovation, cooperation, and sustainability.

They also emphasized

• deepening collaboration on tuberculosis through the BRICS TB Research Network,
• strengthening the BRICS integrated early warning system for infectious diseases,
• enhancing digital health architectures to improve access (especially in remote and vulnerable communities),
• advancing regulatory cooperation
• local production of medicines and vaccines.

Weeks after the US Food and Drug Administration (FDA) approved Eli Lilly's Orforglipron, marketed as Foundayo, the regulator is asking Eli Lilly to share more safety data on its first oral pill for weight loss.

The FDA has also sought more information on whether Foundayo could be linked to liver and heart problems, according to the FDA's new drug application approval letter.

Foundayo won FDA approval this month under the Commissioner’s National Priority Voucher, a pilot program intended to fast-track drug reviews.

Foundayo: What More Does The FDA Want From Lilly

In the approval letter, the FDA noted that the currently available data do not fully clarify several potential risks, including

• heart problems such as heart attack and stroke,
• drug-induced liver injuries,
• delayed stomach emptying, which is when food remains in the stomach for too long.

However, the FDA asking for more data “doesn’t mean a safety problem has been found. It means they want more definitive long-term data,” Dr. Christopher McGowan, a North Carolina-based gastroenterologist, told NBC News.

“With orforglipron, it’s a newer, non-peptide version of a GLP-1, so we don’t yet have the same depth of safety data as the injectables,” he added.

Also read: Eye Drops: US FDA Recalls Over 3 Million Products Over Safety Concerns

Further, the agency also requires Lilly to run a series of new studies, including a registry tracking children with obesity who use weight loss drugs and a pregnancy registry to monitor outcomes.

Foundayo: How Did The FDA Approve?

In a statement, the US FDA said that "Foundayo has been approved for use in combination with a reduced-calorie diet and increased physical activity. The pill is targeted to reduce excess body weight and maintain weight reduction for the long term in adults with obesity or overweight".

The US FDA approved Foundayo after two randomized, double-blind, placebo-controlled trials in adults with obesity or overweight showed benefit.

In these trials, 72 weeks of treatment with Foundayo, in combination with a reduced-calorie diet and increased physical activity, resulted in a statistically significant and clinically meaningful reduction in body weight.

Foundayo’s approval comes after the US FDA in December last year approved Novo Nordisk’s Wegovy pill — the first-ever GLP-1 pill for weight loss. The Danish drugmaker rolled out the pill in January this year.

Novo Nordisk was also the first to launch oral GLP 1 Rybelsus to treat type 2 diabetes. It was approved by the US FDA in September 2019.

Also read: US FDA Recalls China-made Cough Drops And Throat Lozenges

How Did Lilly React To The FDA's Query?

The FDA’s post-approval requirements are routine and consistent with the agency’s approach to ongoing safety reviews of newly approved drugs, according to a Lilly spokesperson, NBC News reported.

“Patient safety is Lilly’s top priority, and we actively monitor, evaluate, and report safety information for all our medicines,” the spokesperson said.

Meanwhile, Lilly has started selling the drug from April 6 through its direct-to-consumer platform LillyDirect at $149 per month for the lowest dose for self-pay customers, on par with Novo's pill. "Shortly after,” it will be available through retail pharmacies and telehealth providers in the US, as per Lilly.

Indian pediatrician Dr Sivaranjani Santosh has resigned from the Indian Academy of Paediatrics (IAP) over lack of support, alleged threats, and false allegations, amid an ongoing controversy over the marketing of oral rehydration solution (ORS)-like products.

The Hyderabad-based pediatrician has been a key public health figure who fought for eight long years to stop FSSAI—the country’s apex food regulator—from using the term ORS by brands of fruit-based, non-carbonated beverages, in October last year.

She again voiced her concerns with the IAP when the manufacturer in January 2026 launched a rebranded version, ERZL for everyday hydration.

Dr Santosh opposed the move and called out on IAP to prevent the launch, saying it closely resembled ORS and could mislead people, especially those in rural areas.

However, she did not receive any support from the IAP, and no action was taken. Rather, she received a legal notice from Kenvue over her comments. Kenvue Inc. is an American consumer health company and was formerly the Consumer Healthcare division of Johnson & Johnson.

The notice from Kenvue claimed that Dr Santosh has been maligning the names of ORSL and ERZL for her "own commercial benefits" and for "increasing the number of followers" on her page.

Deeply saddened by the leadership at the IAP, which she alleged is supporting Kenvue, Dr Santosh resigned. She now vouches to fight alone.

“I thought enough of this toxicity. I'll fight it alone. All this while, if I could fight it alone, why can't I do it?” she told HealthandMe.

What Is The Controversy About Dr Sivaranjani Santosh?

Speaking to HealthandMe, the pediatrician narrated the ordeal – legal notices from pharmaceutical companies, false accusations of her integrity and character in the last few years.

Dr Santosh has been campaigning that commercial beverages labeled as ORS were often high in sugar and nutritionally different from the World Health Organization (WHO)-recommended Oral Rehydration Solution, a life-saving treatment for dehydration.

Her fight began in 2022, when she filed a Public Interest Litigation (PIL) in the Telangana High Court seeking directions for manufacturers to remove the letters “ORS” from the product name ORSL.

Eight years after the PIL, the Food Safety and Standards Authority of India (FSSAI), in October 2025, banned the use of the ‘ORS' label on beverages — including ORS that did not meet the WHO standards. The regulator deemed such branding to be misleading and a potential health risk, as many products contained excessive amounts of sugar compared to genuine medical ORS.

However, Kenvue launched a rebranded version, ERZL, in January this year. She again opposed and stated: “ERZL is not ORS. And it should not be given to children below two years of age".

Noting that her messages "upset these people”, she faced a backlash, including a legal notice from the company.

According to Dr Santosh, attempts were also made to gather endorsements from pediatricians claiming that sucralose is safe and to submit these to the FSSAI. She publicly criticized the move, calling it “shameful.”

Further, Dr Santosh also voiced out her concerns against IAP for allowing the company to set up a stall with the controversial product at the Pedicon, a major pediatric conference.

When she raised the matters on social media, the company made the statement: “Our products are very scientific. Some people are spreading misinformation and scientific information”.

The pediatrician also claimed to have alerted IAP leadership weeks earlier, warning that the ERZL’s branding could mislead people—especially in rural areas—into confusing it with ORS.

“We are not talking about the educated people who have been following this. We are talking about the ignorant poor people in the villages,” the doctor said.

She further alleged that instead of backing her concerns, sections of the leadership attempted to discredit her.

Following a series of exchanges and growing tensions, she announced her resignation, citing a “toxic environment.”

Dr Santosh said that "parallelly, the leadership was spreading messages to all the people that I am abusive and I'm arrogant." In response, she stated: "If I have to choose between children and IAP, I will choose children".

Amid the controversy, the IAP released a position statement on ORS and electrolyte drinks. The doctor criticised the statement as “ambiguous” and questioned its focus solely on sucralose, alleging a potential conflict of interest.

She added that Kenvue also marketed for "ERZL as the new form of ORSL", which also bypassed the FSSAI and Delhi High Court orders.

What Is The Way Forward?

Noting that her battle will continue against ERZL, Dr Santosh said she will continue advocating for child health issues in India

"I'm trying to raise awareness about first aid and CPR. I've trained so many people. Now I'm motivated."

The pediatrician also wants to advocate for safer drug formulations, restrictions on over-the-counter medicines, and wider awareness of first aid and CPR.

The list includes paracetamol, which is being sold under various names and doses in the country.

"We want one paracetamol in India".

HealthandMe is trying to reach out to the Indian Academy of Paediatrics (IAP). The copy will be updated once a response is received.