Children's hospitals in the US are being slammed by the double whammy of the flu and RSV, or respiratory syncytial virus, even as Covid cases start to climb in some areas. With the winter holidays coming up, we seem to be headed straight toward a dreaded "tripledemic". But there are some precautions we can take to avoid making a bad situation worse.

"People are just working really hard, there's patients everywhere," says Surabhi Vora, an infectious-disease specialist at Seattle Children's Hospital. She sounded exhausted after a week on call. Daily reports on her hospital's capacity show it's often over 100 per cent. The emergency room? Full. Acute care? Full. The ICU? Full.

I heard a similar story from paediatric infectious-disease doctors around the country. Just when children's hospitals thought they were turning a corner on RSV, the flu started to surge. The Centers for Disease Control and Prevention's flu map is lit up like a Christmas tree, with nearly every state in the US currently at "high" or "very high" flu activity. Covid, meanwhile, also seems to be trying to make a comeback.

Worse, certain medicines, particularly ones used to treat children, are in short supply. Those include Tamiflu, an antiviral that can be given to young children and older adults within the first few days of the flu, the liquid form of amoxicillin, and the asthma treatment albuterol. I've also heard from parents struggling to find children's Tylenol and Motrin, which are used to reduce fevers in young kids.

It's a recipe for a horrible, no good, very bad holiday season.

To avoid the worst of it, make a thoughtful plan for keeping your family healthy over the holidays — especially for how to celebrate together without putting the most vulnerable at risk.

"Gathering is still important. But we can do it safely," says Amy Arrington, medical director of the Pediatric Special Isolation Unit at Texas Children's Hospital in Houston.

The first thing on every infectious-disease doctor's plan for safer holiday celebrations is an obvious one: get a flu shot.

The US has a lot of room for improvement here, particularly among our most vulnerable. As of November 19, only about 40 per cent of children had received their flu vaccine, according to the CDC. The numbers are worse for pregnant people, with just 36.5 per cent vaccinated as of the end of October — a significant drop from the 48.6 per cent coverage in the group by that time in 2021.

Some might skip the flu vaccine, thinking it's too late to matter before the holidays. Not so, infectious-disease doctors say. Protection starts to kick in about a week after the shot, and is really effective two weeks post-inoculation. In other words, if you celebrate Christmas and plan to gather with family, you still have time — if you act now.

Even if you've had the flu this year, it's still worth getting the shot, says Elizabeth Schlaudecker, an infectious-diseases doctor at Cincinnati Children's Hospital Medical Centre. That'll extend your protection longer, and against other flavours of the virus.

"We suspect with the way that viruses have been circulating that we will probably see additional strains of flu going into winter and spring," she says.

Now for step two: Get your Covid booster. The virus is starting to elbow its way back into the mix - Los Angeles County, for example, is reporting a spike in cases — yet the most vulnerable people in the US are not as protected as they could be. As of November 30, only 32.6 per cent of people aged 65 and older had gotten their bivalent Covid booster, a group for which hospitalisations are once again on the rise. As with the flu vaccine, the immune system needs about two weeks to become trained after this shot.

Beyond vaccines, any holiday plan should consider the people most at risk of serious infections, whether that's flu, RSV or Covid. Because my family's gathering will include my 92-year-old grandmother and my cousin's one-year-old daughter, I'm advocating for everyone to be more cautious for the week or so before the event. That means masking in public places (yes, an unpopular move, but I'd rather do it on the subway than at our Christmas dinner) or opting for outdoor activities that lower the chances of catching a bug.

Several doctors I spoke with also put in a plug for handwashing. While perhaps oversold in the early days of Covid, it's a useful tool for mitigating the spread of the flu and RSV. Schlaudecker's family all lined up together at the sink at Thanksgiving to make sure everyone got in a good scrub before dinner.

The final part of the plan is something we all know, but really need to heed this year: If you're sick, stay home. Many use at-home Covid tests to feel a bit safer about large gatherings (on that front, experts recommend taking two, one a few days before an event and another just before it starts).

But we also might be tempted to use that negative Covid test as a free pass to go out into the world. It's not. Those sniffles or aches might signal the flu or RSV or something else, so take them seriously. Don't be a germ-spreading Grinch.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.