Acute Respiratory Illness
Update prepared by Lea Hamner, Contract Epidemiologist for Barnstable County Department of Health and Environment. This page is updated every other Friday.
Introduction
If you’ve navigated to this page, you’re likely wondering how to understand the current climate of respiratory disease transmission in our communities here on Cape Cod. Perhaps you’re worried about COVID-19, RSV, the flu, or all three; the trifecta of what are now referred to as “acute respiratory illnesses”.
Previously, we provided COVID-19 Case Data in Barnstable County as verified by healthcare providers and reporting of targeted diagnostic testing to state and local public health agencies. Now, with the changing landscape of at-home COVID testing along with the co-occurrence of flu and RSV—two viruses which present with similar symptoms to COVID-19—we need a broader perspective to look at viral transmission in our region.
Included on this page:
Latest epidemiology summary for the Cape & Islands
Data details on COVID-19, seasonal influenza, H5N1 bird flu, and RSV
Dashboards for disease severity (ED visits and hospitalizations) & vaccination
Lower Cape TV Talks to Contract Epidemiologist about Seasonal Influenza
March 14, 2025 – CAPE COD, MA – There has been a lot of attention on the avian flu this winter, but at the same time – perhaps somewhat under the media radar – this season is seeing higher than normal activity of the regular influenza. The Massachusetts Department of Public Health has “observed a possible increase in the number of cases of children with influenza with neurologic complications compared to prior seasons. Since July 2024 ten children have died from complications.” LCTV spoke with Barnstable county’s epidemiologist about the situation.
March 17, 2025 Epidemiology Update:
Seasonal influenza is circulating at VERY HIGH levels in the Cape & Islands, while other respiratory viruses like RSV and COVID-19 have decreased since New Years. Bacterial respiratory infections like whooping cough (pertussis) and walking pneumonia (mycoplasma pneumonia) are circulating as well.
Infectious respiratory diseases are preventable. You can protect yourself from these illnesses by:
- Staying up to date on vaccinations
- Practicing good hand washing
- Practicing cough/sneeze etiquette
- Taking steps for cleaner air
- Opting to mask and/or physically distance when you feel sick or are around others who feel sick.
See below for detailed information about COVID, Flu, and RSV. For more information on other respiratory conditions on the rise, please visit:
- Pertussis (whooping cough): a bacterial infection, with infections increasing locally, statewide, and nationally and is currently exceeding pre-pandemic levels. Teenagers have been especially impacted.
- Mycoplasma pneumoniae (walking pneumonia): a bacterial infection with increases observed statewide and nationally, especially in young children.
Data Details
Acute Respiratory Disease
Emergency Department visits for acute respiratory disease are decreasing from peak activity in January and February. Activity is now at moderate levels on the Cape & Islands compared to low levels in the rest of the state. Young children (under 5 years old) and the elderly (over 65) are most severely affected.
Nationally, the amount of acute respiratory illness causing people to seek healthcare is at a moderate level as of March 14, 2025. (CDC)
Table 1. Acute Respiratory Disease Severity Indicators, Number of Visits and Percent of Total Visits that Week
| Most Recent Week | Prior Week | |
| County | (3/2–3/8) | (2/23–3/1) |
| Emergency Department Visits | Number (Percent) | Number (Percent) |
| Barnstable | 274 (13.9%) | 310 (14.9%) |
| Dukes | 47 (20.0%) | 48 (20.3%) |
| Nantucket | 57 (23.1%) | 38 (16.8%) |
| MA State | 12.6% | 14.8% |
| Hospitalizations | ||
| Barnstable | 114 (26.4%) | 119 (26.5%) |
| Dukes | 5 (31.3%) | 4 (20.0%) |
| Nantucket | 1 (25%) | 4 (36.4%) |
| MA State | 16.3% | 21.1% |
Source: MA DPH Respiratory Illness Dashboard, embedded at bottom of page.
“Acute respiratory disease” is a broad category that includes viral respiratory illnesses like COVID, influenza, and RSV but also bacterial infections like pneumonia and whooping cough (pertussis) and many other respiratory conditions. Learn what is included in “Acute Respiratory Disease” here.
COVID-19
Transmission: COVID-19 case counts and wastewater are showing LOW & DECREASING levels of transmission in the state and Cape & Islands region. While reported COVID-19 cases are the tip of the iceberg, trends have steadily decreased from the New Years peak. On Cape & Islands, weekly case rates and percent positivity dropped from the week prior which may indicate lower transmission but could also be a product of fewer people testing.
Table 2. COVID-19 Transmission Indicators
| Most Recent Week | |
| County | (3/2–3/8) |
| Weekly Case Rate per 100,000 Residents | |
| Barnstable | 6.6 |
| Dukes + Nantucket | 8.6 |
| Percent Positivity | |
| Barnstable | 2.5% |
| Dukes + Nantucket | 3.3% |
Statewide, wastewater concentrations are at low-to-moderate levels (0.4 million) for the week of 2/23–3/1. Locally, the most recent wastewater data comes from Wareham and Nantucket. Wareham wastewater concentrations were low (0.3 million copies/L) on 3/6. In Nantucket, where the tourism season has slowed to its lowest levels, concentrations registered at low levels (0.15 million) on 3/6.
Severity: Emergency department visits and hospitalizations remain at LOW/BASELINE levels locally and statewide. However certain populations are more affected. People older than 65 and younger than 5 years old are most likely to be seen in the emergency department or hospitalized for COVID-19.
Table 3. COVID-19 Severity Indicators, Number of Visits and Percent of Total Visits that Week
| Most Recent Week | Prior Week | |
| County | (3/2–3/8) | (2/23–3/1) |
| Emergency Department Visits | Number (Percent) | Number (Percent) |
| Barnstable | 14 (0.7%) | 12 (0.6%) |
| Dukes | 1 (0.4%) | 3 (1.3%) |
| Nantucket | 0 | 0 |
| MA State | 0.5% | 0.6% |
| Hospitalizations | ||
| Barnstable | 7 (1.6%) | 7 (1.6%) |
| Dukes | 0 | 1 (5%) |
| Nantucket | 0 | 0 |
| MA State | 0.8% | 0.9% |
Source: MA DPH Respiratory Illness Dashboard, embedded at bottom of page.
Nationally COVID-19 activity is declining but elevated in some areas of the country. Wastewater levels and emergency department visits are at low levels, and laboratory percent positivity is stable. Emergency department visits and hospitalizations are highest in older adults and emergency department visits are also elevated in young children.
There is still time to benefit from getting your recommended immunizations to reduce your risk of illness this season, especially severe illness and hospitalization. CDC expects the 2024-2025 COVID-19 vaccine to work well for currently circulating variants. There are many effective tools to prevent spreading COVID-19 or becoming seriously ill.
To read more about trends, visit:
- State data sources: MA DPH Viral Respiratory Illness Reporting
- National data sources: CDC Data Tracker, CDC Variant Tracker
Seasonal Influenza
Seasonal influenza is circulating at VERY HIGH levels in the Cape & Islands, even while the rest of the state has dropped a level to “high.” We’re seeing an significant number of children (especially those under 5 years old) going to the Emergency Department for influenza. The oldest in our community (those over 80 followed by those 60-79 years old) are the ones increasingly being hospitalized.
Seasonal influenza activity remains elevated nationally but has decreased for four consecutive weeks. Data to date suggest the season has peaked, however, flu-related medical visits, hospitalizations, and deaths remain elevated, and CDC expects several more weeks of flu activity. Additional information about current influenza activity can be found at: MA DPH Influenza Reporting Dashboard and CDC Weekly U.S. Influenza Surveillance Report.
Table 3. Flu Severity Indicators, Number of Visits and Percent of Total Visits that Week
| Most Recent Week | Prior Week | |
| County | (3/2–3/8) | (2/23–3/1) |
| Emergency Department Visits | Number (Percent) | Number (Percent) |
| Barnstable | 50 (2.5%) | 74 (3.6%) |
| Dukes | 22 (9.4%) | 16 (6.8%) |
| Nantucket | 7 (2.8%) | 3 (1.3%) |
| MA State | 3.1% | 4.5% |
| Hospitalizations | ||
| Barnstable | 17 (3.9%) | 25 (5.6%) |
| Dukes | 1 (6.3%) | 0 |
| Nantucket | 1 (25%) | 0 |
| MA State | 3.1% | 5.2% |
Source: MA DPH Respiratory Illness Dashboard, embedded at bottom of page.
Avian Influenza (H5N1 Bird Flu)
**Cape & Islands Bird Flu information can now be found in a dedicated page here: www.capecod.gov/birdflu.**
RSV
RSV activity has decreased to LOW levels locally, statewide, and nationwide. RSV activity peaked in Massachusetts around the Christmas holiday and has since decreased. Emergency department visits and hospitalizations are highest in children and hospitalizations are elevated among older adults in some areas.
Nationally, RSV activity is declining in most areas of the country. Emergency department visits and hospitalizations are highest in children and hospitalizations are elevated among older adults in some areas.
Table 4. RSV Severity Indicators, Number of Visits and Percent of Total Visits that Week
| Most Recent Week | Prior Week | |
| County | (3/2–3/8) | (2/23–3/1) |
| Emergency Department Visits | Number (Percent) | Number (Percent) |
| Barnstable | 1 (0.1%) | 3 (0.1%) |
| Dukes | 0 | 1 (0.4%) |
| Nantucket | 2 (0.8%) | 2 (0.9%) |
| MA State | 0.2% | 0.3% |
| Hospitalizations | ||
| Barnstable | 1 (0.2%) | 1 (0.2%) |
| Dukes | 0 | 0 |
| Nantucket | 0 | 1 (9.1%) |
| MA State | 0.2% | 0.5% |
Source: MA DPH Respiratory Illness Dashboard, embedded at bottom of page.
Respiratory Illness & Vaccination Dashboards
These dashboards provides data on:
- Emergency department (ED) visits and hospital admission related to acute respiratory diseases, including COVID-19, influenza (the flu), and RSV.
- Vaccination rates
Dashboards are maintained by MA DPH, updated on Thursdays. Please visit the source webpage–MA DPH Viral Respiratory Illness Reporting–for the most accessible format of this dashboard and the underlying data.
