Leadership

Respiratory season: The emergency you can put on a calendar

Written by ShiftKey

September 28, 2026

Respiratory season is one of the only emergencies that predictably arrives every year in roughly the same months, in a shape that is broadly known in advance. Yet it can still produce conditions that look similar to those of a disaster: emergency departments running at capacity, beds added in hallways and care teams working stretches nobody scheduled.

One of the reasons the respiratory surge catches hospitals and long-term care facilities flat-footed every year is that it builds slowly. The volume climbs just a little each week starting from October through December – until early January, when it suddenly stops being manageable. And the respiratory season doesn't just fill the building, it impacts the healthcare professionals working in the buildings at the same time.

What last season looked like for hospitals

Last year, flu hospitalizations tracked through CDC's surveillance network reached the third highest rate since 2011, with almost 30,000 confirmed admissions between October and late April.

Among children it was the second highest rate for that age group in the same span. At the January peak, 33 states reported high or very high activity, and outpatient visits for flu-like illness hit their highest level in nearly three decades.

According to CDC assessments, the peak of combined hospitalizations from COVID, flu and RSV fell on a single week ending January 3, directly during the end-of-year holiday period.

Some areas were already feeling the strain earlier. Connecticut hospitals were adding beds and setting up makeshift rooms byThanksgiving. In Phoenix, three of the region's largest systems were simultaneously strained, and leadership brought nurses from Prescott to provide coverage.

The same wave, a different shape in post-acute

Post-acute facilities don't necessarily experience respiratory surge as an immediate influx of new patients through the front doors. In long-term care facilities, it can start inside the building with a resident population that is considerably more vulnerable to what's circulating.

Research published in the Journal of Infectious Diseases found RSV-associated hospitalization rates three to nine times higher among assisted living residents and three to four times higher among skilled nursing residents, compared with adults 65 and older living independently.

That difference is just a reflection of those who live in these settings (age, comorbidity burden and the realities of congregate living), not how the facilities are managed.

The surge also moves fast. In federal long-term care reporting last season, the resident flu hospitalization rate more than doubled inside a single week, from 6.6 to 14.3 per 100,000 residents, as the season turned in early December.

The two settings of acute and post-acute are linked. When hospitals fill, discharge activity accelerates and post-acute census climbs during the same weeks that a building is managing respiratory illness among its existing residents.

The parts that hit both

Neither hospitals or post-acute settings can plan for the surge in isolation, because it doesn't distinguish between the people in the beds and the people at the bedside.

Care team members live in the same communities, they have children in the same schools and they encounter the same seasonal spread as everyone else. When regional transmission peaks, some of them will be out and some will be in the building: in surveys compiled by AHRQ, between 50% to 90% of clinicians report they have worked or would work while experiencing symptoms of infection.

In one survey of 536 clinicians at a large children's hospital, 83% worked sick at least once in the previous year. A prospective study of acute care teams found 28.3% missed at least one workday over a season, with more than 80% of those absences tied to flu-like illness.

This lands on a baseline with already very little slack. The national shortage of registered nurses and certified nursing assistants is both well-known and ongoing. In a McKnight's 2026 outlook survey, hiring RNs and CNAs ranked as the top two workforce concerns.

Demand rockets, while available coverage drops, in the same weeks, in both settings.

Planning before the season, not in the middle of it

The advantage of identifying risks on a schedule is that decisions can be planned early. These are a few to think over well before November:

What surveillance signals does your team watch? Is there a specific threshold that activates the plan?

Who owns that call? What has to happen before they make it?

Can the schedule handle several absences at the same time during a peak week?

For hospitals, that extends to ED throughput, boarding capacity and coordination with the post-acute providers that you transfer patients to.

For skilled nursing and assisted living facilities, CDC's viral respiratory pathogens toolkit covers the outbreak side (early identification, cohorting and response protocols) along with how admissions velocity can change when referring hospitals discharge their patients quickly during a surge.

Coverage belongs in the plan

Emergency preparation is all about identifying failure points in advance and planning what to do when you hit it. Respiratory season is actually one case where you can put a rough date on it. A decision made in September is a different decision than one made in the second week of January.

A technology marketplace can be part of a seasonal plan. ShiftKey allows hospitals and post-acute facilities to connect directly with independent, licensed professionals in their own communities who can step in when internal teams are stretched, with the visibility to see who's interested in covering shifts and the flexibility to scale coverage as the curve moves. It can be one option among several, and the time to put it in place is before the respiratory season starts.