Monitoring Report: Respiratory Viruses - February 2026 Data

Based on Truveta EHR data from October 2020 to March 2026, respiratory virus-associated hospitalizations in the US declined slightly in February 2026 overall and among older adults due to reduced influenza and COVID-19 activity, while hospitalizations among children aged 0–4 increased slightly, driven primarily by a sharp rise in human metapneumovirus (HMPV).

The Gist

Imagine the United States as a giant, bustling hospital city. Every day, thousands of people walk through its doors, some for broken bones, some for heart issues, and some because they can't breathe well. This report is like a weather forecast for the "sickness storms" that hit this city, specifically looking at the six most common germs that make people's lungs sick: COVID-19, the Flu, RSV, HMPV, Parainfluenza, and Rhinovirus.

Here is the simple story of what happened in February 2026, told with some everyday analogies.

🌧️ The Big Picture: The Storm is Calming Down

Think of respiratory viruses as a heavy rainstorm hitting the hospital.

• In January, the storm was quite heavy. About 4.3% of all people in the hospital were there because of these germs.
• By late February, the rain started to let up. That number dropped to 3.6%.
• Why? The two biggest "clouds" (the Flu and COVID) started to shrink. The Flu dropped by about a third, and COVID dropped a bit too. The other germs (like RSV and HMPV) were like a light drizzle—steady and low, but not getting worse.

👶 The Kids' Playground (Ages 0–4)

Now, let's zoom in on the toddlers and babies. Their playground is usually the most chaotic during virus season.

• The Trend: While the storm was calming down for everyone else, the kids' playground actually got a tiny bit busier in February. The rate of sick kids went up by about 12%.
• The New "Boss" of the Playground: Usually, RSV (a germ that makes babies cough a lot) is the king of the playground. It still holds the top spot.
• The Surprise Guest: However, a germ called HMPV (Human Metapneumovirus) decided to throw a surprise party. It more than doubled in activity! Imagine if a quiet kid suddenly started running around twice as fast as everyone else. That's what happened with HMPV.
• The Rest: The Flu, COVID, and others stayed pretty steady for the kids, not getting much worse or better.

👴 The Senior Center (Ages 65+)

Now, let's look at the older adults. This group is usually the most vulnerable to these storms.

• The Trend: Good news! The storm here is definitely clearing up. The number of sick seniors dropped from 5.3% to 4.4%.
• The Reason: Just like the general population, the Flu and COVID are retreating. They are the main reason the numbers are going down.
• The One Glitch: While the big storms left, RSV decided to stick around a little longer and actually got slightly stronger for seniors. But overall, the senior center is seeing fewer sick people than it did in January.

🔍 How Did They Know? (The Detective Work)

The authors didn't just guess; they acted like super-detectives.

• They looked at real-time medical records from 18% of all the doctors and hospitals in the US. That's a massive amount of data, like checking the diaries of millions of people.
• They counted how many people were admitted to the hospital and checked if they tested positive for these six germs within two weeks of arriving.
• They also looked at test positivity rates (how often a test came back "Yes, you have a virus"). This is like checking how many people in the city are actually carrying an umbrella when it rains.

🚧 The Fine Print (Limitations)

Even the best detectives miss a few clues. The authors admit:

• Under-testing: Some people might be sick but never got tested, so they aren't in the count. It's like counting raindrops but missing the ones that fell on the roof instead of the ground.
• Privacy: To protect patient privacy, some tiny numbers were hidden, which might make it look like zero people were sick in a specific week, even if a few were.
• Preliminary: This is a "snapshot" taken in March 2026. As more data comes in, the picture might get slightly clearer or change a little.

🏁 The Bottom Line

February 2026 was a month of transition.

• For the whole country: The worst of the winter virus season is passing. The Flu and COVID are taking a break.
• For the elderly: They are breathing a little easier as the big viruses fade.
• For the little ones: The playground is still active. While the Flu is quiet, HMPV is having a moment, and RSV is still the main troublemaker.

The takeaway: The "virus winter" is slowly turning into spring, but parents of young kids should still keep an eye out for that sneaky HMPV, while seniors can feel a bit more relief as the Flu season winds down.

Technical Summary

1. Problem Statement

Public health surveillance for respiratory viruses often relies on fragmented data sources, leading to gaps in real-time understanding of hospitalization trends. While the CDC provides surveillance data, there is a need for more granular, timely, and comprehensive data derived from electronic health records (EHR) to monitor the burden of six common respiratory viruses: COVID-19, Influenza, Human Metapneumovirus (HMPV), Parainfluenza, Respiratory Syncytial Virus (RSV), and Rhinovirus.

Specifically, there is a lack of detailed insight into how these viruses impact high-risk populations—infants and children (ages 0–4) and older adults (ages 65+)—during the seasonal transition periods. This study aims to fill that gap by providing current hospitalization trends through March 1, 2026, to inform clinical care and public health policy.

2. Methodology

• Data Source: The study utilized a subset of real-world EHR data from Truveta, a collective of US health systems representing over 18% of all daily clinical care in the United States. The data covers ten states: California, Florida, Texas, New York, Illinois, Virginia, Washington, Michigan, Ohio, and Arizona.
• Study Period: October 1, 2020, to March 1, 2026.
• Population:
  • Total Cohort: 1,029,468 hospitalizations involving 904,312 unique patients.
  • Inclusion Criteria: Patients hospitalized who tested positive for one of the six target viruses within 14 days prior to or during hospitalization.
  • Sub-populations: Infants/children (0–4 years) and Older adults (65+ years).
• Data Processing:
  • Infection Grouping: To avoid double-counting, hospitalizations occurring within 90 days of a positive test were grouped as a single infection event.
  • Metrics Calculated:
    • Hospitalization Rate: Weekly rate of virus-associated hospitalizations divided by total hospital admissions.
    • Test Positivity Rate: Monthly rate of positive lab results divided by total lab results with known outcomes.
  • Limitations: The data is unadjusted for undertesting, variability in testing protocols across providers, and potential suppression of small counts for privacy.

3. Key Contributions

• Granular Surveillance: Provides a comprehensive view of six respiratory viruses simultaneously, rather than focusing solely on Influenza or COVID-19.
• Demographic Stratification: Offers specific trend analysis for the two most vulnerable demographics (pediatric 0–4 and geriatric 65+), highlighting divergent trends between these groups.
• Timeliness: Delivers data up to March 2026, supplementing CDC surveillance with independent, real-world clinical data.
• Comorbidity Context: Includes data on high-risk comorbidities (e.g., Asthma, COPD, Chronic Lung Disease) associated with these hospitalizations.

4. Key Results (February 2026 Trends)

A. Overall Population

• Trend: Respiratory virus-associated hospitalizations declined slightly in February 2026, dropping from 4.3% of all hospitalizations (end of Jan) to 3.6% (end of Feb), a 15.3% decrease.
• Drivers of Decline: Primarily driven by Influenza (-34.2%) and COVID-19 (-16.0%).
• Stable Viruses: RSV, Rhinovirus, HMPV, and Parainfluenza remained relatively low and stable.
• Dominant Pathogen: Despite the decline, Influenza remained the largest contributor to respiratory virus-associated hospitalizations.

B. Infants and Children (Age 0–4)

• Trend: Contrary to the overall population, hospitalizations in this group increased by 11.8%, rising from 3.8% to 4.3% of all pediatric hospitalizations.
• Primary Driver: HMPV was the sole driver of this increase, with HMPV-associated hospitalizations more than doubling (+111.7%).
• Other Viruses: RSV, Rhinovirus, Influenza, COVID, and Parainfluenza remained stable.
• Dominant Pathogen: RSV continued to represent the largest share of respiratory virus hospitalizations in this age group (2.1% of all hospitalizations), followed closely by the rising HMPV.

C. Older Adults (Age 65+)

• Trend: Hospitalizations declined modestly, dropping from 5.3% to 4.4% of all hospitalizations (-17.0%).
• Drivers of Decline: Significant reductions in Influenza (-38.3%) and COVID-19 (-18.7%).
• Notable Increase: RSV-associated hospitalizations increased by 22.6%, while other viruses remained low/stable.
• Test Positivity: Influenza and Parainfluenza test positivity decreased significantly, while RSV, HMPV, and Rhinovirus test positivity increased.

5. Significance and Conclusion

• Seasonal Transition: The data indicates a general seasonal decline in respiratory virus burden as the winter season wanes, particularly driven by the reduction of Influenza and COVID-19.
• Divergent Risks: The study highlights a critical divergence in risk profiles:
  • Older adults are seeing a relief in hospitalization burdens as Influenza and COVID recede.
  • Young children (0–4) are experiencing a rise in hospitalization burden, driven specifically by a surge in HMPV, suggesting a shifting viral landscape in pediatrics that requires targeted monitoring.
• Public Health Implication: While Influenza remains the dominant overall contributor, the surge in HMPV among young children and the persistent presence of RSV in both pediatric and geriatric populations suggest that surveillance must remain vigilant for non-Influenza/non-COVID pathogens.
• Clinical Utility: These findings support the need for continued clinical vigilance and resource allocation, particularly for pediatric units where HMPV activity is accelerating, and for geriatric units where RSV activity is rising despite the decline in other viruses.

Note: As a preprint not yet peer-reviewed, the authors caution that these findings should not yet guide clinical practice but serve as a robust supplementary surveillance tool.