America shrugs off its twindemic

• Though less lethal than COVID-19, the viruses pose a major threat to children and immunocompromised adults. And we're just in November, with the threat of new COVID variants still looming as people plan indoor gatherings and firm up holiday travel.

Yes, but: Americans are good at normalizing risk and have been less and less willing to change their personal behavior since the pandemic's Delta wave.

• The creeping threat of another viral outbreak has also been pushed aside by elections, the economy, war and natural disasters.
• "If you don’t have children and are a young healthy adult, it's going to be hard to convince you to mask up to protect the population at large," said Yale infectious diseases specialist Scott Roberts.

Driving the news: Much of the current focus is on RSV, or respiratory syncytial virus, which is affecting high numbers of children and has been straining hospitals for weeks.

• Boston Children's Hospital postponed some elective surgeries to ease the crush, while Johns Hopkins Children's Center began using triage tents to manage caseloads the way that it did during the worst of the pandemic.
• Children's National Hospital in Washington, D.C., at one point in October had 18 children waiting for a pediatric intensive care unit bed, according to the Washington Post.

Meanwhile, seasonal flu has been surging through the southeast, hospitalizing thousands and stressing some emergency departments and urgent care centers.

• Some surveys suggest as many as four in 10 Americans are uncertain about or don't plan to get a flu shot this season.

The intrigue: COVID is actually the least worrisome piece of the triple threat right now. Cases are down, the new variants seem no deadlier than Omicron, and there are plentiful treatments and vaccines.

• And yet COVID remains on track to be the third leading cause of death in the U.S. this year, behind heart disease and cancer, per the Peterson-KFF Health System Tracker, which projects 230,000 U.S. lives were lost to the virus in 2022 through September alone.

Go deeper: Public health experts say another year living with the pandemic threat has left many Americans resolved to use their personal experience as a guide. The question is whether they can sort through ailments with similar symptoms — and see past themselves.

• "It’s important more than ever, not to go to family functions if you are sick even if you test negative for COVID," said Courtney Gidengil, a pediatric infectious disease physician and director of RAND Corp.'s Boston office. "You might have the flu, you might have RSV and it’s important to be thoughtful about that."

• “The way I thought about it three years ago where everybody’s behavior impacts the risk of everyone else's was appropriate and felt very right during the heat of the pandemic before we had the kinds of tools we have now," said Bob Wachter, chair of the department of medicine at the University of California, San Francisco. "At this point, I don’t pass moral judgment on people. People are exhausted, they want to get back to their lives."

The bottom line: Public opinion polls show about 20% of Americans still worry about the pandemic and public health more broadly, said Ipsos pollster and senior vice president Chris Jackson.

• Reaching the rest to message a new threat will be difficult, because of people's tendency to look inward. "It does come down a little bit to understanding and social trust, which has been fraying for many years," he said.
• Plus, he said, "Americans are so tired of being scared that even when they see [a health threat] their eyes glaze over."

Tina Reed and Caitlin Owens contributed to this report.