Halloween gives us plenty of imaginary threats to fear: ghouls, goblins, your neighbor trying to dress like Kid Rock, and the monster under the bed (which, admittedly, makes a compelling argument for keeping your feet under the covers).
Infectious disease experts have a bigger list, but what tops the list isn’t usually what scares people the most. Headlines about rare infections and unfamiliar illnesses tend to increase anxiety, but, experts say, some of the biggest dangers have become so familiar that we underestimate them.
There are large gaps between what the public fears most and the threats that actually cause the most harm, says Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP). “There’s often a lot of confusion between what’s killing you, what’s hurting you, what’s worrying you, and what’s panicking you. »
This Halloween, we asked Dr. Osterholm to describe the top three infectious disease threats that concern him most and what people can do to reduce their risks. And, in true Osterholm fashion, he provided four bonus scares.
Threat #1: Respiratory diseases
The flu is so much a part of the fabric of fall and winter that most people barely consider it a threat. COVID-19 has also receded in the public imagination, becoming just another disease we hope to avoid. And respiratory syncytial virus (RSV) often resembles a cold, making it easy to ignore, although it is the leading cause of hospitalization among infants in the United States and also hits older adults hard.
But familiarity does not make these illnesses harmless. During the 2025-2026 respiratory virus season, CDC estimates there have been as many as 57 million flu cases, 390,000 flu-related hospitalizations, and 81,000 deaths. Before that, the 2024-2025 flu season was the most serious flu season in more than a decade, with hospitalization rates up to 2.8 times the historical median and 280 pediatric deaths– the highest number of non-pandemic influenza cases since pediatric influenza deaths became reportable in 2004.
The COVID toll has declined significantly since the height of the pandemic, but the virus remains a significant threat to public health, particularly for the elderly, infants, pregnant women and people with weakened immune systems. During the 2025-2026 respiratory virus season, COVID was associated with there are estimated to be between 5.2 million and 14.6 million illnesses and up to 2.7 million outpatient visits, 270,000 hospitalizations and 48,000 deaths nationwide.
Infants and the elderly are at greatest risk of developing serious RSV-related illness. During the 2025-2026 season, RSV caused it is estimated that there will be between 2.8 and 5.8 million outpatient visits, between 170,000 and 340,000 hospitalizations and up to 25,000 deaths.
“When you look at the morbidity and mortality each year in this country from respiratory diseases, it’s remarkable,” Osterholm says. The record is particularly striking, he says, given the resources available in the United States.
“When we see several hundred children die every year from infectious disease in this country, we have to ask ourselves, ‘How could this happen?’ “, he said. “We do not live in a country where the water supply is unsafe or where medical care is lacking. »
Getting vaccinated against flu and COVID every year remains the best way to protect yourself against serious illnesses. RSV vaccinations provide protection to eligible groups. To find out who should receive vaccines and when, Osterholm directs people to the American Medical Association websitewhich compiles recommendations by age, medical condition and vaccination.
One thing to remember, Osterholm says, is that the protection provided by different vaccines varies. For respiratory infections, for example, vaccines do more to protect against serious illness than against the infection itself.
“When we talk about COVID and flu in particular, we talk about not necessarily protecting against infection. You get relatively little protection from these vaccines,” says Osterholm. “What’s really important is that they’re very effective at reducing serious illness, hospitalizations and deaths, and if you’re at risk of having an infection that puts you down for a few days but doesn’t send you to the hospital or the ICU (intensive care unit), it’s definitely worth it. And that’s what these vaccines do.”
Threat #2: antibiotic resistance
“If you were to take a quiz on antibiotic resistance (AMR) and offer $1 million to people who answered correctly,” Osterholm says, “you could probably keep your million dollars.”
The problem of bacteria evolving in ways that allow them to survive drugs designed to kill them doesn’t make much headlines. And it can seem like a diffuse, distant problem – something that’s happening to other people or building up to a future catastrophe, rather than a threat that deserves immediate attention.
“People forget how many people die every day in this country from antimicrobial-resistant infections,” Osterholm says. And mortality isn’t the only concern. Resistant infections make treatment more difficult, while the development of new antibiotics struggles to keep pace.
According to the CDC Antimicrobial Resistance Threat ReportDrug-resistant bacteria and fungi cause an estimated 9.7 million infections in the United States each year, compared with around 2.8 million in 2019. A Estimated 2022 study that AMR directly caused 1.27 million deaths worldwide in 2019 and was largely associated with 4.95 million deaths.
More recent research, drawing on data submitted by more than 100 countries, found that one in six laboratory-confirmed bacterial infections were resistant to antibiotics in 2023.
As resistance spreads, treatment often requires more antibiotics. Yet overuse of antibiotics can perpetuate the problem, creating favorable conditions for resistant bacteria. For example, overuse of antibiotics can disrupt the gut’s protective microbes, making the gut more vulnerable to serious infections caused by pathogens such as Clostridioides difficile (difference C), a potentially fatal colon infection.
“This causes severe, even life-threatening diarrhea,” says Osterholm. difference Cis estimated causing half a million infections per year in the United States.
Most cases of difference C occur during or shortly after taking antibiotics, notes the CDC– and most cases require treatment with specific antibiotics. It’s a cycle that illustrates the delicate balance of working responsibly with antibiotics.
“This is a slowly unfolding crisis,” Osterholm says.
Gn Health
