Rise in RSV hits children’s hospitals across US

Children’s hospitals across the country are dealing with an increase in respiratory syncytial virus (RSV) cases, stressing health services and millions of parents with sick children.

RSV is a common and usually mild illness, but millions of children are at risk later in life due to the coronavirus pandemic. Babies locked up during the pandemic did not catch RSV, and now children born just before or during the pandemic are catching it en masse.

“We had RSV last year, but it wasn’t at the level this year, partly because we were still doing some of the mitigation efforts around masking and people were still staying away,” said Jason Newland, a pediatric infectious disease specialist in Washington. University of Saint Louis.

“We see older patients who are admitted with RSV because they’ve never seen it before,” he said. “And your first illness is usually the worst and results in more people being hospitalized.”

Overcrowded hospitals are also a concern as the country expects a tough flu season and an increase in COVID-19 cases as temperatures cool and people spend more time indoors.

Newland said St. Louis Children’s Hospital had seen “super high” RSV admissions in the past two to three weeks, levels he hadn’t seen in the six years he was at. this place.

Providers in other states reported similarly high admissions. Caroline Njau, senior vice president of patient care services and chief nursing officer at Children’s Minnesota, said this year’s RSV surge far exceeds what she’s seen in at least the past six years.

“The cases continue to rise and we haven’t seen a spike yet,” Njau said. “And RSV itself accounts for about two-thirds of the respiratory viral illnesses we see.”

Publicly available data from the Centers for Disease Control and Prevention (CDC) indicates a strong presence of RSV in the Midwest, with states such as Minnesota, Nebraska, Missouri and Wisconsin among the top ten states in terms of infection rates. positivity. This data is incomplete, however, with about a quarter of states reporting no case data.

The CDC said in a Friday briefing that RSV cases are increasing in 8 of the 10 regions into which the states are divided under the Department of Health and Human Services. Southeast and south-central regions of the United States are seeing a decrease in cases, including states like Alabama, Arkansas, Florida, Georgia and Texas.

Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at the University of Utah, noted that RSV cases have moved in waves from the southeast to the northwest this year, a reversal of the virus that has generally been observed from west to east across the US

Although RSV is a very common pathogen, Pavia said it is “considerably more complicated” in terms of the mode of transmission.

“We don’t really understand why. It does not follow strict weather patterns. It doesn’t follow a strict movement of people,” Pavia said. “But what you can say with some certainty is that once it starts accelerating rapidly in one area, it will increase for eight to 12 weeks, or there will be an outbreak of eight to 12 weeks. .”

Pavia noted that it might be a good thing the virus is not reaching equal levels of severity across the United States.

“There are regions where the pediatric health care system is really overwhelmed and there are no intensive care beds for children in the whole region. And that’s happening right now in the Midwest where people are crossing two or three states to find an intensive care bed,” he said.

Healthcare providers who spoke with The Hill agreed that this recent RSV surge has highlighted issues within the US pediatric healthcare system, old and new.

Newland said there are concerns that children’s hospitals are understaffed, which could lead to situations where some services like non-emergency surgeries are delayed, as happened during the most challenges of the COVID-19 pandemic.

Pavia noted that pediatric health systems have lost many staff members over the past three years and the remaining workers are facing burnout.

Another problem providers cite is the lack of capacity in children’s hospitals. Stephen Dolter, division chief of pediatric hospital medicine at Children’s Hospital & Medical Center of Nebraska, said his main concern during this virus surge was running out of space.

“We will do everything we can to get them into the hospital, whether that means turning the hospital playrooms into treatment rooms or turning our emergency department into an inpatient unit,” Dolter said.

There are no vaccines for RSV, although Pfizer announced promising results from a maternal vaccine earlier this week. Monoclonal antibodies are sometimes used primarily as a preventative measure for children who are at high risk of developing serious disease. Suppliers who spoke with The Hill said they had so far had no problems sourcing and maintaining sufficient supplies of monoclonal antibodies.

Experts and healthcare providers say it’s critical for parents to recognize the signs that a child needs to go to hospital for care if they contract a respiratory infection. RSV symptoms usually appear about two to eight days after exposure to the virus, and symptoms usually last about a week on average.

Njau of Minnesota Children’s advised parents to watch for signs that their child is having trouble breathing easily. If breathing has become difficult, the infant will begin to take short, rapid breaths and may grunt while breathing. A child’s rib cage that rolls inward when inhaling is also an indicator that they are working too hard to breathe.

A child’s skin can also take on a blue or purple hue if they don’t get enough oxygen. In darker-skinned children, a lack of oxygen may manifest as a similar discoloration of the lips, gums, and eye area. Njau said parents should also watch for signs that their child is dehydrated or has lost their appetite.

“Fortunately, almost all children recover from infection on their own, but for those, especially those who may have been born premature [and] have other comorbidities [it] can have a significant impact on the respiratory system. And that’s why it’s really important for them to get treatment,” Njau said.

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