Temperatures are dropping and the risks of COVID-19 and flu are increasing. And for the past few months, patients with a different disease – respiratory syncytial virus, known as RSV – have been overwhelming hospitals. Public health officials are warning that next winter there could be a “triple outbreak.”
The unusually high number of RSV infections so early in the year is already pushing hospitals to capacity. In normal years RSV sends thousands of children to hospital in the fall and winter, but for the second year in a row experts have seen an unprecedented rise in the number of cases beginning in the summer months.
While RSV mostly manifests as a mild illness with cold-like symptoms in adults, it can cause pneumonia and bronchiolitis in very young children. It can be life-threatening in infants and the elderly.
But how worried should parents be? Here are answers to some of the most common questions about RSV infection, who is most at risk, and what could be causing this year’s outbreak.
Why could RSV be particularly bad this year?
While it may be too early to know for sure, health experts agree that the earlier-than-usual surges are a consequence of the broad lifting of COVID-19 precautions, which served to protect the public from a variety of viruses.
“When the pandemic hit the United States in March 2020, we saw the rates of all viruses drop,” Dr. Vandana Madhavan, director of advanced pediatrics at Mass General Brigham in Boston, told NPR. This was largely due to people staying indoors, wearing masks and frequently washing or sanitizing their hands, she added.
Once restrictions began to ease in the spring of 2021, health experts began seeing strange patterns of circulation of these respiratory viruses. This year, the return to pre-COVID social activities and interactions, travel and classroom teaching has led to another dangerous spike, Madhavan explained.
Something else is happening, she added. Very young children born just before or during the pandemic did not benefit from regular or early exposure to common viruses, including RSV, which would have helped develop immunity.
“We’ve had this whole cohort of young kids who haven’t had this usual constant exposure to viruses in daycare or preschool or in the community. And so now they’re being exposed and it’s hitting them very hard.” , said Madhavan.
These conditions have led to what some doctors call an unprecedented number infants and children in emergency rooms and pediatric intensive care units across the country.
“I hope this is not the new normal,” Madhavan said on Friday. “But for this year it is worrying because it is still only the end of October and we don’t know what we’re going to see as we head into fall and especially this winter.”
Why are infants and young children most vulnerable to respiratory viruses?
According to the Centers for Disease Control and Prevention, almost all children become infected with RSV by age 2. In most cases, it will cause mild, cold-like symptoms, as it does in the vast majority of healthy adults. But it can also cause severe bronchitis or pneumonia in very young children, especially infants and those under 5 years old.
The problem is that their small lungs and muscles cannot muster the power to spit up or sneeze the increased secretions and mucus caused in their airways.
“They find it difficult to pass out that excess fluid and that’s why they find it difficult to breathe, which leads to problems with eating and drinking,” Madhavan said.
In such cases, RSV treatments may include oxygen support, suctioning, and IV fluids.
According to CDC data, approximately 58,000 children under the age of 5 are hospitalized with RSV each year. The second most vulnerable group are adults over the age of 65, among whom the infection causes 14,000 deaths a year.
What precautions can you take to avoid RSV?
Health officials say washing your hands, staying hydrated, keeping your hands away from your face, and disinfecting surfaces helps stave off RSV or prevent it from becoming a serious illness.
But for those with newborns or children under the age of one, Madhavan said the best thing to do is to keep children away from adults who have recently been sick.
She suggested not being shy about asking others about how they feel. “Most of the time when people ask this question, the person on the other end of the line doesn’t really think to mention anything unless they’ve been really sick, so they don’t think to mention if they’ve had a mild cold. But it could become a severe case of RSV for an infant or toddler, she added.
Madhavan said the effective way for children and adults to try to stay healthy through the remaining fall and winter months is to get COVID reminders and updated flu shots.
Anyone over six months old can get the flu shot. Madhavan noted that it takes a few weeks for the full shot protection to take effect. “If a child is under eight years old and has never had the flu shot before, they need two doses a month apart before they get full protection two weeks after that second dose,” a- she added.
Bivalent COVID boosters for people ages 5 and up became available in September. And children over six months old can receive one of three available COVID-19 vaccines. “Don’t wait until you’re in the middle of another wave of COVID to get the booster,” Madhavan warns.
Is there a vaccine against RSV?
There is no vaccine against RSV yet, although there are many in development.
There is, however, a treatment called palivizumab that is available for high-risk infants. This is an injection that can be given to premature babies and other babies born with certain lung or heart conditions who are at high risk of severe RSV disease. It is given once a month throughout the RSV season.
“It’s not a vaccine in that it doesn’t help the immune system provide longer-term immune protection, but it does continue to give antibodies against RSV every month during these high-risk times for these high-risk children in order to give them extra protection,” Madhavan explained.
Yet, Madhavan pointed out, palivizumab is not routinely given to all children. This is partly due to the possible, more serious side effects associated with the drug, which include throat swelling, difficult or rapid breathing, muscle weakness, and unresponsiveness.
When to seek emergency care?
Hospitals, emergency rooms and pediatric intensive care units across the country have been teeming with RSV patients for weeks now. It is therefore important to know when to go to the emergency room and when it might be better and healthier to stay at home, said Madhavan.
She strongly advises people against going to the emergency room to get tested for RSV or other respiratory viruses.
“If you suspect you or your child has it, it is better to pick up the phone and call your doctor or nurse than to enter an environment that could mean a long wait or exposure to other virus that your child and your family do not have and cannot have risks on their own,” she said.
Madhavan said that in most cases, medical professionals can run through a checklist of warning signs and make suggestions for potential home treatments.
“Based on this information, they may recommend that you start using nasal saline drops, use a humidifier or douche, or do other things to help loosen mucus and reduce congestion,” she said. “If it’s a child over a year old, they can say to try honey to help with a cough or give suggestions on how to bring down a fever.”
But, warns Madhavan, it may be time to seek more intensive care when an infant or young child is working very hard to breathe. This includes flare of the nostrils, grunting when inhaling and exhaling, or skin going in or under the ribs or the collarbone in and out.