- Physicians working in emergency rooms, intensive care units, and urgent care clinics across the US are seeing an increase in RSV cases.
- Some infants and young children needed help breathing and clearing mucus to survive the disease.
- “I don’t have a drug that can eliminate this virus,” said one doctor.
There is one disease that currently occupies more pediatric beds in emergency departments and intensive care units than any other. For many adults and older children, it may feel like a typical cough or cold, but it can be very dangerous for newborns, small toddlers, and the elderly.
It’s called respiratory syncytial virus, or RSV for short, and it’s appearing earlier than usual this year.
Emergency physicians from Texas, California, Washington, Utah and Maryland told insiders they fear the RSV surge they’re seeing now could be just the beginning of a month-long wave of nasty winter viral illnesses in children.
The media has been talking about a “triple disease” on the horizon – a looming storm of RSV, influenza and COVID. For the time being, the RSV is the leader.
Infant RSV hospitalization rates are worse than flu or COVID. In some of the worst cases, children struggle to breathe on their own and require oxygen and mucus suction to clear their airways.
“It’s like a roller coaster ride – we feel like we’re now going up that big steep hill and we expect RSV activity to keep increasing,” said Dr. Per Gesteland, a children’s hospital physician at the University of Utah Health and Intermountain Primary Children’s Hospital, Insider told.
The beginning of a great wave
dr Christina Johns, an emergency room physician at PM Pediatric Care in the Washington, DC suburbs, told Insider that doctors know how to treat children with RSV and how to deal with surges that occur annually. The “hard part” is that this year’s RSV spike came early and amid a wave of other diseases, including the flu.
In addition, this increase is due to summer peaks in enterovirus, RSV, and parechovirus. Hospitals are already understaffed and there are fewer cots available.
“It’s wild,” she said.
Between 2008 and 2018, the number of inpatient pediatric units fell by nearly 20%, according to a January 2020 study in the journal Pediatrics. During the pandemic, the shortage has only worsened.
It’s difficult to say exactly how widespread RSV spread is right now, since most cases can be treated at home without testing. Even in the hospital, not every sick person is tested.
dr Melanie Kitagawa, medical director of the pediatric intensive care unit at Texas Children’s Hospital, told Insider that there are more than 40 children hospitalized with RSV and more than 10 of them are in their intensive care unit.
“I don’t have a drug that can eliminate this virus,” Kitagawa said. “I just have to help the kids and give their bodies time to fight.”
dr Behnoosh Afghani, a pediatric infectious disease specialist at UCI Health in Orange County, Calif., said the number of RSV patients at her hospital is also “rising rapidly” this week.
Gesteland helped develop a “GermWatch” disease prediction system at his Utah hospital, and while RSV activity is “moderate” for now, he expects the disease to “fill our beds pretty heavily in the coming weeks.”
During a weekend shift Oct. 23, Johns said about half of the children she saw had flu-like illnesses. Among them, about 30% tested positive for RSV and 25% for influenza.
Across the country at Seattle Children’s, it’s a similar story: almost a third of the tests done for viral diseases are positive for RSV.
“We see about 20 to 30 positive results a day,” said Dr. Seattle Children’s EMS clinical director Russell Migita told Insider. That’s double what is usual for October in the Pacific Northwest, where RSV typically peaks in February and March.
This year’s cases are both earlier and more severe, aggravating the status of Migita’s already overburdened emergency room, which he says routinely operates at 200% capacity. ER patients are constantly waiting for inpatient beds, and more than half are there for respiratory illnesses. Migita, like the other doctors interviewed for this story, expects that the number of RSV cases will “probably only increase” in the coming months.
“Don’t kiss the baby” — or the toddler
RSV is usually a milder disease for young children and school-age children that only severely affects newborns. But dr Kurt Lucas, an emergency room physician working in the greater Houston area, has noted a worrying trend of 3- and 4-year-old children becoming very ill with RSV this year. Johns and Gesteland saw the same thing.
Migita said that normally “kids get a lot of viral infections spread out over their first two years of life,” but now those illnesses are all being “clustered” as COVID restrictions ease and more toddlers reappear in school and daycare.
“You have a pretty serious infection with viral pneumonia, you need oxygen, you need support,” Gesteland said. “It seems like they saw RSV for the first time.”
There is no vaccine for RSV, although there is one in late clinical trials for pregnant women and another in development for older patients. High-risk infants can receive monoclonal antibody treatment designed for RSV, but it is expensive and requires monthly injections during flu season.
“Just be careful when you’re exposing other people with colds,” Afghani warned. What RSV infection can be a nuisance for a healthy mother, father or older sibling can be a serious illness for a newborn.
“Don’t kiss the baby,” Johns said. “If ever there was a time not to do it, it’s now.”