RSV is on the rise. Here’s what to look out for and answers about treatment options: NPR
Temperatures are dropping, and the risk of COVID-19 and flu is increasing. And for the past several months, patients with another disease — respiratory syncytial virus, known as RSV — have been flooding hospitals. Public health officials warn that in winter there could be “tripledemia.”
An unusually high number of RSV infections so early in the year already pushing hospitals to capacity. In normal years, RSV sends thousands of children to the hospital during the fall and winter, but for the second year in a row, experts are recording an unprecedented increase in the number of cases starting from the summer months.
While in adults RSV mainly manifests as a mild illness with cold-like symptoms, in very young children it can cause pneumonia and bronchiolitis. 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 might RSV be particularly bad this year?
While it may be too early to tell for sure, health experts agree that the waves are an earlier-than-usual consequence of the widespread lifting of COVID-19 precautions, which have served to protect the public from various viruses.
“When the pandemic hit the U.S. in March 2020, we saw the rates of all viruses plummet,” Dr. Vandana Madhavan, director of advanced pediatrics at Mass General Brigham in Boston, told NPR. This is mainly due to people staying indoors, wearing masks and washing or disinfecting their hands frequently, she added.
After restrictions began to ease in the spring of 2021, health experts began to notice strange patterns in the circulation of these respiratory viruses. This year, the return to pre-Covid social activities and interactions, travel and classroom activities has led to another dangerous spike, Madhavan explained.
Something else is happening, she added. Very young children born just before or during a pandemic did not benefit from regular or early exposure to common viruses, including RSV, to help build immunity.
“We had a whole group of young kids who weren’t the usual constant exposure to viruses in daycare or preschool or out in the community. And so now they’re exposed and it’s really affecting them,” Madhavan said.
These conditions have led to what some doctors call an unprecedented number infants and children in emergency departments 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’s worrying because it’s still only the end of October and we don’t know what we’re going to see as we move deeper into the fall, and especially this winter.”
Why are infants and young children most susceptible to respiratory viruses?
Almost all children get an RSV infection by the age of 2, according to centers for disease control and prevention. In most cases, it will cause mild cold-like symptoms, similar to 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 of age.
The problem is that their small lungs and muscles cannot muster the strength to cough up or sneeze out the increased secretions and mucus built up in the airways.
“It’s hard for them to get rid of that excess fluid and that’s why they have trouble breathing, which then leads to trouble eating and drinking,” Madhavan said.
Treatment for RSV in such cases may include oxygen support, suctioning, and IV fluids.
According to the CDC dataevery year about 58,000 children under the age of 5 are hospitalized due to RSV. The next most vulnerable group is adults over the age of 65, in 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 help prevent RSV or prevent it from becoming a serious illness.
But for those with newborns or children under one year old, Madhavan said it’s best to keep children away from adults who have been sick recently.
She suggested that you don’t feel ashamed to tell others how you feel. “Often when people ask that question, the person on the other end only really thinks to mention anything if they’ve been really sick, so they don’t think to mention if they’ve had a minor cold.” But it could become a serious case of RSV for an infant or toddler, she added.
Madhavan said an effective way for children and adults to try to stay healthy during the remaining fall and winter months is to get updated vaccines against COVID and flu.
Anyone older than six months can get it flu vaccine. Madhavan noted that it takes several weeks for full protection from the injection to take effect. “If a child is under the age of eight and has never received a flu shot before, they need two doses a month apart before they get full protection two weeks after that second dose,” she added.
The Bivalent boosters for COVID-19 for people aged 5 and over became available in September. And children older than six months can receive any of the three available vaccines against COVID-19. “Don’t wait until we’re in the middle of another COVID wave to get a refill,” warns Madhavan.
Is there a vaccine against RSV?
There is no vaccine against RSV yet, although many are in development.
There is, however, a treatment called palivizumab which is available to high-risk infants. It 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 serious RSV disease. It is applied once a month during the entire RSV season.
“It’s not a vaccine in that it doesn’t help the immune system create long-term immune protection, but it continues to give RSV antibodies every month during those high-risk periods for those high-risk kids to give them extra protection,” Madhavan explained.
However, Madhavan emphasized, palivizumab is not routinely given to all children. Part of it is because of the possible, more serious drug-related side effects, which include swelling of the throat, difficulty or rapid breathing, muscle weakness, and unresponsiveness.
When to seek emergency help?
Hospitals, emergency rooms and pediatric intensive care units across the country have been swarming with RSV patients for weeks. That’s why it’s important to know when to go to the emergency room, and when it would be better and healthier to stay at home, Madhavan said.
It strongly discourages people from going to the emergency room to be tested for RSV or other respiratory viruses.
“If you think you or your child has it, it’s best to pick up the phone and call your doctor or nurse instead of going into an environment that could mean a long wait or exposure to other viruses that your child and family don’t have and may have risks by themselves,” she said.
Madhavan said that in most cases, healthcare professionals can review a list of warning signs and make suggestions for possible at-home treatments.
“Based on that information, I can recommend that you start taking saline nasal drops, use a humidifier, or take a shower or do other things to help loosen mucus and reduce congestion,” she said. “If it’s a child older than one, they may say they 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 toddler is having trouble breathing. These include flaring of the nostrils, gurgling as they breathe in and out, or the skin between or under the ribs or collarbone pulling in and out.