- Doctors working in ERs, ICUs, and urgent care clinics across the US are seeing a spike in RSV cases.
- Some infants and toddlers have needed help breathing and clearing out mucus to survive the illness.
- “I don’t have a medication that can take this virus away,” one doctor said.
There is one illness taking up more pediatric beds in ERs and ICUs than any other right now. It may feel like just a typical cough or cold for many adults and older kids, but for newborns, young toddlers, and elderly people, it can be very dangerous.
It’s called respiratory syncytial virus, or RSV for short, and this year it’s shown up earlier than usual.
Emergency doctors from Texas, California, Washington, Utah and Maryland told Tausi Insider they fear the RSV surge they’re seeing now may be just the beginning of a monthslong wave of nasty viral winter illnesses in kids.
There’s been chatter in the media about a “tripledemic” on the horizon — an incoming storm of RSV, influenza, and COVID. For now, RSV is leading the way.
RSV hospitalization rates for small children are worse than for flu or for COVID. In some of the worst cases, children are having trouble breathing on their own, needing oxygen and mucus-suctioning to clear their airways.
“It’s kind of like a roller-coaster ride — we feel like we’re climbing up the big steep hill now and expect to continue to see increasing RSV activity,” Dr. Per Gesteland, a pediatric hospitalist at the University of Utah Health and Intermountain Primary Children’s Hospital, told Tausi Insider.
The beginning of a big wave
Dr. Christina Johns, an emergency physician at PM Pediatric Care in the Washington, DC suburbs, told Tausi Insider that doctors know how to treat kids with RSV and deal with surges, which happen yearly. The “hard part” is that this year’s RSV spike has come early and amidst a wave of other illnesses, including flu.
Additionally, this surge comes on the back of summer spikes in enterovirus, RSV, and parechovirus. Hospitals are already short staffed, with fewer pediatric beds available.
“It’s wild,” she said.
Between 2008 and 2018, the number of inpatient pediatric units decreased by almost 20%, according to a January 2020 study in the journal Pediatrics. During the pandemic, the shortage has only gotten worse.
It’s tough to be precise about how rampant RSV spread is right now, because most cases can be managed at home without a test. Even in the hospital, not everyone who’s sick gets tested.
Dr. Melanie Kitagawa, medical director of the pediatric intensive care unit at Texas Children’s Hospital, told Tausi Insider more than 40 kids there are hospitalized with RSV, and more than 10 of them are in her ICU.
“I don’t have a medication that can take this virus away,” Kitagawa said. “I just have to help the kids through, and give their bodies time to fight.”
Dr. Behnoosh Afghani, a pediatric infectious disease specialist at UCI Health in Orange County, California, said the number of RSV patients in her hospital is also increasing “rapidly” this week.
Gesteland helped develop a “GermWatch” illness forecasting system at his hospital in Utah, and while RSV activity is “moderate” for now, he expects the illness will be “filling up our beds pretty significantly in the coming weeks.”
During an October 23 weekend shift, Johns said about half of the kids she saw had flu-like illnesses. Among them, roughly 30% tested positive for RSV, and 25% for the flu.
Across the country at Seattle Children’s, it’s a similar story: nearly a third of the tests done for viral illnesses are coming back positive for RSV.
“We are seeing about 20 to 30 positives per day,” Dr. Russell Migita, a clinical leader of Emergency Services at Seattle Children’s, told Tausi Insider. That’s double what’s normal for October in the Pacific Northwest, where RSV typically peaks in February and March.
Cases this year are both earlier and more severe, exacerbating the status of Migita’s already overburdened ER, which he says is routinely running at 200% capacity. ER patients are constantly “waiting for inpatient beds,” and more than half are there due to respiratory illnesses. Migita, like the other doctors interviewed for this story, expects the number of RSV cases is only “likely to go higher” in the coming months.
‘Don’t kiss the baby’ — or the toddler
RSV is typically a milder illness for toddlers and school-age kids, hitting only newborns hard. But Dr. Kurt Lucas, an emergency medicine physician working in the Houston metro area, has noticed a troubling trend of 3 and 4 year-old kids getting very sick with RSV this year. Johns and Gesteland have seen the same thing.
Migita said that typically “children get many viral infections spread out over their first two years of life,” but now those illnesses are all being “clustered” as COVID restrictions relax and more toddlers re-emerge into school and daycare.
“They’re having a pretty significant infection with a viral pneumonia, needing oxygen, needing support,” Gesteland said. “It seems like it’s the first time they’ve seen RSV.”
There is no vaccine for RSV, though there is one for pregnant women in late-stage clinical trials, as well as another for elderly patients in development. High-risk infants can receive a monoclonal antibody treatment developed for RSV, but it’s expensive and requires monthly injections during flu season.
“Just be careful about exposure to other people with colds,” Afghani cautioned. What may be a sniffly nuisance RSV infection for a healthy mom, dad, or older sibling, could be a serious illness for a newborn.
“Don’t kiss the baby,” Johns said. “If there ever was a time not to do it, it’s now.”