Dr. Elizabeth Murray shares her advice on how to deal with the rapidly spreading virus
Respiratory Syncytial Virus (RSV) cases are surging across the United States.
The virus, which causes mild, cold-like symptoms among adults and older children, can result in severe complications in babies younger than 12 months as it spreads to the lower respiratory tract, causing pneumonia (infection of the lung) and bronchiolitis (inflammation of the lung).
Spread through coughing and sneezing, RSV usually peaks in late winter, but it’s striking earlier this year and causing a shortage of pediatric hospital beds. About 71% of the nation’s 40,000 pediatric beds are currently filled, according to the Department of Health and Human Services.
Why is RSV Spiking Now?
RSV is often one of the first germs we get early in life. Once you’ve had it, your body is able to identify it and fight it faster the next time you get the germ. These germs don’t provide lifelong immunity, but your body will recognize the germ from a prior infection and fight it more quickly, making you less ill. However, because of pandemic precautions like masking and social distancing, kids who are infants, or 2 or 3 years old, probably haven’t been exposed to RSV, like their older brothers and sisters were during previous years. So there’s an “immunity gap” and more children now are getting more sick from this germ.
For the past few years, no one was in school and everyone was wearing masks, so we had hardly any diseases spreading. And then last year we had schools back in session, but a lot of kids were still wearing masks. And now this year, there’s almost no masking in school. So we have have the normal fall season — when germs always spread because everybody’s back in school — combined with nobody wearing masks anymore. And all of those germs have been waiting in the corner for their chance to spring back into action. They’re back — and they’re back with a vengeance.
What are the symptoms? How do parents know it’s not just a bad cold or the flu?
The good news here — if there can be any good news — is that the signs are not subtle. RSV is notorious for getting worse around day 3 to 5 of illness, and parents don’t need to worry that they’re going to miss something. When to get concerned is if a child is really having difficulty breathing, meaning that you can see their muscles really sucking in around their rib cage or, for a baby, their nose starts to flare or they kind of grunt with every breath. Babies often have difficulty bottle feeding or breastfeeding because they’re so congested. They can’t breathe and suck and swallow at the same time, so they really start to struggle. Parents are going to notice that something is very wrong.
We’ve heard of the twindemic of COVID and flu; can RSV make this a tripledemic?
Even potentially quadruple? In our community, we’re still seeing a lot of enterovirus, or the common cold. So yes, we are seeing flu just starting. RSV is definitely here. And COVID never left. Flu is very much the kind of hit-by-a-truck, feeling, like, ‘I was fine and and then all of a sudden I had muscle aches and am feeling miserable with a high fever.’ Enterovirus does seem to be kind of somewhere in between where they’re, they’re congested, they’re having some mucus, but they get sick pretty fast. And then COVID can have a variety of symptoms involved with it. So it really does kind of depend on the germ. Regardless of what germ your child may have, a key point here is if you or your child are sick with symptoms of a lot of congestion or strong cough or fever, you need to stay home. It, it doesn’t matter the germ. If you’re sick, you’ve got to stay home.
When should parents seek medical care, and should they call the pediatrician or go straight to the ER?
If a child is really, truly struggling to breathe, or if they’re old enough to talk and they really can’t talk and they’re really struggling, then that’s a call to 911 or a trip to the emergency department. But if a child is kind of just slowing down, ask yourself: If I had these cold symptoms, how would I be acting? And if it seems disproportionate, then that’s a clue that yes, you need to reach out to your doctor. If you have a pediatric urgent care available, that’s fine. This is really a time where you need to have your child evaluated by a specialist who’s used to taking care of children. So a pediatric emergency department or pediatric urgent care or certainly your pedicatrician.
Is there anything parents can do to prevent this?
Parents should do everything they can to tip the odds in favor of success. Lessen the chances of getting illnesses this fall and winter by getting COVID and flu vaccines. Even if it doesn’t fully prevent the disease, it will lessen the symptoms significantly. And if you have a child who has a history of asthma or reactive airway disease, make sure you have the rescue medications on hand. Talk to the pediatrician about getting preventative medicine started, because those often take about a week or so to fully reach effect. Starting those preventative medicines for children with a history of asthma right now can help to lessen their symptoms if they get sick.
Beyond that, it’s, it’s the regular stuff that we always know. Really good hand washing. Every time you come home, wash your hands, make sure everybody is washing their hands before they eat anything. And obviously after going in the bathroom, but everyone knows that. Those two other times are really important. I think sometimes if we’re home, we don’t necessarily think about washing your hands before we eat, but this time of year it’s really critical to do so. Teaching kids to cover their cough, using tissues, all of that kind of stuff can be helpful. And then again, that other key point here is if you are sick or your child is sick, you gotta keep ’em home.
What else should parents know?
Whether your child is having trouble breathing or if your child needs stitches, when you come to the emergency department, they will be evaluated. We use the triage system. It’s never been first-come, first-served. We have to take the sickest kids first. Just know your child will be evaluated. We’ll make sure that they have what they need to keep them comfortable. It’s just that those kids who need stitches or have appendicitis — all of the normal kid things that are still happening — may be more important at a particular moment. But if you really think your child needs care in the emergency department, please don’t hesitate to come. Please don’t think, ‘Oh, they’re gonna to be too busy. Let me wait it out.’ We will take care of you and we will make sure that children get the care they need. If you can use other resources, that’s great, but don’t worry: Kids who need to be seen will get the care they need right away.