Briefing

America's RSV surge, explained

COVID-19 isn't the only respiratory virus of note making the rounds this year — in fact, an "unusually early" spike in RSV infections is burdening underprepared and overwhelmed hospitals and pediatric units across the country. Here's everything you need to know:

What is RSV?

RSV, or respiratory syncytial virus, is a common seasonal illness that affects the lungs and typically manifests in "mild, cold-like symptoms that resolve in one to two weeks," The Cut reports. The virus can be particularly serious for infants under one, whose tiny airways are easily blocked by just a bit of mucus, and can lead to "more severe complications," like bronchitis and pneumonia; premies, children with asthma, and children with sensitive lungs and chronic lung disease are also high-risk. "They're smaller to start with and don't have a lot of reserve," Mount Sinai's Dr. Christopher Strother told The Cut. "If you put mucus and inflammation in their lungs, they get distressed more easily and get sicker than bigger, healthier kids." 

Though RSV symptoms are similar to those of COVID-19 and the flu, the virus is the "most taxing" of the three on the lungs, The Cut writes. An RSV infection is "going to look like the classic flu," Dr. Strother explained. "Usually you'll see lots of mucus, a bit of congestion, and a junky, mucus-y cough." Older kids will most likely experience flu-like sore throats and body aches, while adults will feel like they have a mild cold. Adults or parents of young children should take themselves or their child to the hospital in the event of breathing difficulty.

The virus is currently surging at unanticipated levels, consequently overwhelming hospitals and pediatric units across the U.S. Nearly one in every 500 babies 6 months and younger was hospitalized with RSV since the start of October, per rough estimates from the Centers for Disease Control and Prevention and The New York Times, and that true total is likely much higher, the agency said. "Every children's hospital that I'm aware of is absolutely swamped," Dr. Coleen Cunningham, a pediatrician in Southern California, told the Times. (Orange County declared a health emergency over the virus on Nov. 1.)

Why is there a surge?

Think of the current spike in RSV infections in children as a sort of "immunity debt," Dr. Michael Daignault explains for USA Today. "The theory is that three years of public health measures like social distancing, masking, and school closures, enacted to protect [children] from COVID-19, significantly reduced their exposure to other common infections." Now, with the world largely re-opened and many of those measures gone, "we're seeing a lot of RSV at once," said White House COVID-19 Response Coordinator Dr. Ashish Jha.

"The immune system works by recognition and repetition," emergency medicine physician Dr. Sarah Combs told the Times. "And when you give it a bit of a rest, like we did during the pandemic — and for good reason — we now have a generation of immune-naive children." Fortunately, the increase in hospitalizations does not suggest the emergence of a more severe strain of RSV; rather, numbers are up because the virus is, in most areas, infecting more children overall, and "a small percentage of a high number is still a high number," Dr. Buddy Creech, professor of pediatric infectious diseases at Vanderbilt University Medical Center, told the Times

Why exactly are hospitals so overwhelmed?

Outside of the general shock of the spike, children's hospitals have "relatively few beds … available to begin with," meaning even "small increases" in pediatric cases "can have a major impact," reports the Los Angeles Times. For instance, let's say a hospital has 12 pediatric ICU beds, and six of them are already occupied. "You can really pretty quickly get up to 100 percent capacity just by admitting six patients," Dr. Christina Ghaly, director of the Los Angeles County Department of Health Services, told the Los Angeles Times. "And then, depending on what their turnover is and how long they're in the hospital, you can see how very quickly you run into a difficult situation."

Further, many of the once-empty pediatric floors that were transformed into adult COVID units in the throes of the pandemic were simply never changed back, the Times adds. With those beds gone, the demand for treatment now "falls largely on children's hospitals that take transfers from increasingly distant emergency rooms."

How is RSV treated?

For mild cases that don't require hospitalization, parents should keep their child "well hydrated and comfortable," and administer Tylenol or Motrin in the event of a fever, Dr. Strother told The Cut. There is no magic cure for the virus, so "[i]t's really just about getting them through it so their bodies can heal," Strother said.

In the event of hospitalization, treatment is "largely supportive," The Cut writes. Doctors will give struggling infants and children extra oxygen and fluids as needed, and might also provide them with a mask to help them breathe.

How can you protect yourself and your child?

There is currently no vaccine for RSV … but at least one is on its way. Pharmaceutical company Pfizer recently announced that its maternal RSV vaccine (which has not yet been approved by the U.S. Food and Drug Administration) is 82 percent effective at preventing severe RSV in newborn infants through three months old, Scientific American reports, and another shot from GSK has also finished late-stage clinical trials. As for an expected timeline, former National Institutes of Health virologist Barney Graham told Scientific American he expects to see "at least one RSV vaccine approved by the end of 2023, if not sooner," the outlet summarizes.

In the meantime, high-risk children (or even high-risk adults) might qualify for preventative antibody treatments, such as the drug palivizumab (though it's very expensive, Scientific American notes). Otherwise, experts advise taking precautions similar to those of the pandemic: wear a mask, wash your hands, stay home when sick, and make sure you're up to date on your COVID and flu vaccines. Given the influx of infections, it's also not a great time to bring your kids to the hospital with broken bones or run-of-the-mill bumps and scrapes.

"I don't want to say to parents, 'Be scared,' or 'Hide away,' because RSV is not new, and I think stoking that pandemic-era anxiety is damaging," emergency medicine physician Dr. Combs told the Times. "But get your shots, and if your kid bikes, put a helmet on him. This is not the time to go wild at the trampoline park."

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