A virus common among young children is surging in the US and sparking concerns that hospitals could become overwhelmed this year by potential winter spikes in both the flu and COVID-19.
Respiratory syncytial virus (RSV) is extremely common, with nearly everyone having been exposed to the pathogen by the time they’re 2 years old. In healthy adults and older children, RSV typically causes mild, cold-like symptoms that go away with moderate rest and self-care.
Younger children, especially those less than 6 months old, have the highest risk of developing severe cases that could lead to hospitalization.
There are currently no vaccines available for RSV, and the only treatment is monoclonal antibodies, usually reserved for extremely high-risk cases, including infants born prematurely or those with chronic diseases related to the heart and lungs.
Data from the Centers for Disease Control and Prevention (CDC) shows that more than 4,000 cases of RSV are being reported each week recently, similar to the last major surge, which was experienced in the summer of 2021.
“We always expect it around November, to start appearing late November and peak through December, January and then decreasing by March, April,” Diego Hijano, an infectious disease specialist at St. Jude Children’s Research Hospital, told The Hill.
“That has not been the case over the last few years, where we had one outbreak over the summer and then not a lot of activity early on,” Hijano said. “We have already seen above what we expect for October any given year in terms of RSV locally and around the country. So certainly, it’s a concern as we kind of head into the winter with COVID, flu and RSV.”
The CDC is projecting that cases have already begun to decline, though the information is incomplete and subject to change.
Like the influenza virus, exposure to RSV has been lower over the past few years as people worked from home and kept their children out of daycares during the coronavirus pandemic.
At St. Jude in Memphis, where he is based, Hijano said he is seeing an equal amount of COVID-19, flu and RSV cases.
“That’s concerning, you know, because it will definitely overwhelm the emergency department and the health care system as these trends continue,” he said.
As the Washington Post reported this week, several children’s hospitals in the DC area have already reached capacity as they respond to spikes in RSV and the common cold.
Juan Salazar, the vice president of Connecticut Children’s Medical Center, told NBC’s “Today” on Thursday that in his career of more than 30 years, he had never seen this level of viral transmission or need for hospitalization when it came to RSV. Salazar said that his hospital was considering temporary units out on its lawn, as well as the use of resources from the state and National Guard.
Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital, said she felt her hospital was prepared for a potential surge in cases. Speaking to The Hill, Moffitt noted that the sharp increase in virus cases has not yet been observed where she works but opined that the Northeast should expect an uptick soon.
“I can only speak for my hospital. We are very, very adaptable,” Moffitt said. “And frankly, children’s hospitals and pediatric emergency rooms have been adapting for two-and-a-half years now to what has been a real — especially in the last year-and-a-half — a real unbelievable surge in utilization of pediatric emergency rooms.”
“I’m not terribly worried that we won’t be able to rise to a demand if need be and if there’s a real surge in pediatric hospitalizations,” Moffitt added.
She said the recent shift in the annual recurrence of RSV cases has presented a potential challenge in treating severe cases. Monoclonal antibodies do not last very long and must be ordered monthly. RSV’s previous predictability had allowed hospitals to order enough treatments in advance, but Moffitt said the earlier surge increases the chances that a hospital will not have enough on hand.
With no vaccines available for the virus and only one viable treatment, the infectious disease specialists who spoke with The Hill said the best way for parents to approach this season of respiratory viral spread is to limit and prevent potential exposure in general.
Hijano noted that mask-wearing, particularly in daycares and preschools, is all but forgotten now. Acknowledging that this option can be difficult for parents to consider, he advised that children be kept at home if they are sick to prevent the potential spread of any viruses in the community.
“When it comes to day-to-day basis, basically stay home if you’re sick, wash your hands and avoid coughing into each other,” Hijano said.
Moffitt said that parents should make sure to be aware that the people who are in close contact with their young infants are feeling healthy themselves. She added that parents could also take the additional step of asking people outside their households not to kiss their babies, as respiratory secretions from the mouth are a common pathway for transmission.
She added that parents with a young infant as well as a toddler should also ensure that their toddler is clean and isn’t displaying symptoms before interacting with their younger siblings, as toddlers are often exposed at daycare or playgroups.
“I think parents can make decisions about what their risk tolerance is,” Moffitt said. “Steps like that can help to probably not eliminate but at least decrease the possibility of exposure for the infants.”