NEW YORK — At a time of year when COVID and seasonal flu have many confused about what their symptoms might represent, the earlier-than-usual onset of RSV, a common childhood respiratory virus that most we contract when we are young children, it is creating another problem in public health plans at the state, local and national levels.
Children’s hospital bed capacity is already overstretched in nearly a half-dozen states due to the atypical influx, doctors say. Doctors are investigating whether COVID plays a role in the spread, with children back together in classrooms.
Sankaran Krishnan, chief of pediatric pulmonology at Maria Fareri Children’s Hospital, is among those who believe COVID has been a factor in what he describes as an “unusual increase” in RSV cases. But without a diagnostic test, it’s hard to know for sure what problem is affecting you or your child.
So what is RSV, how can you best protect yourself, and what else should you know?
Short for respiratory syncytial virus, RSV is a common ailment that typically causes mild, cold-like symptoms, according to the CDC. Most people recover in a week or two, but the virus can be serious, particularly for infants and older adults.
Krishnan says the key warning signs for children include rapid breathing, developing a persistent cough or fever, or ongoing shortness of breath.
The virus typically peaks in winter, but it began circulating this summer, surprising and worrying clinicians, and likely reflecting how the COVID pandemic has disrupted circulation patterns for conditions like RSV. The CDC notes that the season typically begins between mid-September and mid-November and peaks between late December and mid-February.
Positive tests begin to drop between mid-April and mid-May, typically. Florida has an earlier start to the RSV season and it lasts longer there as well compared to other parts of the United States.
RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (lung infection) in children younger than 1 year in the United States.
According to the CDC, each year RSV leads to approximately:
- 2.1 million visits to the doctor among children under 5 years of age.
- 58,000 hospitalizations among children under 5 years of age.
- 177,000 hospitalizations among adults older than 65 years.
- 14,000 deaths among adults over the age of 65.
- 100 to 300 deaths in children under 5 years of age.
Little comparative data is available for this season at this time, depending on testing limitations and other factors, according to the CDC. The five-week average of positive RSV PCR tests in New York, for example, has increased weekly since mid-April, when the last season ended. The average for the week ending October 8 is 133,333, up from 41.4 in early August, when the CDC began noticing trends earlier than usual. That compares with a five-week average of 47,333 positive PCR tests in New Jersey that ended that week on Oct. 8. Connecticut data is incomplete. See more state-by-state analysis here.
How is RSV diagnosed and what are the symptoms?
Like COVID, RSV can be diagnosed by antigen or PCR testing. The most common diagnostic measure is a mouth swab or a blood test that evaluates the count of white blood cells, which are affected by viruses. In severe cases, additional tests such as chest X-rays or CT scans may be needed to assess for possible pulmonary complications.
Symptoms are similar to those of COVID, the common cold, and the flu. According to the CDC, people typically show symptoms within four to six days of infection. These can include runny nose, cough, sneezing, fever, wheezing, and decreased appetite. In particular, symptoms often appear in stages and do not appear all at once.
This is once the US government stops buying the shots, but the drugmaker says it hopes many people will continue to get it for free.
Almost all children will have had an RSV infection, diagnosed or not, by their second birthday, according to the CDC. For very young babies, irritability, decreased activity, and breathing difficulties may be the only identifiable symptoms.
Parents are advised to call their pediatricians if their child is having difficulty breathing, not drinking enough fluids, or experiencing worsening symptoms. Dehydration and shortness of breath are more likely to lead to severe cases and hospitalizations. In the worst, children may need to be intubated. In most cases, hospital stays last a few days.
How is RSV transmitted and what about treatment?
RSV transmission is also similar to how COVID and cold-like illnesses are spread. This virus spreads when an infected person coughs or sneezes; you get virus droplets from coughing or sneezing in your eyes, nose, or mouth; touching a surface that has the virus on it, such as a doorknob, and touching your face without washing your hands; and you have direct contact with the virus, such as kissing the face of an infected child.
The contagious period usually lasts three to eight days, but in cases involving some infants or immunocompromised adults, RSV can continue to spread for up to a month, even when patients no longer show symptoms.
Children are often exposed to RSV outside the home, such as at school or day care, and can pass it on to the family.
RSV can survive for many hours on hard surfaces such as crib and table rails, and typically lives on soft surfaces such as handkerchiefs and hands for less time.
You can get RSV at any age, but subsequent infections tend to be less severe, according to the CDC. People at higher risk for severe illness from RSV include premature infants, young children with congenital heart or chronic lung disease, people with weakened immune symptoms, and older adults, especially those with underlying heart or lung conditions.
There is no specific treatment for RSV infection, but researchers are working to develop antivirals and vaccines. A drug called palivizumab is available to prevent severe RSV illness in some children, but the CDC says it can’t help cure or treat children who already have severe RSV-related illness and can’t prevent infection.
What about symptom relief and prevention?
Over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen, can help control fever and pain, although parents should never give their children aspirin. Make sure infected people stay hydrated.
Here’s what the CDC has to say about prevention, which should sound familiar:
- Cover coughs and sneezes with a tissue or upper sleeve, not your hands.
- Wash your hands often with soap and water for at least 20 seconds.
- Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with other people.
- Clean frequently touched surfaces, such as doorknobs and mobile devices.
- When possible, people with cold-like symptoms should avoid interacting with children at high risk for severe RSV. If they can’t, they should follow prevention steps and make sure they don’t kiss high-risk children while they have symptoms.
Parents of high-risk children are advised to take extra precautions, the CDC said. Those include:
- Avoid close contact with sick people.
- Wash your hands often with soap and water for at least 20 seconds.
- Avoid touching your face with dirty hands.
- Limit the time they spend in day care centers or other potentially contagious settings, especially during the fall, winter, and spring. This can help prevent infection and the spread of the virus during RSV season.