Why is RSV so bad this year? Covid-19 may worsen it.

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Staff in US hospitals — particularly on pediatric wards — have seen a sharp increase in the number of patients with respiratory syncytial virus, or RSV, this fall.

The virus came earlier and hit harder than most years, experts say. Infectious disease specialists worry about what will happen to the healthcare system if RSV, influenza and covid-19 peak at the same time – a “tridemia”, as one expert has called it.

RSV primarily affects children, but a spike would tax all parts of the medical system. As in the worst days of the coronavirus pandemic, elective surgeries could once again be interrupted, doctors’ offices could be inundated with calls, people could fill emergency rooms.

Here is what RSV is and why it has become such a problem on such a large scale:

RSV is a common respiratory virus that causes cold symptoms in most people. Adults can usually clear RSV within a week or two. But that’s a different story for kids under 1.

The virus typically causes bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (infection of the lungs) in children who have not reached their first year, according to the Centers for Disease Control and Prevention. According to the CDC, approximately 58,000 children under the age of 5 are hospitalized each year in the United States due to RSV infection. Between 100 and 500 children under the age of 5 die from RSV each year.

RSV, other viruses making it difficult to find a bed in children’s hospitals

The virus can give children a fever, runny nose and cough and cause difficulty breathing. So how do you tell the difference between RSV and the flu or covid-19?

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“It’s almost impossible,” said Thomas Murray, an associate professor at Yale University School of Medicine who specializes in pediatric infectious diseases.

There is a rapid antigen test, but it cannot be administered at home like coronavirus tests.

Murray said RSV, unlike the coronavirus, spreads more via surfaces than droplets. He suggests disinfecting high-touch areas such as toys, doorknobs, kitchen counters and bathroom sinks, as well as washing your hands.

“Where these infections might have spread in time, they’re all happening at once now,” said Celine Gounder, assistant clinical professor of medicine at New York University’s Grossman School of Medicine.

Simple physics is another reason children under 1 struggle with RSV: they have smaller airways, so they’re more likely to need oxygen or treatment because inflammation causes them to affects more seriously.

Why is RSV so bad this year?

Experts agree that people have done the right thing by wearing masks and social distancing because of the coronavirus, but the lack of interaction with germs has also made our bodies much less resistant to disease.

Small interactions with viruses prepare our system to better handle future virus exposures. After years of masking in schools and distancing, children have fewer biological defenses to fend off multiple viruses at once. Most children under 3 have never known a world without covid-19, so neither have their immune systems. Part of this is also a numbers game – the longer viruses are prevalent for months, the more likely the immune system is to be caught off guard.

All of this means that young children are almost helpless against any respiratory viruses that develop during the winter.

Elizabeth Mack, head of the pediatric intensive care unit at the Medical University of South Carolina, said she gets calls from staff in neighboring states asking if she has any pediatric beds at her facility.

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“Children’s hospitals in this country are drowning right now,” she said.

Mack said RSV is the most common reason infants are hospitalized. The RSV season usually starts in October, she said. This year, the wave started in September or even August.

“He seems to be back early,” she said.

For decades, fear and failure in the hunt for the RSV vaccine. Now, success.

There is no research to show that RSV has changed. Instead, we have.

Cases starting about a month earlier might not seem like much, Mack said, but there are other disruptive forces beyond anyone’s control: She expects a worse flu season in South Carolina because the Hurricane Ian delayed delivery. flu vaccines.

The pandemic has made RSV and influenza present in new ways and at odd times of the year, said William Schaffner, medical director of the nonprofit National Foundation for Infectious Diseases and professor of infectious diseases at the faculty. of Medicine from Vanderbilt University.

“It’s just that the children were protected from it,” he said.

Covid makes flu and other common viruses act in unknown ways

Unlike measles or mumps, people can get RSV several times in their lifetime. After the virus has run its course, Schaffner said, people typically have more immunity for a year or two. But that becomes a problem, with all the different respiratory diseases that bloom during the winter.

“Some of us are worried about having a tridemic” of RSV converging with covid-19 and influenza, Schaffner said.

There is no government-approved RSV vaccine, Gounder said.

Researchers have been trying for half a century to develop a vaccine or treatment for RSV, she said, and they are closer than ever.

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“We might have one in about five years from now that’s available for young children under the age of 5,” Gounder said.

She said there are two expected methods for vaccinating children against RSV: a direct injection and vaccinating the person carrying the child.

It’s especially exciting for the medical community because few vaccines are given to children under 6 months old, Gounder said. Children are born with antibodies provided by their mothers, and research shows that vaccines given during this time may not be as effective as those given later.

There may not be a cure, but there is preventative medicine for RSV. Palivizumab, sold as Synagis, is a monoclonal antibody treatment given to at-risk infants before RSV season, Schaffner said.

But, as with the coronavirus, doctors prefer active vaccination that gives the body what it needs to create its own protection instead of monoclonal antibody treatment. Think of it as teaching a body to fish rather than just giving it fish.

What should I do if my child has RSV?

Besides cold-like symptoms, Gounder said there are other signs of a severe case of RSV – children may be more irritable, not feed as well, seem lethargic or cough so much they can’t not breathe.

Another sign of a severe case of RSV is if a child “pulls,” which Gounder characterized as a struggle to breathe, pulling the skin around the ribs or collarbone.

Much of the focus has been on children contracting RSV and filling pediatric units, but the elderly are also susceptible to the virus. Expert advice remains the same: wash your hands, clean surfaces and see a doctor if anyone is unwell.

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