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Hospitals across the US are under tremendous strain due to an unseasonably early spike in respiratory syncytial virus (RSV). "RSV (or respiratory syncytial virus) is one of the many viruses that cause respiratory illness―illnesses of the nose, throat, and lungs," says Andrea Jones, MD, FAAP. "This virus occurs in the late fall through early spring months, but can vary in different parts of the country. With mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020. However, once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021. The spread of RSV and other seasonal respiratory illnesses like influenza (flu) has also started earlier than usual this year."
"RSV tends to occur and spread in the winter and early spring. It starts as an upper respiratory infection, with familiar cold symptoms," says Purvi Parikh, MD. "What makes it so dangerous is its ability to quickly spread down from the nose and throat into the lower respiratory tract, where it infects and causes inflammation in the tissues of the lungs (causing pneumonia) and the tiny bronchial air tubes (causing bronchiolitis)."
While cases of RSV went down during COVID-19 lockdowns, health professionals believe the weakened immune response thanks to years of masking will result in a bad winter. "We have been extremely busy. Flu, RSV, and other respiratory viruses all at the same time. Not much COVID currently," said Dr. Hugo Scornik, a Conyers pediatrician and former president of the Georgia chapter of the American Academy of Pediatrics. "We didn't have bad flu seasons for the past two years due to masking, etc. but I am afraid we are in for a severe season this year. All children 6 months and up need to get their flu shot ASAP to prevent a severe case of flu."
"It used to be that RSV, in this part of the world, was a late fall through the winter into the early spring kind of disease," says Doctor Lori Patterson, pediatric specialist at East Tennessee Children's Hospital. "We had almost 120 cases. Now, that doesn't mean they were all hospitalized, but still, a lot of them were and so it's keeping the hospital very busy right now. We are starting to see flu as well. We would see a few cases here and there over the summer. But similar to RSV, our numbers have been going up faster than we'd expected." Knowing the symptoms of RSV is important for early and effective management of symptoms. Here are five sure signs you have RSV, according to experts. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.
Trouble breathing could be a sign of RSV and should never be ignored, experts warn. In many cases trouble breathing will manifest as wheezing and rapid breaths. If any of these symptoms are witnessed, seek medical help immediately. For babies, the struggle with breathing can interfere with eating and drinking, an issue of urgent concern for health professionals.
"And that's really when we start to worry," says Dr. Melanie Kitagawa of Texas Children's Hospital in Houston, where more than 40 children currently have RSV. "They're breathing fast, breathing deep. We see them using muscles in their chest to help them breathe. These are kids who are having difficulty taking a bottle because their breathing is being impacted and they can't coordinate both at once."
Fever is one of the earliest signs of RSV, doctors say, although not all people will experience one. "Fevers are really hit or miss with RSV infections, especially in young infants," says Dr. Priya Soni, assistant professor of pediatric infectious diseases at Cedars Sinai Medical Center. "You may need to take your baby to be evaluated sooner rather than later. Parents should be really astute to any changes, like in their activity and their appetite, and then pay particular attention to any signs of respiratory distress."
"We're seeing RSV infections going rampant all throughout the country," says Dr. Juanita Mora, from Chicago. "The emergency department is getting completely flooded with all these sick kids, so we want parents to know they can go to their pediatrician and get tested for RSV, influenza and even COVID-19."
RSV has many symptoms in common with the common cold, like a persistent cough. Doctors are warning people not to assume they simply have a cold, or even COVID—but to get tested as soon as possible to rule out any dangerous complications. When it comes to RSV in very young children, every minute counts.
"The virus dramatically increases secretions in the airways," says Ira Wardono, MD. "Older pediatric and adult patients are able to cough or sneeze out the extra secretions, but that is not the case for infants. Their muscles are not strong enough to cough up all the extra fluid. It's almost like they are drowning in their secretion, and that's what causes the trouble breathing. Parents or healthcare providers need to do the job for them by suctioning the airways, either at home or, if needed, in the hospital.
With RSV, inflammation of the upper respiratory tract can cause congestion and a runny nose. "The hallmark of RSV is that it causes a lot of mucus production that causes you to blow your nose more frequently," says Magna Dias, MD. "The vast majority of kids who get RSV appear to have nothing worse than a simple cold, and never have to be hospitalized for RSV."
"The one therapy that has shown any consistent improvement is bronchodilator therapy (nebulized breathing treatments)," says Bonnie Carter, MD. "I do recommend frequent nasal suctioning to help keep their nose clear and Tylenol to help fever. On average, an infection with RSV lasts about a week, with the worst symptoms being in the first three to four days.
Headache is a common symptom of RSV, especially for older adults. As with other symptoms like a runny nose or cough, it can be hard to tell at first whether it's RSV, a cold, or even COVID-19. So what should people be looking for?
"So, they both are viral infections and the presentation is somewhat similar," says Dr. Meena Iyer, the chief medical officer at Dell Children's Medical Center. "There are not many differences between the two viruses, especially in pediatric patients. So, both of the viruses can present with some cough, congestion, sneezing, fever, increased breathing, not eating or drinking much. So any time a parent sees that a child is having these symptoms, we advise that they go to their local pediatrician or family practice doctor to have their child checked out."
How Is RSV Treated?
RSV has to run its course, but if you—or your child—gets it, it's very important to make sure there are enough fluids being taken. "There is no Paxlovid-like drug for RSV. There is no Tamiflu drug like we have for influenza," says Dr. Charlotte Boney, pediatrician-in-chief at Baystate Children's Hospital in Springfield, Massachusetts. Sometimes non-aspirin pain relievers like acetaminophen or ibuprofen are prescribed to deal with the symptoms.
"RSV can make kids very dehydrated, especially when they're not eating or drinking, especially when we're talking infants," says Dr. Mora. "Once they stop eating or their urine output has decreased, they're not having as many wet diapers, this is a sign they may have to go to the pediatrician or emergency department."