What is causing this 'incredible surge' of RSV? Experts explain.

RSV surge - African American premature baby being examined
RSV cases and hospitalizations are surging across the U.S. (Photo: Getty Images)
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RSV is surging across the country. The Centers for Disease Control and Prevention (CDC) is reporting a rise in both RSV detections and RSV-associated emergency department visits and hospitalizations throughout the U.S., which are stretching pediatric hospitals thin.

“There is such an incredible surge this year,” Dr. John Carl, a pediatric pulmonologist at the Cleveland Clinic, tells Yahoo Life.

Although the common respiratory virus normally causes coldlike symptoms that typically resolve in a week or so, RSV can be severe in infants and elderly people, according to the CDC, as well as in those who are immunocompromised.

While, for some, it may feel like this virus came out of nowhere, RSV is not new. It was first discovered in 1956 and, according to the CDC, is considered one of the most common causes of childhood illness. “RSV has always had a major impact,” Dr. Pedro Piedra, professor of molecular virology and microbiology and of pediatrics at Baylor College of Medicine, tells Yahoo Life. “So it’s not that it’s new. It’s a major cause of hospitalization and mortality in infants. In older adults, it’s similar to influenza — it has a huge impact.”

And yet this year, the incidence of the disease seems particularly high. “Here’s this typical virus, but it’s coming in triple and quadruple the numbers and severity,” says Carl. “This is the pediatrician's COVID, really.”

So what’s going on? Experts explain.

What is causing the RSV surge this year?

RSV season arrived early this year — cropping up in the summer rather than its typical fall and winter season — and has persisted, says Piedra — “and that’s unusual for the amount of virus we’re seeing for RSV.”

Adding fuel to the fire is the fact that RSV isn’t the only respiratory virus making the rounds — along with COVID, influenza cases are “growing like wildfire,” says Piedra, which is creating a "tripledemic." “Never before have we had this many hospitalizations and cases at this time,” he says. “I think it’s going to be a bad season, because it’s caught a number of people off guard in terms of [influenza] vaccines, since people tend to delay when they get vaccinated.”

While there has been some debate about “immunity debt” or “immunity gap” — namely, that we’re seeing a greater number of respiratory infections after hunkering down for the first two years of the pandemic, and limiting our exposure to these viruses — experts say the pandemic played a role.

Almost all children have experienced at least one RSV infection before they turn 2 years old. For babies in the first six months of life, RSV can be “particularly severe, leading to bronchiolitis — infection of the lung passages — and pneumonia,” according to JAMA Network. “Subsequent infections usually are milder, causing coldlike symptoms. But there was essentially no RSV in 2020, and now kids are paying for it.”

Carl explains that during the first two years of the pandemic, “people were really adhering to isolation. We had nothing to offer it,” meaning that respiratory viruses, including RSV, didn’t have as many hosts to infect while people stayed home for the most part. As the protections that people had used to avoid COVID started falling by the wayside, respiratory infections have soared, with RSV “rearing its ugly head,” says Carl.

Piedra agrees, saying that SARS CoV-2 had a “tremendous” impact on the epidemiology of other respiratory viruses. “It could be because of the nonpharmaceutical interventions that occurred — wearing masks, social distancing, decreasing the amount of gatherings — impacting the incidence of all the other respiratory viruses,” including RSV, he says.

However, as children went back to school, families started traveling again and nonpharmaceutical interventions such as mask wearing were significantly reduced, “We saw basically the uptake of many respiratory viruses,” says Piedra.

COVID — which, like RSV, is spread through droplets from an infected person’s mouth or nose when they speak, cough or sneeze — has also made us more conscious of respiratory viruses in general, including better understanding how they spread and how to prevent them. Cases of RSV “happened every year before COVID, but because of COVID, it’s caused us to be much more aware of respiratory viruses,” says Carl.

What can people do to protect against RSV?

Both Carl and Piedra recommend making sure that children and adults are up to date on their COVID and influenza immunizations, to minimize getting other competing infections. Pfizer is working on an RSV vaccine, but, as Carl points out, “It’s not here in our hands right now.”

So in the meantime, experts recommend regular handwashing. For daycare centers and school settings, Carl says that sanitizing any hard surfaces also helps, since the virus can survive on objects, such as doorknobs and toys. “Teaching kids if you have to cough, cough into your elbow,” he adds.

Experts recommend that kids (and adults) stay home when they’re feeling sick. If a child has a stuffy nose and you’re on the fence about whether to send them to school, Carl recommends having them mask for three to four days to prevent infecting others. They can “explain to classmates, ‘I have a cold, and I don’t want to give it to you.’”

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