What the RSV increase means for doctors and patients

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October 25, 2022 – In early October, the respiratory syncytial virus, or RSV, swept through Victoria Thiele’s Indiana home. Her three older children had manageable symptoms. But her 8-week-old newborn developed a severe case.

Thiele, whose family lives in Fort Wayne, said the baby is experiencing breast retractions breathing and was taken to the emergency room at a local hospital, where she was diagnosed with RSV and bacterial pneumonia.

An unprecedented increase in RSV

Thiel’s experience mirrors what’s happening across the country. On October 21st, the CDC director tweeted that respiratory viruses, including flu and RSV, are rising sharply. Data from the CDC shows the percentage of those testing positive for RSV has more than doubled in the past month – straining the capacity of children’s hospitals as they try to care for the sickest patients.

“No one has enough beds,” says Renee Higgerson, MD, pediatric critical care physician and medical director of Pediatrix Critical Care of Texas and St. David’s Children’s Hospital. “We take care of patients in every possible place in the hospital.”

Yvonne Giunta, MDDirector of pediatric emergency medicine at Staten Island University Hospital, part of Northwell Health in New York, said her facility’s pediatric emergency department has a high volume of RSV cases along with other respiratory infections.

“It’s not uncommon for pediatric volume to spike sharply in late fall and early winter,” says Giunta. “But this increase seems to have started earlier than in previous years.”

What’s behind the flood?

RSV usually has a predictable seasonal pattern, peaking in late December to mid-February. according to CDC. The virus hits young children hardest, causing about 58,000 hospitalizations of children under the age of 5 and 100 to 300 deaths per year in this age group. but as the CDC notedRSV was almost non-existent in 2020 when pandemic prevention methods nearly wiped the virus out of circulation.

Christopher J Harrison MDProfessor of Pediatrics at the University of Missouri-Kansas City said that children get RSV until they are 2and these first exposures make children less susceptible to the virus.

But the COVID pandemic means some children born in recent years have never been exposed to RSV.

“Since the hiatus where we lost normal viruses, we’ve really messed up the whole epidemiology thing,” Harrison says.

The easing of pandemic control measures coupled with a much more vulnerable younger population is a “perfect storm” for this outbreak, he notes.

Hospitals are tackling

Higgerson says she’s been heartened by how hospitals in her area have come together and invited patients to take free hospital beds on the rare occasions they become available.

“Everyone works cooperatively together,” she says.

But the biggest hurdles are lack of care and staff.

“We’re opening some sections of the hospital for adults and making cribs,” she says. “But what limits us is the availability of nurses. We just need more nurses.”

Giunta says she is already developing strategies to meet staffing needs.

“We encourage the rotating shift, which typically covers mostly the adult ER, to cross over to the pediatric area in the later afternoon and evening hours,” she says.

upbringing of parents

Michael Chang, MD, a pediatric infectious disease specialist at UT Health Houston and Children’s Memorial Hermann Hospital, whose facility is also at or near capacity due to a high incidence of RSV, emphasizes the importance of parent education in managing this outbreak.

Many parents have resumed normal pre-pandemic activities and have been burned out by the pandemic protocols, Chang says.

“People are so sick of thinking about the pandemic that we’ve really gone back to our old ways of shaking off mild illnesses, runny noses, etc.,” he says.

Hospitals and pediatric practices should emphasize the ABCs of disease prevention related to RSV, such as: B. Avoiding crowds, staying home when sick, and washing hands, says Chang. Teaching parents to recognize when symptoms can be treated at home and when a child should be taken to the emergency room could also help reduce the number of patients overwhelming emergency rooms.

What parents need to know

In most children, RSV causes mild cold symptoms such as sore throat, congestion and cough. But for children under 2 years old, children with weak immune systems or those with asthma, RSV can be more serious.

For children at riskcan cause RSV bronchiolitis, an inflammation of the small airways that makes breathing difficult. It can also cause lung infection.

Most cases of RSV can be treated at home with additional liquid, Cool Mist Humidifier, and nasal suction. However, some children may need emergency medical care.

Theile’s baby was given high-flow oxygen, but her oxygen levels remained below normal.

“At that point, they told me she needed to be put on a ventilator,” Theile says.

After 4 days of ventilation, antibiotics and treatment with steroids, the child was able to breathe on its own. Thiele says she is grateful for the compassionate care her daughter received but that the atmosphere in the hospital was chaotic and scary.

“When we went to the ER, they had to take their stats in a hallway because all the rooms were full of kids with RSV,” says Thiele. “The PICU was filled with sounds of children coughing and monitors going down due to their declining stats. It was really heartbreaking.”

According to the Academy of American PediatricsSigns that your child may need immediate medical attention include:

  • Labored breathing
  • Flared nostrils when breathing
  • Indentations on abdomen or ribs
  • Pull in your collarbone as you breathe
  • gasping
  • Gray or blue skin or lips
  • Extreme lethargy
  • Dehydration symptoms such as B. Decreased wet diapers





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