What the RSV Surge Means for Doctors and Patients

In early October, respiratory syncytial virus, or RSV, tore through Victoria Thiele’s Indiana home. Her three older children had manageable symptoms. But her 8-week-old newborn ended up developing a severe case.

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

An Unprecedented Surge in RSV

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

“Nobody has enough beds,” says Renee Higgerson, MD, pediatric intensivist and medical director at Pediatrix Critical Care of Texas and St. David’s Children’s Hospital. “We’re taking care of patients in every possible location we can in the hospital.”

Yvonne Giunta, MD, director of pediatric emergency medicine at Staten Island University Hospital, part of Northwell Health in New York, said the pediatric emergency department at her facility is seeing a high volume of RSV cases, along with other respiratory infections.

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

What’s Behind the Surge?

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

Christopher J. Harrison, MD, professor of pediatrics at the University of Missouri-Kansas City, said children get RSV by the time they are 2, and these first exposures make children less susceptible to the virus.

But the COVID pandemic means that some children born over the past couple of years were never exposed to RSV.

“Since the hiatus where we lost regular viruses, we ended up really shaking up the whole epidemiology thing,” Harrison says.

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

Hospitals Pitching In

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

“Everybody is working cooperatively,” she says.

But the biggest hurdles are nursing and staffing shortages.

“We’re opening some sections of the adult hospital, creating pediatric beds,” she says. “But what’s limiting us is the availability of nurses. We just need more nurses.”

Giunta says she is already strategizing ways to accommodate staffing needs.

“We are encouraging the swing shift, which typically would cover mainly the adult emergency department, to cross-cover the pediatric area in the later afternoon and evening hours,” she says.

Educating Parents

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

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

“People are so tired of thinking about the pandemic that we have really returned to our prior behavior of shrugging off mild illnesses, runny noses, etc.,” he says.

Hospitals and pediatric offices should emphasize the ABCs of disease prevention when it comes to RSV, such as avoiding crowds, staying home when sick, and hand washing, Chang says. Teaching parents to recognize when symptoms can be managed at home, and when to take a child to the ER, could also help decrease the number of patients overwhelming emergency rooms.

What Parents Need to Know

In most children, RSV causes mild cold symptoms like sore throat, congestion, and coughing. But for children under the age of 2, children with weak immune systems, or those with asthma, RSV can be more serious.

In vulnerable children, RSV can cause bronchiolitis, an inflammation of the small airways, making it difficult to breathe. It can also cause pneumonia.

Most cases of RSV can be treated at home with extra fluids, cool-mist humidifiers, and nasal suctioning. But some children may need emergency medical care.

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

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

After 4 days of ventilation, antibiotics, and treatment with steroids, the infant was able to breathe on her own. Thiele says she’s grateful for the compassionate care her daughter received, but that the atmosphere at the hospital was chaotic and frightening.

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

According to the Academy of American Pediatrics, signs your child may need immediate medical attention include:

• Labored breathing

• Flared nostrils while breathing

• Retractions at the belly or ribs

• Sucking in at the collarbone while breathing

• Wheezing

• Gray or blue skin or lips

• Extreme lethargy

• Dehydration symptoms, such as decreased wet diapers

Sources

Michael Chang, MD, pediatric infectious disease specialist, UT Health Houston and Children’s Memorial Hermann Hospital, Houston, TX.

Yvonne Giunta, MD, director of pediatric emergency medicine, Staten Island University Hospital, Staten Island, NY.

Christopher J. Harrison, MD, professor of pediatrics, University of Missouri – Kansas City, Kansas City, MO.

Renee Higgerson, MD, pediatric intensivist and medical director, Pediatrix Critical Care of Texas and St. David’s Children’s Hospital, Austin, TX.

Twitter: @cdcdirector, Oct. 21, 2022.

CDC: “RSV National Trends.” “RSV Trends and Surveillance,” “RSV in Infants and Young Children,” “Symptoms and Care.”

AAP: “RSV: When It’s More Than Just a Cold.”

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