By Linda Nwoke

Over the past few weeks, the Pediatric intensive care units in U.S. hospitals have been experiencing an overflow in cases of sick children. Many presenting symptoms are associated with the Respiratory Syncytial Virus (RSV), an illness that causes 2 out of every 100 deaths in healthy under 5-year-old children. The increasing cases and their consequences formed the basis of the discussions among a group of experts. They shared insights on the causes, how to differentiate between a cold, COVID, and RSV in young children, as well as preventive measures, treatment, and therapy.

The State of RSV in America
According to experts, a definite surge in pediatric patients is associated with RSV and other viral illnesses. The observed increase in emergency room visits and hospitalizations is linked to RSV and other virus-related conditions. As winter approaches, doctors are warning of an impending danger because of the alarming trend in the timing of the increased respiratory illness and viruses among children. “It’s merely November, and we’re seeing an uptick which we would see in December, January, and February. We’re seeing a very early spike, which is alarming for us because we don’t know what’s going to happen the rest of the season,” says Dr. Mina Hakim, Pediatrics Specialist at South Central Family Health Center in Los Angeles,

Differences between an Influenza (Flu), COVID, and RSV
RSV is a common winter virus with a predictable seasonality and has been around for many decades. Although the recent spike in cases has surpassed many other types of respiratory viruses. Some experts have attributed the return and mingling of school children, without immunity against certain viruses in an ongoing pandemic, as a possible reason for the spike. They agreed that the three illnesses have some similarities in symptoms. “They can present with cough, runny nose, fever or sore throat,” says Dr. Manisha Newaskar, Clinical Asst Professor of Pediatrics, Pulmonary medicine at Stanford Medicine Children’s Health.

However, the main difference is that the onset of symptoms in the Flu is quick, with body aches, fatigue, high fever, and headache. Incidentally, the symptoms are hard to differentiate for children under five years, especially among babies. “Any child or an infant less than six months of age with cough, congestion, and fever needs to be monitored. We need to keep an eye on the progression of the baby’s symptoms because the viruses can be complex and devastating at that particular age,” revealed Dr. Manisha Newaskar.
She further explained that RSV in young babies happens in stages during winter, characterized by loss of appetite, coughing and sneezing, and runny nose, with or without fever in the baby.

However, the baby’s symptoms may progress to respiratory distress, difficulty breathing, and poor feeding. They recommend keeping an open line of communication with the child’s pediatrician and primary care provider to ensure that the child can be seen for further evaluation.

Developing Multiple Viruses Illness at the Same Time
Evidence shows that kids with Flu can get co-infections with COVID and RSV. Doctors claim that many viruses coexist in one patient, which can be alarming for caregivers. The kids may get better, and then they get hit with another virus, resulting in a prolonged singular illness, they say.

The virus is typically spread through exposure and contact with the droplet from an infected individual’s cough or secretions. Thus, wearing a mask by the symptomatic patient is a way of preventing the spread to others. Secondly, the uninfected person should also wear a mask around someone who may be sick, especially in cases of RSV. Moreso, regularly cleaning high-touch surfaces, such as doorknobs and crib handles, and regular handwashing are prevention measures.

Keeping Children Safe Outside the Home
Caregivers with sick children are advised not to send them to daycare or school if they are ill or coming down with any illness. The experts recommend keeping them at home to prevent virus transmission.

In New York, where people are sick with a lot of breathing problems and travel on public transportation like buses and trains. Doctors advise that people should receive a booster shot, especially the fourth booster shot for COVID and Flu vaccine, Also, to prevent being infected, basic hygiene measures such as washing hands and wearing masks are recommended. “So, if you’re planning to travel in crowded places, especially now that there is the surge of viral infections. Using a mask when going out may not be a bad idea. And if you are sick, avoid traveling because then you will not infect other people,” says Dr. Manisha Newaskar.

Flu Vaccine and RSV Treatment
The flu vaccine is strictly for the prevention of Flu. It will not prevent an RSV infection, say the doctors, because the virus is different, and presently there is no vaccine for RSV. However, there are studies on the horizon and promises of an RSV vaccine in the pipeline. According to experts, babies become severely ill from RSV because they have smaller airways and cannot clear secretions like older adults. “The RSV virus can be a mild cold, but babies can get bronchiolitis and other complications. So, it’s essential to support the baby by clearing the secretions manually for them. There is no treatment or therapeutic antiviral for RSV virus.” Says Dr. Mina Hakim

How Parents Can Detect RSV
Dr. Priya Soni, the Pediatric Infectious Disease Specialist at Cedars-Sinai Medical Center, affirms that a parent should first contact the pediatrician. Communication is essential. “Talk with your pediatrician. Let them know if your child is not feeling well. They will provide the proper support to the child.” Contact them early to assess the baby and the stage of the illness. The expert will gauge if additional measures, including IV fluids or oxygen support, are needed through a physical examination. “They will listen to the child and see if there are any risk factors for the child getting worse with the illness,” Dr Soni advises.

However, some pediatricians may need rapid antigen testing, making diagnosing the exact case difficult. This test helps them rule out the Flu through the quick or COVID antigen tests. Doctors conduct further tests in urgent care and emergency rooms in an emergency. Sometimes, they test for all three viruses with one rapid test and have an answer in 15 minutes. Dr. Soni thus recommends that parents should prepare for the respiratory illness season. “One of the ways is by getting nasal suctioning devices that can help clear secretions in small babies who may need help,” she says.

Furthermore, it is essential to get a humidifier. “Invest in a humidifier, and that’s really helpful during the respiratory season. The dry air allows viruses to spread and multiply more. Therefore, keep the air nice and moist,” she advises. Finally, the best protection against seasonal illness continues to be COVID-19 vaccination for everyone ages six months or older, updated bivalent COVID-19 boosters for people ages five-and-older, and the annual flu shot for everyone 6 months and older.

“With so many preventive measures in place over the past two and a half years due to COVID-19, we have been less exposed to many seasonal illnesses compared to pre-pandemic,” said NYC Health Commissioner Dr. Ashwin Vasan. “That means these viruses are circulating earlier and getting more people sick. The best protection is to get your flu shot and bivalent COVID booster right away, and to wear a mask in crowded public indoor settings. You should also stay home when sick to protect others from getting sick. Additionally, we can stick to the tried-and-true disease prevention measures, like handwashing and avoiding contact with others, especially children, when we’re not feeling well.”

Prevention and Treatment Strategies – Vaccines, Boosters, & Future Cures
RSV is the leading cause of respiratory disease in infants younger than six months and other age groups. Common colds in older children and adults have less severe symptoms than in a tiny baby, which is why it spreads faster in little kids.

Studies show that most children would experience RSV infection by their second birthday. They also have bronchiolitis, a condition where there is inflammation of the small airways of the lungs. Any swelling or mucus collection can make it very difficult for infants with small bronchial tubes to breathe, resulting in low oxygen levels.

The swelling makes the heart work hard and often results in dehydration. In some instances, the baby will have acute respiratory failure, which can result in admission to the ICU and being placed on ventilator support.

Some infants are predisposed and are at higher risk for developing RSV. For instance, premature babies are at the most risk of contracting severe RSV and underlying medical conditions like heart disease. “Using bulb suction in the nose can help the baby breathe better. Acetaminophen and Tylenol can be helpful for fever control,” suggested Dr. Newaskar. She recommended keeping the baby hydrated. “The treatment option for RSV is what we call supportive therapy. We make sure that we suction the passages. We give them oxygen if needed, IV fluids to keep them well hydrated, and respiratory support in the hospital,” says Dr. Newaskar.

The illness runs as a viral infection and then slowly gets better. RSV is considered contagious and lasts for 8 to 10 days. Data shows that the RSV virus survives on unwashed hands for thirty minutes or more and stays on surfaces for up to 6 hours.
Thus, prevention and thorough hand washing are essential, in addition to wearing a mask at the first sign of a cold, practicing isolation, and using the Synagis vaccine. “Only premature babies are eligible candidates for that vaccine. They are monthly injections given during a typical RSV season, starting October through March, every year. It doesn’t prevent the baby from getting RSV. Still, it will prevent them from getting severely ill, so they don’t end up in the hospital with respiratory failure,” says Dr. Mina Hakim.

Populations at High Risk
Specific populations have a higher risk of contracting RSV. They include Caucasians, Hispanics, and American Indians. According to the CDC, more Hispanic and American Indians have been hospitalized for RSV this season. According to the experts, there is a higher tendency for RSV occurrence in Hispanic populations with low socioeconomic status, multiple families, and ten to fifteen children in the same house. However, the populations considered the highest risk are children younger than six months of age. Data shows that while the hospitalization rate for the general population is about 13 per 100,000, for children less than six months of age, the hospitalization rate can be up to 2%.

Risk Factors
Children with underlying conditions, such as infants born less than 29 weeks of age at the time of birth and children with chronic lung disease, are always high risk. “Other conditions like asthma, cystic fibrosis, and muscular dystrophy decrease the immune system and malnutrition,” says Dr. Hakim.

When children or families don’t have good access to food, formula, and breastfeeding, they also have a higher risk for RSV. “Studies have found that kids exposed to smoking at early stages are more likely to be hospitalized due to RSV. Babies that have not been breastfed, especially for more than three months of breastfeeding.”

Another risk factor is living in older houses, houses explicitly built before 1990. They were found to increase the risk of having severe bronchitis from RSV. “And that is probably due to the environmental exposures to the dust, fungus, and other respiratory irritants that can increase severity,” says Dr. Newaskar.

Infants also risk contracting the virus by the number of people around them. The more adults in the house, the more likely that there will be someone who smokes, which increases the risk for RSV.

“We want to encourage our patients to go to their primary care doctors, avoid E.R.s, and avoid urgent care as much as possible. Because if your child has the rhinovirus, which is a common cold, and then you end up going in the E.R., and you catch influenza, COVID, or the RSV, then you’re going to be back in the E.R. with more severe disease,” says Dr. Hakim.

Help
Many pharmacies and doctors’ offices offer both flu and COVID-19 vaccines, and it is safe to get them at the same time. To find a nearby COVID-19 and flu vaccination provider, visit vaccinefinder.nyc.gov/ or contact NYC Health + Hospitals at 1-844-NYC-4NYC (844-692-4692) to schedule an appointment with a primary care provider who can offer your child vaccines.

The Health Department posts flu and RSV data on its surveillance summary webpage: Influenza Surveillance — NYC Health.

  coronavirus, COVID-19, flu, health, RSV