Trio Of Misery: RSV, Flu, COVID

 

Here we are in the final week of October, waiting for the expected fall surge of COVID-19, anticipating a brutal influenza season (CDC is already reporting “early increases in seasonal influenza activity” in most states), knowing that other respiratory viruses are gaining traction as the weather gets cold and people gather together closely indoors.

RSV (respiratory syncytial virus) is one of the most common and most contagious respiratory viruses out there. RSV appears every autumn and hangs around until early springtime, causing typical cold symptoms (runny nose, congestion, cough) in most people and more serious disease (wheezing, respiratory distress, dehydration) especially in the youngest among us, as we learned on The PediaBlog in 2016:

In the United States, according to the CDC, nearly 60,000 children under the age of five are admitted to the hospital with RSV bronchiolitis and pneumonia every year. For every child hospitalized, approximately 30 more are sick enough with the virus to require a visit to a pediatrician, other outpatient clinic, or emergency room. Globally, RSV kills tens of thousands of young children each year; in the U.S., it’s about 200. But RSV isn’t a menace to newborns and young children alone; it causes 177,000 hospitalizations and 14,000 deaths among adults older than 65 years in the U.S. every year.

 

Dr. Damian Ternullo taught us about bronchiolitis way back in 2013:

Bronchiolitis is caused by RSV (respiratory syncytial virus) and results in the inflammation of the tiny airways in children’s lungs, which are called bronchioles.   As the inflammation in these airways progresses, swelling and excess mucous production causes a lot of coughing and can make breathing difficult.  One of the most common signs of this illness is wheezing.  A child can be infected more than once (sometimes even in the same season) but subsequent infections are usually less severe.  Bronchiolitis typically affects children younger than 2 years of age with peak incidence between 3-6 months.  For an older child or adult, the symptoms may simply be cough, runny nose and congestion, but to many younger children these symptoms can be more significant and cause significant illness.  Pretty much everyone has been exposed to this virus by age 3 years.

 

You may have heard over the weekend that children’s hospitals across the U.S. are currently being slammed by RSV. Jen Christensen calls the level of the surge occurring so early in the season “unprecedented.”

The CDC does not track hospitalizations or deaths for RSV like it does for flu, but it said Thursday there has been a rise in RSV cases in many parts of the country. Several children’s hospitals told CNN that they’ve been “overwhelmed” with patients at a time of the year when it’s unusual to have a surge of RSV patients.

Overall, pediatric hospital beds are more full now than they’ve been in the past two years, according to federal data.

 

Fenit Nirappil says the surge of RSV in infants in children is “denying a respite for health-care professionals ahead of a potential hectic winter as the coronavirus, influenza and other viruses collide.”

This month, the United States has been recording about 5,000 cases a week, according to federal data, which is on par with last year but far higher than October 2020, when more coronavirus restrictions were in effect and very few people were getting RSV.

“It’s very hard to find a bed in a children’s hospital — specifically an intensive care unit bed for a kid with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a doctor who chairs the committee on practice and ambulatory medicine for the American Academy of Pediatrics.

 

AHN pediatrician Dr. Joe Aracri advised parents what to watch out for in an interview with CBS Pittsburgh last week:

Dr. Aracri says parents need to keep an eye out for when it appears the virus moves to the chest. That signals the need to seek help from a doctor.

“Whenever your child starts to wheeze and have difficulty breathing, trouble oxygenating or unable to feed, those are all reasons to go see your pediatrician to see what kind of support you need to help your child through this,” said Dr. Aracri.

“A child would end up being admitted if they’re not able to oxygenate and need supplemental oxygen, or they’re using all their energy to breathe and they’re not able to feed and they’re at risk for dehydration. Those are the kids that end up staying in the hospital.”

RSV can also start with a fever, mostly affecting babies under the age of 1. Dr. Aracri tells KDKA that parents and guardians of preemie or micro preemie babies should proactively monitor symptoms due to their more underdeveloped lungs.

 

Treatment for bronchiolitis caused by RSV is supportive; there are no medicines specifically useful to treat the virus (and there are no vaccines to prevent it). Dr. Ternullo helped us understand what works to help relieve the symptoms… and what doesn’t:

What works?

• Ensuring their nostrils are clear from the copious nasal secretions (nasal saline, bulb syringe, and humidifier). Keeping the nasal discharge loose and the nostrils clear helps the child not only breathe better, but feed better as well. This will help prevent dehydration.

• Fever control – acetaminophen can be given to children over 3 months of age (discuss with your pediatrician) to provide comfort. (While fever in and of itself is not dangerous, it can raise the heart rate and respiratory rate.)

• Knowing the signs and symptoms of respiratory distress, including grunting, nasal flaring, rib and clavicular (collarbone) retractions, bluish color change to lips or nail beds, head bobbing, or poor feeding. (See video below.] Call your pediatrician’s office if you notice any of these signs of breathing difficulties.

 

What doesn’t work?

• Albuterol – numerous studies demonstrate that this common inhaled medicine used for children who wheeze with asthma doesn’t work with kids who wheeze with bronchiolitis.

• Antibiotics – remember that bronchiolitis is caused by a virus, not a bacteria.

 

Preventing the spread of RSV employs many of the same tactics shown to be effective in preventing the other members of the trio of misery, influenza and COVID-19:

• Avoid smoking, which increases the risk and severity of respiratory disease in children.

• We say this all the time but its true: Wash hands with soap and water for 30 seconds!

• Alcohol-based hand rubs have also been proven effective in preventing spread.

• Avoid sending your child to daycare or school when they are sick. This simply gets other children sick.

• Infants born prematurely (usually less than 32 weeks gestation), or those infants with chronic lung disease (often a complication of severe prematurity) or congenital heart disorders may qualify to receive the medication Palivizumab (Synagis), an antibody treatment that is given by injection in the pediatrician’s office once a month for 5 months, beginning at the start of RSV season.

 

Read more about respiratory syncytial virus (RSV) from the AAP here and the CDC here.

 

Watch this video to learn the visual warning signs of respiratory distress in infants.

 

(Google Images)

 

source http://www.thepediablog.com/2022/10/24/trio-of-misery-rsv-flu-covid/