Doctors explain RSV in ASL

Alex: I’m noticing a big increase in RSV cases. RSV is short for Respiratory Syncytial Virus. I’ve seen news reports from all over about the virus’ spread. Can you explain what the RSV virus is, what kinds of cases you’ve been seeing in your medical facilities, and why are we seeing a surge in RSV cases now compared with the past?

Dr. IV Mirus: RSV is a virus. It typically spreads every year just like the flu. It has symptoms like the common cold. Coughing, runny nose, congestion. Sometimes it causes breathing problems. Most of the RSV cases I’ve seen have traditionally been in babies who are 2 months old to 6 months old. They are really young children who were just born and they get RSV. But that’s changed this year. I’m not sure if you’ve noticed, Dr. Featherstone, but I’ve noticed more older children getting sick, as well as adults. It’s changed a bit this year. But typically most children, by age 2, will have had a bout with RSV. It is very common. The worst times are during the fall and winter seasons as that’s when the cases start to spike and then they come down. That happens every year. But this year it is a little different because we’re seeing a lot more cases compared with last year. I think it’s increased by 40% by now compared with last year. The peak is worse than last year. We exceeded last year. So what happens when a child is admitted to the emergency department? The parents typically are concerned because there is a fever, they are not drinking enough milk or water, or there is a problem with their breathing. You can notice their ribs and they look sunken. The belly area will look bloated and they struggle with breathing. That’s a concern and that’s why they are admitted to the emergency department, right? That causes wheezing. It’s called bronchiolitis. RSV causes bronchiolitis. That’s what it looks like when they struggle to breathe. So we support these children by giving them oxygen. Sometimes the machines have the pressure that forces the lungs to expand and it helps them too. Hopefully, most of the time, with support, the fever will go away in the hospital at the emergency department. Then we hope to send them home to visit their pediatrician, like Dr. Featherstone here, to them from home. But sometimes they have to stay in the hospital or at the ICU. There can be serious cases. It’s possible.

Dr. Zach Featherstone: You can call me Dr. Featherstone (shows sign name). You don’t have to spell it out!

Dr. Mirus: Thank you!

Dr. Featherstone: So, you’re right, that was a beautiful explanation. I want to add… it is correct that the cases go up during the fall and winter seasons. It is easier for the virus to spread during winter. But this year, we’re seeing it earlier and it’s uncommon. People are noticing that hospitals are filling up with RSV cases in children. I’ve done some research and some experts believe it is because of the coronavirus pandemic. Many families and people stayed at home for the past two years. They did not go out and socialize. The lack of interaction means there was no transmission of viruses, so it means that children’s bodies were not exposed and they didn’t have a chance to build their immune system. So their bodies are not used to all the different kinds of infection because a lot of times when we grow up, we are exposed to everything and we learn how to resist them. But now if a child is not exposed and then suddenly interacts with others, they can easily be exposed. So that matches up with what Dr. IV said about… Oh, I’m sorry, Dr. Mirus.

Dr. Mirus: That’s fine!

Dr. Featherstone: What he explained about seeing more older kids. That’s accurate. It’s interesting because two years ago, when the coronavirus came for the first time that winter — in the past, I’ve always seen because I worked at a busy children’s hospital, I usually saw 10 to 20 children who were usually two months old up to 2 years old, in the hospital and in need of oxygen support. But during that year the coronavirus hit, I only saw two or one. That’s it, the entire winter. Just one or two. It was not normal. But I knew in my mind that there would be a surge because kids, like you said correctly, kids by age 2 are already exposed. It doesn’t mean that they had to be admitted to a hospital with oxygen support because many of them don’t need oxygen support, as they only have mild symptoms. For those kids who have breathing issues, like you said, with the ribs caving in or the stomach expanding in and out — we call these retractions. It happens because RSV causes a lot of mucus buildup in the nose. Babies can’t cough well so they can’t push it out by coughing. The buildup makes it harder to breathe so they need oxygen. If they have to go to the hospital, as you said correctly, they may need a higher flow, which means more pressure, to push the air into their lungs. Also sometimes we use saline nasal drops to help break down all the mucus in their nose and get it out. It works well. The American Association of Pediatrics (AAP) doesn’t recommend the use of albuterol inhalers because it doesn’t help. Steroids don't help either. Many different things don't help. They just need the mucus removed and oxygen support if needed. There is one — it is not a vaccine, but an antibody called palivizumab. Its brand name is Synagis. This is prescribed only to infants who are born premature or have severe illnesses. The antibody can help RSV. But it is very expensive with insurance and is really only for a very specific group. The best prevention is hand washing. If there are others around who are sick, be sure to help to protect your baby. That’s my thoughts. Do you have anything to add, Dr. Mirus?

Dr. Mirus: Yeah, with what you were saying about why it’s very serious right now — the concept where people stayed at home because of the coronavirus pandemic — that’s called an immunity gap. It means that people are not getting sick with RSV for two years. When things finally went back to “normal,” going back to school, they were exposed. Everyone is getting sick at the same time. So there’s a surge in the hospitals. Right now the hospital is full. For example, I work at an adult hospital. When a child is admitted, I’m stuck because I can’t send them to a children’s hospital because they are full! It’s so full that there are no more beds upstairs. So the emergency department becomes full as well. So it’s a bit of a problem, just like the coronavirus during the early days with the adults. Now it has shifted to children with RSV. We are concerned because if we don’t have enough rooms, enough equipment, or personnel to help children and help support their breathing, we’ll be in a similar predicament with adults with Covid-19. So it’s a big problem. We’re really overwhelmed.

Dr. Featherstone: Oxygen is not that easy to get. It is a limited supply as well. You can run out of oxygen. You also may not have enough oxygen machines. So what do you do?

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Alex: Are you two concerned about the remaining part of the fall season? It’s already November. In December, January, and February, will we see more RSV cases? So do you encourage parents with children to keep on washing their hands? So basically the best they can do is keep on washing their hands? And to monitor them and stay healthy? What can parents do?

Dr. Featherstone: RSV is transmitted by droplets. It’s not through the air. If you cough and spit out droplets, they can get on others. So I usually tell parents if they go out shopping or whatever, if they are bringing their baby and they’re still in their car seat, to cover it. If they go out, cover the seat. If a family is visiting, always ask them to not come if they are sick. They can come another time. It’s fine, it’s not the end of the world. If a family comes over and they want to hold the baby, they should wash their hands first. If they sneeze, they should lean in the other direction and wash their hands again. I mean, it is common sense but I like the idea of covering the baby seat because it works great.

Dr. Mirus: It’s interesting because just yesterday news came out that Pfizer is making a vaccine for RSV specifically. They have done some studies already by giving the vaccine to pregnant women and when they give birth, there’s an 80% to 82% success rate in preventing RSV infection for the first three months for the babies. They also administered the vaccines to the babies and they’ve had a 80% rate of prevention. So, it is not yet FDA approved but it is in the process right now. So hopefully there will be some success because we know that children who get RSV — for some, not all — but for some who get sick, they have problems in the future. So the best solution, just like the coronavirus, is to prevent the illness from starting in the first place. Preventive care is so much cheaper and safer. It’s a better opportunity to protect your children compared with waiting for them to get sick before figuring out what to do. So hopefully there will be more data, and more information coming out about the vaccine for RSV.

Dr. Featherstone: That’s neat.

Alex: I appreciate your insights on RSV. I can visualize it and understand it better now.