As COVID-19 Recedes, this Respiratory Virus Spikes

One of the welcomed byproducts of all that mask-wearing, hand-washing, and social distancing was a drop in cold and flu cases during fall and winter. But as we emerge from pandemic isolation, physicians say viruses are making a quick comeback.

Among the more problematic? There has been a spike in cases of respiratory syncytial virus (RSV), a common respiratory virus that usually causes mild, cold-like symptoms in most people but can be dangerous in infants as well as vulnerable young children and older adults. While most people recover from RSV in a week or so, about 177,000 older adults in the U.S. are hospitalized. And of those, 14,000 die every year because of infections, according to the Centers for Disease Control and Prevention. RSV also hospitalizes 58,000 kids and kills between 100 to 500 under five years old each year.

The spike in cases doesn’t surprise Monica Raquel Cardenas, M.D., a pediatric pulmonologist with the University of Miami Health System. While RSV typically is confined to the cooler months in states to the north, Florida and other southern states have a more extended RSV season, one that can extend through the summer.

“We’ve always had to deal with it year-round,” Dr. Cardenas says. “We’d get the first peak in the fall and the second peak in January or February. Then the cases would go down in the summer.”

But the 2020-2021 season has been anything but typical.

Loosening pandemic restrictions has meant more social interaction and close contact. As a result, “this year has been different. We began seeing the levels rise in March,” she added.

The rise in RSV cases has been so noticeable that the CDC issued a health advisory on June 10. Asking that workers in long-term care, childcare, and health facilities stay home if they feel sick, the CDC explained the unusual notice:

“Due to reduced circulation of RSV during the winter months of 2020–2021, older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months.”

RSV is considered one of the dozens of viruses associated with a common cold.

Hence, the most common symptoms are the same:

• runny nose
• congestion
• cough
• decrease in appetite
• fever

In fact, RSV is so common that most kids will have encountered it by the time they turn two.

But RSV can turn serious for those with underlying conditions.

It is the most common cause of pneumonia and bronchiolitis (inflammation of the small airways) in children younger than a year.

“RSV is known to carry a higher risk for babies under six months and for premature infants,” Dr. Cardenas says. “Premature babies have lungs that are underdeveloped.”

Other children who are especially vulnerable include those with chronic lung disease, congenital heart disease, weakened immune systems, or neuromuscular disorders.

Dr. Cardenas advises parents to be on the lookout for respiratory distress signs, such as wheezing, difficulty breathing, or rapid breathing. If a baby or young child has a fever that lasts longer than a few days, is unusually lethargic or overly sleeping, or displays unusual fussiness, she should be immediately checked by a pediatrician.

Older adults, particularly those with compromised immune systems or heart or lung disease (such as asthma or COPD), can also experience RSV complications. Like infants and young children, vulnerable seniors sometimes must be hospitalized if they get dehydrated or need additional oxygen or intubation to help them breathe. Most, however, recover and are discharged within a few days.

There is no cure for RSV, though researchers are working on antiviral treatments and vaccine development. The majority of cases “can be managed at home without a problem,” Dr. Cardenas says. “Essentially, you treat the symptoms.” This means rest, drinking enough fluids, and using over-the-counter fever reducers and pain relievers, usually acetaminophen or ibuprofen but never aspirin for kids. Always check with the child’s pediatrician, of course.

For high-risk infants, she and other pediatric pulmonologists use Synagis (palivizumab), a monthly injection of monoclonal antibodies given throughout the RSV season. “These babies can still get it, but it prevents severe cases,” she explains.

The best therapy for RSV, she adds, is prevention.

• Wash your and your child’s hands regularly.
• Avoid touching your face.
• Stay away from people with obvious cold-like symptoms. You can get the virus from cough or sneeze droplets, by touching a virus-infected surface and then touching your face, or by having direct contact with RSV. Infected people are contagious for 3 to 8 days.
• Disinfect surfaces that people touch a lot.
• Cover your mouth and nose with a tissue when coughing or sneezing. Throw it away immediately after.
• Stay home when you’re sick.

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.

Tags: cold virus, Dr. Monica Raquel Cardenas, prevention tips, pulmonary care