Experts advise clinical laboratories to prepare now for a sharp increase in demand for RSV, COVID-19 and influenza testing
are the COVID-19 the lockdowns responsible for the increase in cases of respiratory syncytial virus (RSV)? Some doctors believe that may be the case and have hospitals, clinical laboratories and pathology groups scrambling to prepare for a possible “tripledemia,” according to UC Davis Health.
The addition of RSV as we go into what is predicted to be a poor influenza (flu) has prompted the Centers for Disease Control and Prevention (CDC) to issue a Health Alert Network Notice (HAN) which states: “Co-circulation of respiratory syncytial virus (RSV), influenza virus, SARS-CoV-2, and others could put pressure on health systems this fall and winter.” This is especially true for clinical laboratories that are still struggling to keep up with the demand for COVID-19 testing.
“COVID cases are expected to increase during the winter. This will occur at the same time that we expect to see an increase in influenza rates, while we are already seeing an early start to the RSV season,” he said. Dean Blumberg, MD (above), chief of pediatric infectious diseases at UC Davis Children’s Hospital. “With all three viruses on the rise, we are concerned about an increase in viral infection rates that could lead to an increase in hospitalizations.” Clinical laboratories must prepare for a marked increase in the demand for testing for RSV, as well as for COVID-19 and influenza. (Photo copyright: UC Davis Health).
Masking, lockdowns and social distancing could be responsible
Every winter in the United States, outbreaks of influenza and RSV occur. However, this year the RSV outbreak appears to be more severe. The CDC cautions that “surveillance has shown an increase in RSV detections and RSV-associated emergency department visits and hospitalizations in several regions of the US, with some regions approaching seasonal peak levels.”
The current spread of RSV infections taking place in the US varies from previous outbreaks in notable ways:
- Incidents occur in the fall, while RSV outbreaks typically peak from late December.
- Older children and babies are being hospitalized.
- The current cases appear to be more serious.
- Episodes are increasing at a time when pediatric hospitalizations are already higher than usual due to other illnesses such as COVID-19, influenza, and biennial. enteroviruses.
Some experts believe that masking and social distancing due to the COVID-19 pandemic resulted in a respite from RSV infections in 2020. However, cases escalated in 2021, most likely as a result of fewer young children being exposed to RSV during the previous year.
Most children usually have had at least one RSV infection before the age of two, and the disease becomes less of a problem as children get older.
“The theory is that now they are all together again and this is a rebound phenomenon,” Dr Jeffrey KlineResearch Associate Chair, Wayne State University School of Medicine in Detroit, said market clock. “If we think about the relative increase, the nine-fold increase, that’s nothing, especially in the pediatric. [emergency departments]. Holy mackerel.”
Most RSV-infected children require hospitalization
Kline is in charge of a surveillance network that aggregates information on incident viral infections from 70 US hospitals. The data shows that more children are being hospitalized with COVID-19 than with RSV, but that 5% of children They test positive for both diseases. About 60% of children in that group require hospitalization.
According to the Centers for Disease Control and Prevention, people with RSV will usually begin to experience symptoms within four to six days of infection. Symptoms of RSV, which tend to appear in stages, include:
- Runny nose
- Decreased appetite
“RSV causes a mild cold illness in most people. But it can be very dangerous for very young children and older adults. And young babies are often the ones most at risk for hospitalizations in what doctors would call their first season of RSV,” he said. Andrea Garcia, JDVice President, Medicine and Public Health, American Medical Association (AMA), in a AMA Update November 2 about the current flu season.
“In a year before the pandemic,” he added, “we would see that 1% to 2% of babies under six months with an RSV infection might need to be hospitalized. And virtually all children have contracted an RSV infection by the time they are two years old.”
Babies are at much higher risk of serious illness from RSV because their immune systems are not fully developed, and infants under six months cannot breathe through their mouths if they are congested.
“Age itself is a risk factor for more severe disease, which means that younger babies are often the ones who are sick.” Asuncion Mejias, MD, PhDprincipal investigator of the Abigail Wexner Research Institute Center for Vaccines and Immunity, National Children’s Hospitalin Columbus, Ohio, said market clock. “We’re also seeing older kids, probably because they weren’t exposed to RSV the previous season.”
Mejías is studying whether previous exposure to COVID-19 alters the way a baby’s immune system reacts to RSV and whether it can lead to more severe illness in those babies.
“That’s something to work on and understand,” he said.
Comorbidities and compromised immune systems are also a factor
Older adults and adults with weakened immune systems are predisposed to RSV infections, but there are things people can do to lessen their chances of getting sick from RSV.
“[RSV] It spreads through contact with droplets from the nose and throat of infected people when they cough or sneeze. It can also spread through respiratory secretions on surfaces,” Garcia said in the AMA update. “So it’s a really good idea to clean and disinfect surfaces, especially in areas where young children are constantly touching things. Washing your hands is always important. And if you’re sick, stay home.”
He added: “Premature babies, children with certain medical conditions, are also eligible to take a monoclonal antibody treatment during RSV season, and that can help them stay out of the hospital.”
Most RSV infections usually clear up on their own within a week or two. But such infections can lead to more serious illnesses, such as bronchiolitis Y pneumonia. More severe cases may require hospitalization with supplemental oxygen, IV fluids, and even intubation with mechanical ventilation. In most cases, hospitalization only lasts a few days, According to the Centers for Disease Control and Prevention.
Be Prepared for a Tripledemia
“Health officials are concerned that this could be a sign of things to come,” Garcia stated in the AMA update. “A difficult winter, with multiple respiratory viruses circulating.”
For clinical laboratory managers, the anticipated arrival of RSV cases at the start of this influenza season provides an opportunity to position their laboratories to better meet the demand for RSV testing. They should also inform their clients’ physicians that there may be an increase in respiratory illnesses this flu season.
—J. P. Schlingman