Newswise – Starts off as a basic bug with a runny nose and cough. And for most babies, the virus stops right there.
But for some, the cough gets worse. A sick child may become unable to drink milk. His breathing becomes so labored that you can see his ribs as they struggle to breathe.
Respiratory syncytial virus, or RSV, is tricky. Most of the time, parents don’t even know their child has had it, even after the disease has come and gone. But already, children with RSV are filling hospital beds across the country. After two winters with virtually no reported cases in medical centers, the disease arrived earlier this year, and with force. Hospitals typically start seeing RSV in late fall or early winter. This year, cases started pouring in in late summer.
The stakes are high. Each year, RSV hospitalizes between 58,000 and 80,000 children under the age of 5, according to the US Centers for Disease Control and Prevention. As many as 300 will die. Between 6,000 and 10,000 adults over the age of 65 will die from the disease, which can range from a mild cough to a serious infection. And to date, there is no cure.
What has been going on with RSV?
Similar to what we’ve seen nationally, since around September, we’ve seen a large number of children with respiratory illnesses. Mainly RSV, but also several other viruses: parainfluenza, adenovirus, enterovirus, and rhinovirus. Everything except the flu. We haven’t seen influenza yet, but that should be here very soon.
What is different this year?
How soon we are seeing the increase. Usually we don’t see it until much later. We really start to see it in what is technically still summer: the end of August and September. So very early.
Also, what is really different is the number of children who have these viruses who are sick enough to be admitted to the hospital: children who need oxygen and need to be admitted to the intensive care unit.
Why is this happening?
For the last two years, we really haven’t had any children hospitalized with these viruses. Like actually zero. None. So those kids who would have been a few months old in 2020-2021, and would have otherwise gotten RSV back then, didn’t. That’s because we wore masks, stayed home, and were very careful to keep our germs to ourselves. Now that we’ve stopped doing that, those kids are now encountering RSV and other viruses for the first time.
What are the symptoms of RSV?
Well, disgustingly, all of these respiratory viruses really start out looking the same, so there’s no way to tell at home or even at your doctor’s office if a child has RSV or influenza or COVID or some other virus without a test. All of them can cause runny nose, nasal congestion, cough, fever and sometimes some other symptoms like diarrhoea, lack of appetite and headaches. The problem with RSV is that, more than many other viruses, it gets into the breathing tubes leading to the lungs. In young children, irritation from these breathing tubes can make the child unable to breathe well, and sometimes they will need oxygen or even a ventilator to help with breathing.
But most people who get RSV don’t end up in the hospital, do they?
That is absolutely true. In most children, it will look like a cold. The younger and smaller the child, the more likely he is to end up needing to be in the hospital. But most of the time, even very young babies don’t need that kind of care. They just have a cough and feel miserable at home for a few days.
The elderly can also sometimes have serious problems from RSV, particularly the very elderly, cancer patients, and adults with immune system problems. But above all, they are young children.
When should you go to the doctor?
When you start to see clues that it’s more than just a cough. When a child coughs so hard, he throws up, or when he coughs so hard, he can’t eat. For a young baby who is being breastfed or bottle-fed, if her nose is so stuffy that she can’t take in the milk, she may end up becoming dehydrated or developing nutrition problems. They need to see a doctor.
The most important thing to watch is your breathing: breathe fast, breathe hard. A baby’s gasping for breath looks like he is using her belly to help get air in and out of her lungs. His skin is sucking between her ribs with each breath. Their head may be moving as they try to use their body to get air into their lungs. If you see any of those types of things, you should definitely call your doctor. Stuffy nose, runny nose, a little cough, even if it lasts a long time, that will be a cold that will get better in most cases.
Should you have your child tested for RSV if they get sick?
In most cases, if your child only has cold-like symptoms, we won’t do a test, because there is no treatment for RSV other than what we call supportive care. That means we help your body do what it can’t do because of illness. So if they can’t eat, we give them nutrition through a tube through the nose or intravenously. If they are dehydrated, we will give them fluids. If they can’t get enough oxygen, we’ll give them oxygen. If they can’t breathe, we’ll put them on a ventilator. But there are no medicines to help a child stay out of the hospital if RSV symptoms get worse. If you take your child to the doctor with mild symptoms, they will tell you, “Your child has a cold. It could be RSV, but we can’t tell just by looking. Call us or come back if they start having trouble breathing.” So there’s not much value in assessing whether they’re doing well and really just have bothersome symptoms.
Really, the value of knowing that a baby has RSV is in what it prevents us from doing to treat other possibilities.
How is the test?
It’s a swab in the nose.
What can you do to stop the spread of RSV?
If your child is sick, if they have a runny nose, if they have a cough, and definitely if they have a fever, they should stay home. And that has always been our recommendation, even long before COVID: if he is sick, stay home.
Beyond that, if you’re not sick and you don’t have a sick child in your home, then I think it’s worth paying attention to think about the environment you’re visiting. It is full? Are there many small children there? Do you live with someone whose immune system is not working well? In those situations, you might consider not going to those types of activities during the winter or taking those activities outside when possible. Consider wearing a mask when not possible.
there have been recent news reports that Pfizer is about to gain approval for an RSV vaccine. Will that be a game changer?
The medical community has been working on developing an RSV vaccine for decades. RSV and similar respiratory illnesses are the leading cause of death in children worldwide. So having an effective vaccine would definitely be a game changer, especially internationally, where children are at quite a high risk of death from respiratory infections. And RSV is the most common cause of respiratory infections in young children.
the medical minute is a weekly health news feature produced by Penn State Health. The articles draw on the expertise of faculty, clinicians, and staff and are designed to provide timely and relevant health information of interest to a broad audience.