RSV surge has Oregon officials concerned about children’s ICU beds

RSV surge has Oregon officials concerned about children’s ICU beds

The number of children hospitalized with RSV in Oregon more than doubled in the past week.

RSV, or respiratory syncytial virus, is a common childhood illness that causes cold symptoms in most children, but can cause serious complications, especially in young infants.

The Oregon Health Authority tracks weekly RSV-associated hospitalizations in the Portland metro area. Last week, 24 children under the age of 5 were hospitalized with the virus. That’s up from a previous peak of 10 children under 5 hospitalized with RSV in mid-October. Hospitalizations are also increasing in other age groups, although the numbers are lower.

The surge in hospitalizations prompted the OHA to send an alert to hospitals and doctors across the state.

The agency is concerned that with the flu season just beginning, hospitals may not have enough staff or beds, particularly pediatric ICU beds, for all the patients who could show up this winter.

As of this morning, there are four pediatric intensive care beds available, out of a total of 40 statewide. The OHA has asked hospitals to try to consider how to serve more pediatric patients by adding staff with pediatric expertise, canceling elective surgeries and converting single rooms to double rooms. The agency has also suggested using adult ICU beds for older pediatric patients and neonatal ICU beds, which are usually reserved for premature babies, for younger pediatric patients.

Like COVID-19, influenza and RSV cause many mild infections, but can cause more severe illness leading to hospitalization in very young children, pregnant people, adults age 65 and older, and people who are immunocompromised.

Both viruses have virtually disappeared during the COVID-19 pandemic, something state public health officials say they have never seen before. The flu typically causes between 12,000 and 52,000 deaths each year in the United States, and RSV is the leading cause of pneumonia in infants.

Experts worry that both viruses may be about to make a comeback this winter, but that’s not a foregone conclusion. Flu season in particular is difficult to predict.

In this file photo from 2017, a girl receives a flu shot.  A spike in RSV hospitalizations has prompted the Oregon Health Authority to send an alert to hospitals and doctors across the state.

In this file photo from 2017, a girl receives a flu shot. A spike in RSV hospitalizations has prompted the Oregon Health Authority to send an alert to hospitals and doctors across the state.

Courtesy of the Centers for Disease Control and Prevention

Here’s what you need to know about RSV and the flu, and how to protect yourself.

Editor’s note: information below has been previously published on OPB.org.

Flu

What it is

Influenza, commonly known as the flu, is a large family of viruses spread through breathing, coughing, and sneezing. Two types in particular, Influenza A and Influenza B, cause the majority of human infections. Each infected person tends to pass it on to one or two others, making it much less transmissible than COVID-19.

How do you know it’s the flu?

Symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Vomiting and diarrhea are more common in children.

What we know about this year

With people gathering and returning to more normal behavior after the COVID lockdown, experts expect a more normal flu season and an increase in cases.

Influenza activity in Oregon is minimal so far, according to the Centers for Disease Control and Prevention, but some states in the southern United States are reporting high infections. This is normal: Flu season usually starts later in Oregon than in other parts of the country.

The winter flu season in the southern hemisphere may be an indicator of what to expect in the northern hemisphere. Dr. Melissa Sutton, medical director of viral respiratory pathogens at the Oregon Health Authority, said this year that it’s particularly difficult to get clues about what to expect.

Data from the southern hemisphere has been “all over the map,” with some places reporting high levels of flu and others reporting lower than typical levels of flu, he said. Sutton said some of the variation may be due to underreporting of the flu as public health departments shift their focus to COVID.

Reduce your risk

Flu shots are readily available and are recommended for everyone over 6 months of age. In Oregon, fewer people have received their annual flu shot than usual this time of year.

Even if you are not personally in a risk group, getting vaccinated is a good way to reduce overall flu transmission and help protect people who are at risk. The flu is known to cause pneumonia. The two conditions are responsible for about 500 deaths a year in Oregon, mostly in adults over age 65, but often include three or four pediatric deaths.

“The more people we can vaccinate, the less we will see it spread in our communities.” Suton said.

There are several different flu vaccines available, including three higher dose options which are recommended, in particular, for people over the age of 65 who are at increased risk of complications.

RSV

What it is

Respiratory syncytial virus, or RSV for short, is a unique virus that is spread by coughing, sneezing, and touching contaminated surfaces. It is usually mild and is one of the most common causes of a cold in children. However, in some cases, it can cause lung infections such as bronchiolitis or pneumonia, particularly in children under 2 years of age. Each infected person tends to infect three others, so it is more contagious than the flu, less contagious than COVID.

Most RSV infections clear up on their own within a week or two and can be controlled with proper nutrition, hydration, sleep, and the use of over-the-counter medications.

Young children, especially those younger than 6 months, are more likely to experience complications. Premature babies, babies with congenital heart or lung conditions, and babies with asthma are at greatest risk.

That’s due in part to their smaller airways and inability to blow their nose, said Eliza Hayes Bakken, a pediatrician and medical director of the pediatrics clinic at OHSU Doernbecher Children’s Hospital.

“It can literally look like babies are drowning in boogers,” he said. “Sucking them so they can breathe a little bit through their nose and feed a little bit better is one of our main interventions that we do for babies.”

How to know your RSV

A runny nose, decreased appetite, cough, sneezing, fever, wheezing, and shortness of breath are signs of RSV. Symptoms usually appear in stages, not all at once. In young infants with RSV, the only symptoms may be irritability, decreased activity and shortness of breath, according to the CDC.

What we know about this year

Some states are reporting surges in RSV-related clinic and hospital visits. The Oregon Health Authority declared the official start of the RSV season last week based on the number of tests that came back positive.

Because RSV has largely stopped spreading during the pandemic, Sutton said there is likely to be a larger group of children exposed to it for the first time.

“So basically we’re concerned that a broader range of ages might experience that serious illness,” Sutton said.

There is also the phenomenon known as decreased immunity, in which a lack of exposure to a virus can reduce antibodies and the immune response. It could affect infants whose maternal immunity may have decreasedmaking them less likely to pass protective antibodies through breast milk.

However, Hayes Bakken said parents shouldn’t put too much stock in news reports of surges in RSV. It is normal for some seasons of RSV to be bad and others mild. In addition, Hayes Bakken said that if his son was delayed in contracting RSV during the pandemic and is now contracting it for the first time, it is likely to his advantage.

“I’d rather have your healthy 3-year-old have RSV for the first time than your 2-month-old,” he said. “The vast majority of kids who are having a tough time are kids who have a tough time every year.”

Hayes Bakken also suspects that part of the reason so many parents bring young children with RSV to clinics is because people who became first-time parents during the pandemic have less experience helping children overcome fevers and respiratory viruses in the home.

Reduce your risk

There is no vaccine for RSV, so people who want to avoid it should consider wearing a mask if they are in a crowded indoor environment. If you live with a child under the age of 2, having adults and older children in the house wearing masks in crowded indoor settings can reduce the risk of transmission.

And if you have an infant under 6 months of age or a young child with underlying conditions, consider limiting the number of visitors to your home during RSV season. Hayes Bakken said he tells parents of young babies to minimize the number of people who come to meet the new baby and to avoid large gatherings. On the other hand, if there’s a small circle of family and friends helping with the new baby, it’s worth the risk.

Handwashing is also a more effective and important tool against RSV transmission than it is for COVID and people are advised to wear a mask if they have a runny nose to prevent others from getting sick.

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