As many parents have recently seen, RSV (or respiratory syncytial virus) infections have gone wild. RSV is a respiratory viral infection that spreads easily through contact with droplets of saliva and mucus. It typically infects children, particularly babies younger than one year, as well as immune-compromised adults. Symptoms begin three to seven days after exposure. These symptoms include runny nose or nasal congestion, fever, chest congestion, wheezing, difficulty breathing, and a cough.
There is no specific medical treatment for RSV short of symptomatic therapies. It certainly is important to keep the child hydrated. Obviously, the normal preventative measures such as covering a cough or sneeze and washing hands are important. Beyond these measures, of course bolstering immune function with proper rest and nutrition and immune-boosting supplementation is important in order to assist in avoiding infection.
WHAT IS HAPPENING?
Today, this viral infection, which has long been familiar to many pediatricians, is acting in very unfamiliar ways. According to Asuncion Mejias, MD, PhD, a pediatric infectious disease specialist and associate professor at The Ohio State University College of Medicine, “For us pediatricians, RSV is like COVID is for adults. This is our COVID.”
RSV typically causes upper respiratory tract infections, bronchiolitis, and pneumonia. It is usually diagnosed based on symptoms; however, a nasal or throat swab can be used to identify the virus. These tests are usually performed in a hospital emergency room or urgent care facility.
RSV outbreaks occur every year, but this year is different. For one thing this outbreak started much earlier. Normally, RSV begins to be seen in late fall; peaks in December, January, and February; and then tapers off by spring. This year, hospitalizations began to be seen in late spring and has been increasing since then. This year, the outbreak is larger and more severe than in the past, according to a study published in JAMA Network.
WHY IS THIS HAPPENING?
The challenging thing for hospitals and pediatricians is that this RSV outbreak has coincided with many other viral respiratory infections such as the flu, SARS CoV-2, parainfluenza virus (Croup), and rhinovirus.
Like RSV, the flu season arrived early this year. This comes on top of the COVID-19 infections that we are still seeing. So, we ended up with a cocktail of earlier-than-expected and stacked infections.
But here is the real reason, one that just takes a little common sense to understand. You see, the way that we normally build up an immunity to something is to be exposed to it, fight it off, and to develop an “immune memory” to the invader. In this way we can fight it off in the future when we are exposed to it once again. Typically, when an infant is exposed to RSV in the first 6 or 12 months of life, they fight it off, and develop antibodies to it for the next time it comes around. Typically, subsequent infections are much less severe in those children who have previously been infected, and symptoms usually are similar to a cold.
Unfortunately, masking, social distancing, and isolation strategies undertaken during the COVID-19 pandemic created an unnatural firewall, keeping infants from being exposed for couple of years. This lack of exposure created what is referred to as an “immunity debt.” Now with the removal of these strategies, children who were unable to develop immunity during an initial exposure to the contracted virus have developed significantly harsher symptoms. So now we are seeing more severe symptoms in the population of children who are three, four, and five years old who had no prior exposure. And with this larger population of children developing symptoms, we are seeing the spread to adults more than previously experienced.
Unfortunately, this situation has created a strain on our healthcare system. As was noted in this study in JAMA Network, “Around the country, pediatric primary care offices, urgent care facilities, emergency departments, and pediatric medical wards and intensive care units are struggling to meet the patient demand from respiratory infections.”
This situation along with hospital staffing shortages brought on in part by the COVID vaccine mandates have caused further complications for hospitals to deal with the increased demand. The Cook Children’s Emergency Department in Texas saw the equivalent to one check in every two minutes on November 2nd.
WHAT CAN BE DONE?
So, what are the takeaways from our current situation? First of all, let’s understand that arguably the best form of immunity is natural immunity. Exposure to a viral antigen and the subsequent development of antibodies is agreed by most experts to be the best form of long-term immunity. This method of developing immunity appears to have been stifled during the COVID-19 pandemic, and as a result, many infants caught up in the mitigation techniques, including isolation, did not have the natural exposure to RSV, and as a result, did not develop natural immunity (or the” immune memory”) to RSV. As a result, in three- to five-year-old population, we are now seeing much more severe infections in a larger pediatric population than in previous years.
Some parting thoughts for us to take include some very simple precautionary measures:
- Cover the mouth and nose when coughing and sneezing.
- Wash hands frequently.
- Hydrate well (as you should do anyway). I am often asked, “How much water should I drink?” My response is to ask, “How much you are currently drinking?” The rule of thumb is to drink half of your body weight in ounces. However, for someone who weighs 180 pounds and drinks only 16 ounces of water a day, that ideal 90 ounces of water intake would be enough to scare anyone. However, if that person could simply double their water intake from 16 to 32 ounces of water, that could be a big step in the right direction.
- Get plenty of rest (minimally 7-8 hours regularly). Rest goes a long way to bolster immune function.
- Use targeted supplementation when necessary. Check your vitamin D levels. It is important to check least every 6-12 months to see if you are sufficient (optimally 60-80 ng/ml). Vitamin C is also helpful along with sufficient zinc supplementation in bolstering immune function.
- If you or your child shows symptoms, be cautious to not be around others who might be susceptible. In other words, stay home from work or school until symptoms resolve.
Remember: the best offense begins with a good defense. Keeping the immune system functioning at its fullest potential is critical for all ages.
FINAL THOUGHTS
Our understanding of many of the aftereffects from what we have just undergone in dealing with the “novel corona virus” that caused the COVID-19 outbreak and the mitigation techniques that were used to deal with it, is critical to how we may deal with any subsequent similar outbreaks. We may have done some things right and some things that were wrong. Only time will tell. We must be honest in our assessment of the outcomes of the techniques used in dealing with the unique situation that we encountered in 2020 and beyond. But one thing is for sure: the unique isolation techniques that we used in dealing with the COVID-19 pandemic in part have been responsible for the situation that we are finding ourselves in today with the high incidence of RSV infections.