At this time of year, our pediatric staff often hear: “Winter is coming! “It scares us all as we prepare for the impending onslaught of snotty noses, feverish children, coughs, and more. Well this year, winter came early, it came quickly and it came with a wildness we haven’t seen in a while. The respiratory syncytial virus (RSV), which has been unpredictable since the start of the COVID-19 pandemic, appeared for the first time this season—now stronger than ever before. The influenza didn’t wait, it hit straight on the trail of RSV, which led to an early “windemic.” Of course, we must not forget COVID-19, which still plays a part in this game and doesn’t want to be forgotten (and shouldn’t be forgotten), leading to concerns about a nasty “tripledemic” in pediatrics this fall and winter.
RSV isn’t a new virus. It’s been around for a long time, but you’ll no doubt be hearing more and more about it this year for a variety of reasons. There are more cases in the community this year as we have resumed many typical pre-COVID activities while losing our masks and social distancing practices. It turned out that the methods we used to combat COVID-19 worked even better with our typical seasonal respiratory viruses. It is also suspected that the immunity of municipalities has declined as RSV has not been as predictable in terms of seasonality or severity since the start of the COVID-19 pandemic.
We’ve seen significant increases in RSV over the last two summers, but the incidence this fall has marginalized many children’s hospitals. While this serious virus can cause a cold in older children and adults, it can be serious in infants and young children. This can cause shortness of breath and result in the need for significant respiratory support. It is one of the main causes of hospitalization and even death in infants. However, as a result of declining immunity, more serious illnesses also occur in typically low-risk populations.
When you have RSV, your airways produce plenty of mucus, making it difficult to breathe. It’s easy to see how an infant under 6 months and/or with
Concomitant respiratory or heart diseases can cause problems with this virus. Unfortunately, there is no medicine to treat RSV and antibiotics are not helpful because it is a virus. Supportive measures such as vacuuming, hot showers, humidifiers, and fluids are the most important treatments to overcome this virus. Some patients may develop ear infections or pneumonia or worse shortness of breath as the disease progresses, which may mean admission to a hospital or intensive care unit. Even infants who are doing well may cough for longer, which often causes parental concern, but ultimately, almost all infants recover when given supportive care.
Thankfully, it appears to be the case in some areas that RSV has risen sharply and may be declining, although this will vary by region. It can raise its ugly head again at any time.
Unsurpassed, influenza has also proved to be a worthy challenger. While it appears that many areas of the country have been severely affected by the flu, Tennessee appears to be at the center of the current surge. Several counties have closed their schools to ensure children’s health and safety. It is important to remember that the flu can still cause serious illness and even death in children. The flu can cause coughing, fever, fatigue, muscle aches, headaches, congestion, and more. Here too, most children will be fine, but certain groups, particularly those with respiratory illnesses
such as asthma, can be at high risk. In general, children need supportive care, but we have antiviral options that can alleviate symptoms and can be used in certain circumstances. As with RSV, some children may need respiratory support, which requires admission to a hospital or intensive care unit, and some children may experience other complications, such as pneumonia. It has been widely reported that this flu season is the worst since the 2009 H1N1 swine flu pandemic. A total of five flu-related deaths among children were reported by the Centers for Disease Control and Prevention (CDC) this season. As we’ve said many times in connection with COVID-19, no child should die from a preventable disease, and we should work to immunize children and keep them safe and healthy. Most children who die from the flu are unvaccinated, but the flu vaccine can make the course less severe and thus limit the need for hospitalizations or other complications.
RSV, flu and COVID-19, oh my god! It seems as though we were picked up and dropped off in an unknown world. But that’s exactly what pediatricians are seeing in our offices and hospitals across the country. Luckily, we have a kind of yellow brick road as to how we can handle the situation.
Get yourself and your child vaccinated against flu and COVID-19 first. After getting the flu shot, it takes about two weeks for your body to build up immunity to get the full benefits of the vaccine. Therefore, it is best to get them as soon as possible. Those who haven’t received their first batch of COVID-19 vaccine should get it now, and those who did should check whether they’re eligible for the new bivalent boosters that are now available.
In addition, good hand hygiene, stay at home when you are ill, cough or sneeze into your elbow, and make sure your body is getting enough sleep, eating enough, and being physically active.
Once again, we can get through this winter together. While there’s no better place than home, don’t let the number of patients keep you away from your doctor’s office or hospital when you need it. Often, you can call your pediatrician first to see if your child can be safely cared for at home.
The American Academy of Pediatrics has asked for support and resources while also finding that we are still in a mental health emergency. Be patient but be alert. We have the tools to fight. Let’s use them and make sure our kids stay healthy during this fight.
Carlenda Smith, MD, FAAP is vice president of the Tennessee Chapter of the American Academy Pediatrics.
Jason Yaun, MD, FAAP, is president of the Tennessee Chapter of the American Academy Pediatrics. Follow him on twitter: @JasonYaunMD