BY Mylika Scatliffe,
AFRO Women’s Health Writer,
mscatliffe@afro.com
The 2022-2023 cold and flu season came in with a bang.
Across the country there has been a surge in cases of respiratory syncytial virus, or RSV, and Maryland is no exception.
“We’ve seen a spike in RSV since approximately the beginning of September with a particular surge over the last couple weeks. It has coincided with high levels of other viruses like influenza and rhino-entero virus. It’s quite a problem for kids when viruses overlap like this,” said Chief of Critical Care at University of Maryland Children’s Hospital, Jason Custer, MD.
The Centers For Disease Control and Prevention (CDC) defines RSV as a common respiratory virus that usually causes mild, cold-like symptoms where most people recover in a week or two but can be serious for vulnerable populations like infants and the elderly.
“RSV is quite common, especially in children. Anyone who has reached adult age and ever had a common cold likely has been exposed to RSV multiple times and developed an immunity to it,” said Dr. Meghan Bernier, medical director of the Pediatric Intensive Care Unit at the Johns Hopkins Children’s Center in Baltimore. “Older school aged children are able to handle RSV better, but children from newborn to three years old have not yet developed the ability to fight RSV which makes it very dangerous for them.”
“It’s not just RSV– it’s all the circulating viruses. Rhino virus is the typical common cold virus that can also make infants very sick.”
RSV, much like other viruses, is spread through droplets when people cough or sneeze and on fomites. Fomite is the medical term for objects that can transmit diseases. Hands and frequently touched items like cell phones, play mats, toys and door knobs are all fomites.
“Maryland Hospital Association member hospitals and health systems, including Children’s National Hospital in Washington, D.C., are reporting a surge in children suffering from respiratory illnesses, including RSV,” said Bob Atlas, president and CEO of the Maryland Hospital Association. “The same surge is evident throughout the nation, particularly in the northeast.”
RSV causes inflammation in the small airways which puts infants and toddlers at extreme risk since they have small airways to begin with. “We have been at capacity in terms of pediatric beds for the last couple weeks, and we have less staffing than before COVID,” said Custer. “Every day that someone is discharged, someone is admitted.”
The increase in patients is seen in community contact with RSV through emergency departments, as well as in acute care situations that result in hospital admissions. Consequently, patients are experiencing longer wait times to be seen in emergency rooms, and for admission if they need more support than can be had in emergency rooms.
“Our hospitals are prepared to care for very sick children; however, this latest surge is straining capacity,” Atlas said. “There is a nationwide shortage of clinicians with the special skills needed to care for sick children, leaving our hospitals unable to staff about one-fifth of available pediatric beds.”
“We encourage families with children who have less urgent medical needs to seek care first from their pediatrician or in an urgent care setting,” continued Atlas. “Help us to preserve limited hospital resources for those who need more advanced care.”
The mainstay of RSV treatment is breathing supportive care.
“One of the main symptoms you’re looking for in a baby or small child is increased work of breathing. If your baby or toddler is working hard to breathe, it’s time to seek medical attention,” said Bernier. “When the severity of the illness reaches of the point of a child having to be admitted as an inpatient, the central treatment element is oxygen therapy, often with specialized nasal cannulas, and intravenous hydration. If the illness escalates to the point where treatment in the pediatric intensive care unit is needed, children receive increased monitoring of breathing and heart rate and even higher flows of oxygen, perhaps even with pressure with a C-PAP machine. In the most severe illness, a child may be intubated, but that is the least seen scenario.”
“You want to take action quickly if your baby or small child is refusing to eat or breathing so hard, they can’t take a bottle or breastfeed, or their ribs are sucking in with every breath,” said Custer.
While RSV is typically seen in those under the age of three years, older children with underlying, chronic medical conditions like asthma or neurological disorders are also dangerously susceptible.
“Along with reports of our local emergency care providers reporting a surge in pediatric cases, we’ve also received reports that one local hospital’s pediatric intensive care unit is full-and has been for several days. RSV appears to be adding stress to the overall system and PICU beds are hard to come by, which is in line with what hospitals are seeing at the national level. We’re also seeing outbreaks of RSV in city schools,” stated Arinze Ifekauche, director of communications of the Baltimore City Health Department.
Immunity against RSV and other viruses among children may be down because there was not as much opportunity for the virus to circulate over these last couple years during the pandemic. “While there is no vaccination for RSV, we can reduce the spread by practicing habits like good hand washing, staying home if you are sick, not sending your children to school or daycare when they are sick, and isolating from those who are especially vulnerable to becoming infected (especially infants), and getting available vaccinations such as for the flu and COVID,” said Custer.
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