Editor’s Note: Syra Madad, DHSc, MSc, MCP is an infectious disease epidemiologist, faculty at Boston University’s Center for Emerging Infectious Diseases Policy and Research, senior director of the system-wide special pathogens program at NYC Health + Hospitals. She is also a fellow at the Belfer Center for Science and International Affairs. She tweets @syramadad. The views expressed in this commentary are her own. View more opinion at CNN.
My 2-year-old daughter, Laila, recently came down with the respiratory syncytial virus or RSV, a common and highly contagious virus, and required trips to our local urgent care clinic, our pediatrician’s office and the emergency department – all within the span of five days.
It started with Laila becoming clingy and irritable – a telltale sign for me that she’s about to come down with something. Shortly after, she had a runny nose and congestion. A day or two later, Laila spiked a fever of 103 degrees that continued for nearly two-and-a-half days, accompanied by a decreased appetite, and a whole lot of congestion and coughing (not to mention sleepless nights for both her and me). By day five, she was on the mend and feeling better – or so I thought. Then came on the viral rash.
I was wrapping up a late evening meeting when my babysitter knocked on my door to say Laila woke up with rashes all over her legs. I immediately ended the meeting and took off her clothes to find that small, red rashes had spread over her limbs, abdomen and chest. I took her to the nearest pediatric emergency department where she was diagnosed with viral exanthem rash, caused by her RSV infection.
Sometimes, the immune system’s response to the virus causes a rash; other times, it’s caused by skin cells being damaged by the virus or the body reacting to a toxin produced by the virus. The rash can appear as bumps, blotches or spots on the skin, and can start and spread anywhere on the body. Not every person who gets infected with a virus experiences a viral rash, but in the case of my daughter, she did. Her rash lasted for another week, on and off.
Cases of RSV are surging across the nation. For most people, RSV causes mild, cold-like symptoms, typically lasting for a week or two. But for infants, young children, the elderly and those with a weakened immune system, it can be dangerous, leading to dehydration, bronchiolitis and pneumonia.
What is unusual about this year’s RSV surge is its untimely appearance, intensity and severity. As an epidemiologist, I know this from the data. And as a parent of a 2-year-old who recently came down with RSV, I know this from experience.
An atypical year for respiratory viruses
During pre-pandemic years, RSV cases typically increased in the winter, with a peak in January and February. This year, however, RSV activity began to increase in the spring in many regions of the US. According to the Center for Disease Control and Prevention’s RSV testing data, as of November 5th over 8,500 tests came back positive for RSV, compared to 4,500 around the same time last year.
Similarly, rates of RSV-associated hospitalizations are also on the rise. Currently, the highest rates of hospitalization for RSV are being seen in infants younger than 6 months. This is troubling as this age group is at highest risk for severe illness. One to two out of every 100 children 6 months and younger with RSV infection may end up needing to be hospitalized, according to the CDC, and 100 to 500 children younger than 5 die each year from RSV in the US.
This year, the early increase in cases of RSV, as well as other illnesses like Covid-19 and the flu, prompted the CDC to issue a health advisory to inform the medical and public health community of the elevated respiratory disease activity. The advisory noted that the combination of illnesses is placing a strain on health care systems in the US.
Already, a pediatric hospital in Michigan has reported this month that it is full due to a surge of RSV cases. Another hospital in Ohio had to go on diversion for a couple of days last month, meaning it couldn’t take external emergency admissions due to the number of RSV cases. Meanwhile, the Connecticut Children’s Hospital, in coordination with state officials, has been evaluating whether to bring in the National Guard to bolster its capacity for care.
When to seek medical care for your child
While most kids recover from RSV on their own, it is important to know when you should seek urgent medical care for your child. Signs of an urgent medical situation can include your child having trouble breathing (labored, shallow or rapid breaths), wheezing, dehydration (for infants this might mean a decrease in wet diapers), their skin, lips, tongue or nails turning blue, or a significant decrease in their alertness or activity.
For young children and infants, a fever should prompt a call to your pediatrician. In addition, if your child’s symptoms don’t improve within a few days, it’s best to err on the side of caution and give your pediatrician a call. As a parent of three, I think it is always a good idea to let your pediatrician know when your child is sick and have a low bar to get them evaluated, especially if they are high risk for severe illness.
If your child breaks out in rash, like mine did, talk to your pediatrician as well. While there is no treatment for RSV or for viral rash, there is supportive care and over-the-counter medication your pediatrician may recommend. If hospitalization is required for RSV, intravenous (IV) fluids to help with hydration, and supplemental oxygen may be provided to help your child’s body receive the oxygen it needs.
Keeping your family healthy
While it’s important to seek medical attention for RSV when needed, it’s equally important to try to prevent the spread of RSV in the first place, especially as hospitals and clinics continue to fill with patients.
The pediatric emergency department I took my daughter to was packed full of children coughing in the waiting room, accompanied by their distraught parents. The emergency department was so packed, a nurse wanted to turn over the room (clean, disinfect and prepare for the next patient) as soon as the doctor left after evaluating Laila. She asked if we could wait in the hallway where she would give Laila some medication instead of doing it in the room we occupied. This is the reality playing out in many pediatric emergency rooms across the nation right now: a struggle to find space as patient volumes increase.
While most children will get RSV by age 2, getting sick is never ideal and for young children, or those at high risk for severe RSV disease. My experience with my daughter was difficult. On top of witnessing her suffering from illness for days, it impacted my work productivity and cost me a lot of sleep.
The good news is there are ways to help prevent RSV infections, and these same measures will also help reduce the chance of infection from other co-circulating respiratory viruses like influenza and Covid-19: wear a mask for those 2 and older, cover your coughs and sneezes, don’t share eating utensils with others, wash your hands often, avoid close contact with anyone who is sick, seek ventilated spaces and frequently clean surfaces and toys.
As for Covid-19, it’s impossible to know what impact the virus will have next, but with signs of increased flu activity ahead of the holiday season, coupled with the increasing burden of RSV, healthcare systems should be bracing for more impact to come. Let’s do our part and help reduce the spread of RSV, get vaccinated against seasonal flu and stay up-to-date with your Covid-19 vaccination.
