Why is RSV such a big deal these days?

Respiratory Syncitial Virus, that is.

Back when my kids were toddlers, this was something we new parents all read about. Basically, an adult might catch it and feel like they’d had a regular cold. A baby or toddler could get quite sick from it. And supposedly it correlated with a higher risk for developing asthma, later on (it wasn’t clear whether the RSV made you more prone to asthma, or latent asthmatics were the ones who tended to get sicker).

My daughter likely had it, at about 9 months or so of age. They didn’t specifically test for it, and she was not hospitalized. A rough few days, as anyone who’s dealt with a sick baby would recognize. We had to use a nebulizer on her for a week or so.

And that was the last I’d thought of it, for years. Yes, she was later diagnosed with asthma - but between the possible RSV, the fact that she was a preemie and had been on a ventilator for a few days, and family history, I always thought it was a matter of when, not whether, she’d get that diagnosis.

But all of a sudden, this year, RSV is all over the headlines. And I keep seeing ads supposedly recruiting volunteers for an RSV vaccine test. Nobody is saying WHY it’s surging, just that it is.

Is it because of the past 2 years of near-shutdown, that it’s finally getting a chance to spread?

I think it’s because the combination of RSV and flu cases in kids this year has skyrocketed, and it’s overwhelming some hospitals. COVID isolation for two years didn’t help.

I have a co-worker whose baby grand daughter died of it last week. :cry: She also lost an adult son to suicide last year. My heart is breaking for her.
I think it’s not just the combination of illnesses, but RSV appears to be more dangerous this time around. I’ve also heard the years of Covid isolation have impacted kids’ immune systems. Damned if you do damned if you don’t.

I’d never even heard of RSV until we got a notice from our daycare that there was a confirmed case there. My son got sick soon after, but he seemed mostly fine. Like a cold. Then I caught it (I assume) and got WAY sick. Not hospitalized, but there was a point I wondered if I should head to the ER. And I haven’t been the same since. I had a negative COVID test, so I dunno what happened.

As I understand it, it’s a big deal because of the confluence with all the other respiratory viruses. Doctors are seeing kids come in with multiple respiratory illnesses at the same time. RSV is a huge driving factor. Our local pediatric hospitals are full. I’m not sure why it’s been such a virulent season, though.

I’m just crossing my fingers my son brings home the manageable crud rather than the dangerous stuff.

Like the flu and some other viruses, some years the symptoms of bronchiolitis are mild, and sometimes more cases are sufficiently severe that the only alternative is to admit the child to hospital. This is when they are working so hard to breathe that they are at risk of exhaustion so require support. It is not always easy, or possible to treat moderate and severe cases on an outpatient basis. Some signs of severe infection can include visible use of rib and diaphragm muscles, breathing quickly (more than one breath per second), not eating or drinking, not interacting with the environment, loud wheezing and skin colour changes.

This year, a higher than usual proportion of children are getting quite sick and requiring hospital beds, sometimes in the intensive care unit. Since Covid and flu are predicted to surge over the next few weeks, already harried hospitals are feeling overwhelmed. In Canada, they are likely to cancel elective surgeries and other things that tie up beds due to the further anticipated demand. There have been murmurs about more masking, just a recommendation at the moment, and much talk of triple threats. Two local pediatricians said on the news tonight that they have never seen such volumes and severity of bronchiolitis patients in the last twenty years. It usually affects children under eight, with severity increasing as age decreases.

Lots more:

I posted too slowly to say bronchiolitis is the most common reason for admitting children aged 12-24 months, 1/3 of kids get it each year, with typically 1-3% too sick to send home. I guess the numbers are higher this year. It is most dangerous in children below the age of four, though eight year olds and occasionally older children get it. Hospital treatment is often just oxygen and fluid until things improve, sometimes taking 1-3 days as it is self-limiting. I am sure @DSeid knows much more about it than I do. But I’ve seen thousands of cases of it.

One thing I was thinking about is that my son entered daycare in October after being socially isolated due to COVID. October is the absolute soonest he could start after completing his vaccinations. How many kids are in the same boat? Millions, I’d wager, kids with untested immune systems probably just entered the system en masse.

Apparently most children get RSV before age 2, but COVID screwed with the pattern. Instead of cases of RSV staggering in at different times, a lot of kids older than two, who never got RSV due to isolation, are now getting it alongside the kids under two.

Right - when my daughter had RSV (or was presumed to - this was 25 years ago), I knew that hospitalization was a very real possibility - thankfully her case did not get that bad.

Are there theories as to WHY such a high proportion is getting sick? Is it because of the shutdown causing more and more youngsters to have “naive” immune systems - combined with more and more people being around, well, more and more people?

I’m glad my kids are a couple decades past the high-risk group, though of course as @Spice_Weasel notes, adults can get pretty sick from various unidentified crud. I’m higher risk for anything respiratory, to the point where my husband really freaked out when I caught the 'rona.

Found an article with some theories. Interestingly, there’s a monoclonal antibody treatment, which I guess is supposed to prevent the illness or prevent it from getting so severe.

This article says that RSV and flu BOTH seem to be hitting earlier than usual.

I think I’ll go find a hazmat suit and crawl into it for a few months.

:sob: How heartbreaking :sob:

There is a confluence of factors and frankly I am very scared.

Lockdown and masks worked very well at preventing children of all ages from getting RSV and influenza for the last three years.

Therefore older children and adults have not been exposed to it and more of them are susceptible to infections. Their infections are still generally mild, sometimes even asymptomatic, they’ve still seen the bug before and have fairly big “small airways”, but they spread it (oh it can trigger asthma episodes and severe illness in a few older children and adults but fairly few).

Children up to three years old though … most have never lived through RSV exposure. They are almost all susceptible, all having their very first infection with it, and all with fairly small small airways. They are relatively high risk for severe disease from RSV, with certain sub populations of that group more so (babies, former premiers, etc.). And they are all being exposed because of all those older sibs and parents bringing it in, with mild symptoms themselves. Volume volume volume! Most of them still have relatively mild disease. Some significant number will wheeze, have modest difficulty breathing, poor feeding, but able to managed fine with attentive parenting, recovering within the week. Some fairly small fraction get hypoxic, can’t breathe well enough to get enough fluids in, and need to be hospitalized, and a very small fraction of infections are fatal. Have many times as many infections occurring in this relatively high risk group and no surprise to have many times more of those serious cases.

Now overlay on that a long term trend that was made much more dramatic during COVID: decreasing pediatric hospital capacity. Over the years the vast majority of community hospitals have dropped have pediatric capacity. Our local one did and I couldn’t blame them. The unit usually had a census of zero to four except during specific infectious disease season spikes. (Various vaccinations, inclusive of for rotavirus diarrhea, and better asthma prevention care made huge impacts in reducing numbers.) And those few small spikes went to zero during COVID, so many more closed up. The pediatric staff moved on, transitioning to adult respiratory care or out of the business entirely. Not possible to re-open those beds quickly even if the corporate hacks gave a green light.

RSV has been steady since Spring and is only increasing with onset of school. And now influenza is in a rapid ascent.

Even before influenza started to rise waits in EDs were often 6 to 8 hours and it has been common to have to transfer kids needing inpatient care out of state to find a bed.

Next week, at this rate, with influenza rising (children under two have a relatively high risk of needing hospitalization with influenza, especially the unvaccinated)? It is reasonably expected that there will not be beds to use anywhere. The child needing admission will stay in the ED on oxygen maybe for days, but the child sitting in the waiting room hypoxic won’t be seen … and there is no back up plan.

When there was a chance that COVID would exceed inpatient capacity the world responded, sometimes in rational ways, sometimes not, separate debate that I gave up on in the time … but pediatric hospital capacity being swamped, the imminent likely preventable deaths of kids due to lack of a bed to get oxygen at? Does not seem to rank.

Schools should go back to masking to flatten the curve … not of COVID which was always a relatively low risk of serious disease for kids, and remains such … but of influenza and RSV. And the chance of that happening is not a rounding error of zero; it is zero.

Do I sound tired and cranky? Well yes I am.

Funny. I was saying something the other day on the bird app about still wearing a mask and was called a “useful idiot” for thinking masks reduce disease transmission and that was absolutely no proof they do.

It could very well be that COVID-19 is the reason there are more RSV cases now.

So more kids with COVID leads to more kids with suppressed immune systems leads to more kids with RSV. Still a theory under investigation, but with some very sobering implications if true.

In the UK at least “RSV” isn’t a big thing but Bronchiolitis has always been one of the main childhood diseases to look out for and RSV is the most common cause of that.

My little girl got it when she about 2 whilst we were away at a theme park. Hit her like a (ghost?) train. In the morning she was fine, a normally active and chatty little thing but I recall putting her on a carousel ride and she just sat there and stared into space, immobile, whilst slowly spinning round. Occasionally casting a mournful gaze at her mother and me. Lunch was a pile of her favourite prawns and tomatoes. Untouched. That’s when we knew she was poorly. Sure enough, fever, cough etc. followed and the bronchiolitis diagnosis came from the doc. Poor little thing. (my daughter, not the doc).

Would not surprise me in the least to see all sorts of infectious diseases re-emerge as major issues. There’s been at least a two year period where natural immunity to all sorts of bugs must have been disrupted, not least with new-borns who had no chance to acquire natural immunity prior to 2020.

Well, you all have done a wonderful job of scaring me!!

I see mixed reports as to whether there’s an RSV vaccine. Some say “yes there was but it proved to be dangerous”, others “there’s one just announced” and so on.

There is not one available for use now. There are research projects ongoing.

Interestingly enough, New Zealand had a winter of high RSV cases in 2021 before the Omicron outbreak (so prior to widespread COVID infection in the community, but after 18 months of relative isolation). So that suggests that COVID exposure does not have much bearing on the current RSV issue elsewhere.

The high rates and severity were attributed to a lack of exposure to respiratory viruses since March 2020, plus significant antigenic shift as viruses arrived when the borders with Australia were relaxed - the incoming viruses had mutated in isolation, and so strains arriving were significantly different from historic exposures, and also from other newly-arriving viruses from other parts of the world.

Both of these things are true.

Years before I was born, back in the 60s, they developed an RSV vaccine and human trials went horrifically wrong. Kids who were in the human trial not only did not avoid RSV, they were vastly more likely to be hospitalized. More than one child died. So of course this put scientists off the idea of another vaccine for decades.

Now, however, things are dire enough to renew interest in an RSV vaccine and there’s at least one candidate in trials.