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The RSV Nightmare We are all hearing about the pediatric RSV horror stories. Kids are getting hospitalized for RSV (an extremely common respiratory virus) like never before--not only is it hitting earlier this year, it is hitting harder. Already, in October and November, we are seeing the incidence of RSV 60% higher in 2022 than in other years (see image below)--accompanied by rampant pneumonia, and even very sadly, some child deaths. In fact, in a variety of states, beds are so full in pediatric hospitals that they are canceling surgeries. Pediatric units are overwhelmed, particularly in the Northeast, leading to major issues in pediatric emergency care access. This is a big deal, and it’s going to get worse. Because of the decreasing temperatures as we enter winter, holiday gatherings, and other co-infections, it is very likely this current viral surge has not peaked. So, why is this happening? Some hypothesize that children’s immune systems aren’t as primed due to the pandemic isolation, and so the virus is hitting them harder. Others think that a large number of infants are experiencing RSV for the first time due to social distancing measures-- but interestingly these theories are coming up empty handed as far as evidence (yet are somehow still making news headlines…). First of all, social distancing has been reduced significantly for the past year-- mask mandates were removed in all states and on public transportation and all schools have been back in session for some time—allowing immune systems to build-up acquired immunity. There is also little evidence to support the idea that immune systems become “untrained” leading to viral surges--in fact we are actually seeing the opposite of this among many pathogens we would expect to rebound if this were true. Some versions of the flu even went extinct. What we are actually seeing is that some viruses kept at low levels, stay at low levels. What is driving RSV hospitalizations? There is one theory that is gaining major ground--raised by pediatricians themselves--and it has accumulated so much evidence it is surprising it isn’t being talked about in more communities. Let’s look at the facts---90% of children have had RSV by the age of 2, but it is rare that this many children are becoming so ill and ending up hospitalized. So, what is causing the uptick in the severity of the illness? Physicians on the frontlines (those seeing the imaging results) are converging on the idea that this newfound severity of RSV cases is related to pre-existing damage in the pulmonary/respiratory system as a result of prior covid infection. The number of adults with COVID-19 is now estimated to be greater than 80%, with about 75-80% of children estimated to have had COVID-19 by October of 2022. Many of these cases were asymptomatic or undetected altogether, but there is one thing that is showing up across both mild and severe cases--respiratory damage. Respiratory damage, inflammation and immune dysregulation are all potential consequences of COVID-19 infection (even in asymptomatic individuals) which may predispose children to more serious outcomes when infected with other viruses--explaining the steep increase in hospitalizations. Children’s airways are smaller than that of an adult, and when there is inflammation or damage it can make further insult (RSV infection) even more severe. One study cited that they found persistent and widespread pulmonary dysfunction in adults and children inflicted with COVID-19. [STUDY LINK]
What can you do? If your child had COVID before vaccination (increasing potential for damage), or wasn’t vaccinated at all, consider masking at school until this RSV surge has calmed. If your child has a sibling less than 6 months of age, give special consideration to masking children who do attend schools. Infections originating at school by older siblings are a major conduit for infant RSV infection. In fact, sibling to infant infection from a school environment is thought to be responsible for 73% of infant infections. Infant’s are more vulnerable and much more likely to be hospitalized than older children. While COVID-19 may not be as much as a direct threat as it once was for children with the introduction of the pediatric COVID-19 vaccine, the “after-shock” of long-covid may be affecting us significantly. Thus, to protect against the triple-demic (flu, COVID-19 and RSV) my best advice is to continue to mask up through this winter season. This is a temporary, yet powerful intervention you can introduce to protect your family while this surge remains strong. I also recommend investing in good quality air filters, especially as temperatures drop and you cannot leave windows and doors open. If you want more information on which air filters I like best for viral reduction for both family rooms and nurseries, send me a message on my social media account @drjendunphy. My favorite masks right now for kids are these N95’s available on amazon, which I will link HERE. I like these masks because they are adjustable and have two flaps on the top and bottom which tend to create a better seal and are more comfortable for longer term wear.