RSV and other boogers

Debra L. Glasser, M.D.

PHOTO BY GLORIA TOWNE

The Respiratory Syncytial Virus (RSV) season is here in our state and community and is already peaking two months early.   

Since the middle of November, we’ve seen a steady increase in influenza cases, with more than 120 patients admitted for flu in the last few days.

Capital Medical Center is currently at capacity, with all their patient beds full.

Mary Bridge Children’s Hospital issued an alert today that they are experiencing high volumes in its Emergency Department with a link to where to get care as well as how to triage your child’s needs; that is, how to prioritize care based on your child’s illness thru your pediatrician, urgent care or emergency department.

News about RSV and viruses abounds these days and is infecting many homes, particularly those with children, school age and younger, to whom it is not news but a living reality.  I don’t have regular relationships with families with children these days (being between my own and grandchildren) but just spent Thanksgiving with my grandnieces, who are ages 5 and 7. Their mother shared that those kids have been sick to varying degrees with at least a runny nose almost constantly since they returned to school and daycare.  These kids are in daycare because their parents work, and if the child can be functional, they go. Some of you may have had to abandon your Thanksgiving plans because kids were sick and adults at risk, as happened to my friend last week.  This is likely not news to parents, teachers and grandparents!

Respiratory Viruses: What are they? How do they make us sick?

Let’s back up to basics. What are respiratory viruses? They are viruses that cause infections in the respiratory tract. What is the respiratory tract? It is the system in our bodies that deals with breathing and air. The organs involved are our nose, throat, sinuses and lungs. The nose, sinuses and throat are called our upper respiratory tract, and the lungs are the lower. The lung parts that are important and relevant to viruses are the bronchial tubes of many sizes (large ones called bronchi, small one’s bronchioles) that bring the air into the lungs and the lung tissue itself (the air sacs known as alveoli) where the actual exchange of oxygen and carbon dioxide take place. 

We get sick in the upper respiratory tract with runny noses, congestion of the nose and sinuses and sore throats and from the lower tract cough due to bronchial tube (and throat) irritation. Bronchitis and sometimes pneumonia follows if the infection is severe and involved the lung tissues themselves. The typical symptoms make us feel mildly ill to miserable but usually don’t cause serious illness unless pneumonia takes hold. Yes, there are deaths yearly from RSV, but that is much less common than with influenza. The actual infection and our bodies’ attempts to fight it off cause other non-respiratory symptoms such as headache, fever, achiness and fatigue.

In children, the whole picture can look different because, well, kids are different. The first thing might be that the kids act different. They get sleepy and no longer act out and play in ways we love and drive us crazy.  The really small ones (think 6 months or less) will get tired, limp and fussy but might not cough and struggle for air but simply stop breathing. These little ones require vigilance on the part of the parent or caregiver. These viruses cause what we colloquially call ‘colds and flu.’

So, what’s all this news about RSV?

Here are the basics from the CDC followed by what’s the big deal?

RSV is not new. It was discovered in 1956 and is one of the many viruses to cause acute respiratory tract illness in persons of all ages. Almost all children are infected by two years of age, and reinfection is common. Its season is typically Oct- April peaking in Jan and Feb but the timing and severity can vary depending on the community year to year. For instance, WA is seeing peak levels already more than a month earlier than usual.

It causes a typical ‘cold’ – starting with a runny nose and loss of appetite in kids. Cough develops a day or two later and soon after sneezing, fever and possibly wheezing.  Very young infants under 6 months, might only be irritable, less active and have spells of stopping breathing.

1-2% of children under 6 months may require hospitalization for involvement of the lungs with bronchiolitis and pneumonia. This is inflammation of the little airways, bronchioles. They may require oxygen and a ventilator in the hospital or pediatric ICU. Fortunately, most of the healthy little ones improve with this supportive care in a few days.

Some kids are more at risk, and if you are parent of one of these kids, you know. They can get sicker, be hospitalized more often and have a treatment that might help if they are tested and have RSV.

RSV affects adults too. Most of us have no or only mild symptoms of a cold.   There are special adults, too, who are more at risk of getting a serious illness from RSV and they are those:

• with asthma or COPD
• over 65,
• with weakened immunes systems or chronic heart disease including heart failure.

What’s the big deal about respiratory viruses this year?

The hype and concern this year is that for the last few winters the main respiratory virus in our midst was Sars CoV2 which causes COVID-19. Because of the prevention measures for COVID that involved isolation and reduced exposure to others, other respiratory infection rates were lower and thus our immunity to these viruses and kids are getting them for the first time was delayed.

Now we are experiencing a surge and co-circulation (i.e., having many different respiratory viruses circulating at the same time) of respiratory viruses at a higher rate than usual for this time of year, especially in children. Yes, you knew that, parents and teachers.  These viruses include: RSV, influenza (showing up early this year too), rhinoviruses, enteroviruses, adenoviruses and more. The concern is that so many kids and elderly sick at once will place a strain on the healthcare system (like COVID did) and some of us may get infected with more than one virus at a time which could cause worse illness. Scientists are studying these coinfections with great interest worldwide because of this unique situation the world is in. All this makes preventive measures more important than ever (see below).

Mary Bridge, the South Sound's children's hospital, is 'over capacity'

“Right now, the biggest impact for our system regarding RSV is at Mary Bridge Children’s hospital in Tacoma," according to a spokesman for MultiCare, which operates the hospital. He added, "Mary Bridge has been over capacity for several weeks dealing with respiratory cases. All our patient beds have been full or nearly full for weeks. Our ED has been full with patients sometimes waiting hours to be seen."

What to do about all this?

The US Centers for Disease Control offers this advice:

RSV can spread when

• An infected person coughs or sneezes
• You get virus droplets from a cough or sneeze in your eyes, nose, or mouth
• You have direct contact with the virus, like kissing the face of a child with RSV or sharing food
• You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands – the virus gets into your respiratory tract that way

People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness.

RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.

Steps you can take to prevent spreading RSV or colds (based on the above science):

• Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
• Wash your and your kids’ hands often with soap and water for at least 20 seconds
• Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
• Clean frequently touched surfaces such as doorknobs and mobile devices
• Avoid close contact with sick people if you are well and stay home if you are sick to avoid infecting others and to take care of yourself
• Avoid smoke exposure and exposing others to smoke (that’s you cigarette smokers) – we know that smoke increases risk of RSV infections and impairs recovery from most respiratory infections for anyone
• Breastfeed your babies if possible – breast milk contains important immune factors that protect babies from infections in general (including RSV) and can lessen the severity when they do occur
• Get a flu shot ASAP because flu season has begun. If you don’t typically get a flu shot consider this year considering that if you don’t get infected with influenza, you won’t pass it on to others and if you do get sick you will not be ill as severely.

Thanks for reading and stay tuned for more about infections and health-related topics of all kinds!

Please comment or email me with any questions or suggestions you have about this column as well as topics you would like me to write about in the future.  

Debra Glasser, M.D., is a retired internal medicine physician who lives in Olympia. Her laughter is infectious. Got a question for her? Write to her at drdebra@theJOLTnews.com