Respiratory Syncytial Virus (RSV) is an orthopneumovirus that is very common during the winter months each year. In adults, it is one of the causes of the “common cold”. However, in infants it can cause a very serious and even life-threatening respiratory illness. It can also cause pneumonia in the elderly. The good news is that most people, including young children, do not get seriously ill and experience only a sore throat, runny nose and red, irritated eyes. Most children have had RSV at least once by the age of 2 and did fine with it. However, about 15% of young children get seriously ill and the risk is much higher in infants. The problem is that RSV causes an intense inflammation of the respiratory tract with swelling and secretions. Small children have smaller airways and these can get blocked more easily. Signs that the illness is worsening include wheezing and loss of appetite. Critical signs are if the child becomes less responsive to the parents, is not drinking fluids or shows signs of respiratory distress which include flaring open of the nose when breathing, grunting when breathing or when the stomach sucks inward with a breath instead of the usual outward. In these cases, the child should be brought to the nearest emergency room immediately.
We have spoken about influenza in past Miller Reports. Influenza usually causes people to have a really “bad cold” with coughing, headache, muscle aches, fever and often profound weakness or loss of energy. In elderly persons or those with compromised immune systems, it can lead to a serious pneumonia. In addition to the higher than usual number of cases of both RSV and influenza this season, we are still seeing a relatively high number of COVID cases.
A reasonable question to ask is, “Are these high number of RSV and flu cases somehow due to our COVID pandemic of the last three years?” Many are speculating that perhaps the fact that we were mostly wearing masks and social distancing is the reason that we are seeing more cases. This would be sort of like us losing our normal herd immunity because we prevented influenza and RSV by our steps to avoid COVID. While that likely plays a role here, it is not the whole story. With RSV, we normally see it pretty much completely go away during summer months, but this past summer it never really did. So, it has gotten a much earlier start this season leading to more cases now.
Something similar has happened with influenza, where the season this year began two months early. For more on that, please see the Miller Report for October 3rd by visiting www.WMillerMD.com. I predicted that we might not have a particularly bad season this year. That prediction is turning out to be wrong and it looks like we will see something like the peak we experienced in the winter of 2017-18. In the low season of 2011-12 there were an estimated 9,300,000 Americans who got the flu, resulting in 140,000 hospitalizations and 12,600 deaths. Compared to the peak season of 2017-18, when 45,000,000 Americans came down with the flu, resulting in 810,000 hospitalizations and 61,000 deaths. These cycles are not unusual, with total cases rising and falling from year to year. RSV and influenza often go hand in hand. This is what we are seeing now.
One indicator of the state of things are the number of students out sick from school. Schools are currently reporting from 24 to 40% of students out sick. In Fort Bragg, 28% of the middle school is out mostly with respiratory illnesses; only a couple of which are COVID and the rest are presumed to be influenza or RSV. “We are following what public health is saying,” said Joseph Aldridge, Superintendent of Fort Bragg Unified School District. “We are asking parents to keep kids home if they are sick so we can limit the spread at schools.” He added that the district will be waiving their usual requirement that children bring in a doctor’s note to return to school as a way of trying to reduce the burden on parents.
Ukiah and Willits and other inland areas in the county are seeing a particularly high number of RSV cases. Out on the Coast, we are seeing a very high number of influenza A cases. Over the next few weeks, those are likely to merge, giving even higher number of folks ill with respiratory infections. We are also seeing a rise in the number of COVID cases and admissions at about the rate we previously expected for winter.
As a result, all three emergency departments are seeing very high volumes of people with respiratory symptoms. Unfortunately, these high numbers are also being experienced by ERs and hospitals around the state. As a result, pediatric ICUs are filling up at the regional medical centers where we normally would send really sick kids. The three hospitals in Mendocino County this week jointly activated our emergency disaster plans so that we can coordinate care and share resources as needed. We have also been working closely with public health officials.
Fortunately, all three viruses are spread the same way through respiratory droplets. So, the same strategies for protecting oneself from COVID also work for influenza and RSV. Not that you need a reminder, but they are: wearing a medical grade paper mask or N95, maintaining social distancing and frequent hand washing. If you haven’t done so yet, this would be a very good time to get your flu shot and COVID booster.
Miller Report for the Week of November 14th, 2022; by William Miller, MD
You can access all previous Miller Reports online at www.WMillerMD.com.
Dr. Miller is a practicing hospitalist and the Chief of Staff at Adventist Health Mendocino Coast hospital in Ft. Bragg, California. The views shared in this weekly column are those of the author and do not necessarily represent those of the publisher or of Adventist Health.