Physicians discuss increase in virus and treatments
Dr. Jenna Holmen
Local health officials have reported seeing higher cases of Respiratory Syncytial Virus this flu season than in recent years and expect this to be a severe season for RSV.
“The percentage of admissions for RSV in Kaiser Permanente facilities in Northern California during Week 41 was 0.5% compared to 0.3% during Week 40,” according to the California Department of Public Health, page 14 of the California Weekly Report and Other Respiratory Viruses. The week 41 report is for October 9-15.
“We are concerned we are seeing it more than usual. Most people will get it at some time in their life, and you can get it more than once,” Dr. Laura Polito, Sansum Clinic urgent care physician director, told the News-Press. “It is most dangerous in children under 2, the immunocompromised or the elderly. It is presented as a common cold for healthy adults.
“This is a lot like what happened with COVID,” she said. “We are mostly concerned with the vulnerable people. We have seen in urgent care eight cases of RSV, which is unusual for this time of year. We usually don’t see any until December or January.”
“We have already started seeing cases earlier than normal and several have been quite severe,” Dr. Jenna Holmen of Pediatric Infectious Disease for Cottage Children’s Medical Center told the News-Press.
The News-Press asked a Sansum Clinic pediatrician, Dr. Daniel Brennan, how many cases of RSV have been seen in pediatrics so far.
“This is difficult to estimate, but I know of several patients already this week who have been hospitalized with RSV, and many others who required visits to the emergency room,” Dr. Brennan said. “We seem to be experiencing a very early start to the cold and flu season. I have seen more RSV and influenza already this October than I recall seeing in October of 2020 and 2021.”
Symptoms of RSV include: cough, nasal congestion, runny nose and fevers sometimes.
“There is testing available and a rapid test is available now. However, testing is mostly for the vulnerable people. If you feel you need to be tested, contact your primary care provider,” said Dr. Polito. “A rapid test is available in urgent care, but we use it mostly for the vulnerable. RSV is spread by droplets. The six feet (social distancing) rule is a really good rule. It can live on a hard surface for several hours and on soft surface for a shorter period of time,”
Noted Dr. Holmen, “For most children and adults, it is like the common cold with extra mucus. The highest risk are babies less than 1 year old and adults over 65. Symptoms include severe respiratory distress, rapid breathing, struggling to breathe, and babies can change colors and turn blue. Other symptoms include the usual cold symptoms such as a cough and sometimes fever.”
Dr. Brennan told the News-Press, “RSV is a virus that pediatricians are very familiar with. For most adults and older children, RSV causes typical common cold symptoms such as runny nose, nasal congestion and cough. But for infants, preemies and those with high-risk conditions like asthma, RSV can create enough mucus and inflammation in the lungs to result in hospitalization to provide things like breathing treatments, deep suctioning, supplemental oxygen, intravenous fluids and sometimes respiratory support in severe cases.”
The News-Press asked Dr. Holmen and Dr. Brennan, both pediatricians, what precautions parents should be taking to protect their children.
“We haven’t seen much in the last two years due to masking,” Dr. Holmen said. “Masking is always an option, but good hand washing is the first line of defense. For babies under a year, try to keep them away from sick children. There is hard work being done on vaccines and one or two are really close. We might get a vaccine in the next year or so.”
“If there is an outbreak of RSV at your school or daycare, it may be a good idea to keep your child home until the illnesses settle down,” Dr. Brennan said. “This is especially true if you have a very young child, a preemie, a child with an underlying health condition or if you have a high-risk person living in your home.
“If your child is sick, it has always been a good idea to stay home until he or she is feeling better,” Dr. Brennan said. “This is just a kind thing to do in order to keep your school community, classmates and teachers healthy. Some viruses take longer to resolve than others, and some children may continue to shed certain viruses longer than most of us realize. These are factors that can be taken into consideration when parents are deciding when to send their kids back to school or when daycares/preschools are setting their return-to-school health policies.”
Dr. Polito said the approach is supportive treatments. “If they are really sick we send them to hospital, where they are monitored and given oxygen and fluids if needed. Antiviral medications have been used, but (we) don’t necessarily have good data behind them including Ribavirin and IVIG, which is an IV infusion of antibodies. There is no definitive treatment but there are ongoing studies.”
Dr. Holmen agreed that physicians provide supportive care. “There are no antibiotics. If a child is struggling to breathe, bring them to an emergency room or pediatrician.”
Dr. Brennan said pediatricians are very familiar with RSV.
“Treatment for most cases of RSV include supportive care, fluids, rest and time,” he said. “Nasal saline drops, humidifier and steamy bathroom treatments can be helpful to keep mucus thin and make it easier to breathe through the nose. For patients with asthma, nebulizers/inhalers may be helpful.
“But for infants, preemies and those with high-risk conditions, RSV can create enough mucus and inflammation in the lungs to result in a need for hospitalization to provide things like breathing treatments, deep suctioning, supplemental oxygen, intravenous fluids and sometimes respiratory support in severe cases,” he said.
“While there is not a treatment for RSV once you are infected, we do have a monthly preventive treatment with a monoclonal antibody called Synagis available for certain high-risk infants,” said Dr. Brennan.
Dr. Brennan said that if children have symptoms and parents suspect it’s RSV, reach out to your doctor and let the physician sort out testing and treatment options.
“Most cases will not require medical treatment,” he said. “But telehealth has become a great tool for patients to access their healthcare provider from home and ask questions, talk through symptoms, review exposures, and discuss when to return to school and how to proceed with testing and treatment.”
Dr. Polito said bring the person in your care to the doctor right away if they have a common cold but seem sicker. “Healthy adults won’t feel sicker. Many have had RSV more than once and don’t even know it.”
Dr. Holmen noted pediatricians know RSV well and that it is around every year.
“But this year is more severe. Parents should have a low threshold for evaluation.”
Dr. Brennan said that while the pandemic has been difficult, it has taught many good lessons for community health.
“Being mindful of when you are sick, and taking steps to protect those around us, is a kind thing to do,” he said. “We now know how well measures like good hygiene, handwashing, ventilation and staying home until we are feeling better can help keep those around us from getting sick.
“We also know that high-quality masks are another tool that can help reduce the spread of germs if you are experiencing symptoms or just want to reduce the chances of being exposed if you are in an indoor or classroom setting,” he said. “Many viruses, including RSV, can survive on surfaces for many hours. When coming home from preschool, a good practice is to wash hands, face and maybe even change into a clean shirt before interacting with other siblings.”
email: kzehnder@newspress.com
