Outbreak of RSV, virus that can seriously sicken infants, fills hospital beds

Sunday evening, 4-month-old Aesop Light was happy and alert. Monday morning, he was having trouble breathing.

Aesop’s parents, Corey and Tara Light, took him to the emergency room near their home in suburban Chicago, but there was no children’s wing, so Aesop was rushed by ambulance to another hospital an hour away. He tested positive for respiratory syncytial virus, or RSV, a common virus that causes lung infections.

Aesop’s condition “deteriorated very quickly,” Tara said.

Hospitals across the country have reported an increase in RSV cases over the past three to four weeks. The virus has started drive in the summerto the surprise of doctors, since it usually peaks in winter.

For many children, RSV symptoms resemble a cold. But for others – young babies or children with lung conditions or weakened immune systems – symptoms can be more severe.

“Those who tend to get sickest are infants under four months old. And then those who are older and tend to get sickest are those with other health conditions,” said the Dr. Sameer Kamath, Chief Medical Officer of Duke Children’s Hospital and Health Center.

RSV can lead to bronchiolitis, an infection that causes the airways to become inflamed and blocked with mucus, making it difficult to breathe. If the infection spreads into the lung sacs, it can lead to pneumonia.

According to the Centers for Disease Control and PreventionRSV causes approximately 58,000 annual hospitalizations and 100 to 300 deaths in children under 5 years of age.

Aesop was moved to a pediatric intensive care unit on Tuesday after his heart and breathing rates skyrocketed. Tara stayed with him in the hospital, as she is still breastfeeding. Meanwhile, Corey goes back and forth to care for their three other children.

NBC News spoke to six doctors in five states — California, Illinois, Massachusetts, North Carolina and Rhode Island — who all said pediatric hospital bed capacity has been stretched due to a influx of RSV patients.

“We really have a capacity issue like I’ve never seen before,” said Dr. Charlotte Boney, chief pediatrician at Baystate Children’s Hospital in Springfield, Massachusetts.

The CDC said it does not keep a national tally of RSV cases, hospitalizations or deaths, but does track changes in the spread of the virus.

“We have observed an increase in RSV in several areas of the United States, and some areas are approaching seasonal peak levels,” a CDC spokesperson said.

Last week, nearly 5,000 tests came back positive, according to CDC data. This is not far from the number of the same week of October 2021 but much higher than in October 2020.

Boney said his hospital saw a higher volume of patients in September than ever before, many of whom had RSV. Its pediatric intensive care unit was closed to new patients on Wednesday because no beds were available.

In a normal winter, her emergency room might see about 100 children a day, Boney said. He now sees about 130 to 150. Many RSV patients in Massachusetts are transferred to neighboring states, she added.

Dr. Michael Koster, director of pediatric infectious diseases at Hasbro Children’s Hospital in Providence, Rhode Island, said his hospital treats RSV patients more than 100 miles away.

Kamath said that in the Raleigh, Durham and Chapel Hill area, “there have been nights where there was a bed available between three institutions, which is very scary.”

At Comer Children’s Hospital in Chicago, hospital and intensive care beds have been full for more than a month. Dr John Cunningham, the hospital’s chief medical officer, said the emergency room was seeing 150 per cent higher volume than usual for October. He said the hospital treats around 10 to 30 RSV patients at any given time, so they take up a large portion of its 30 intensive care beds and 60 emergency beds.

Cunningham Hospital is referring some patients to other facilities, but it can take 24 hours for a transfer, and a child’s condition could easily deteriorate during that time.

“Depending on the severity, it’s no exaggeration to say minutes, hours count,” said Dr. Benny Joyner, pediatric ICU medical director at UNC Hospitals in Chapel Hill, North Carolina.

In San Diego, 50 patients have tested positive for RSV in the past few days at Rady Children’s Hospital, according to Dr. John Bradley, medical director of infectious diseases at the hospital. He said the volume of RSV patients is “two to three times what we’ve ever seen.”

“As of mid-October, an RSV outbreak is virtually unheard of in San Diego,” Bradley added.

What a severe case of RSV looks like

Doctors said RSV was spreading earlier this year and leading to more severe disease in some children, as many children were not exposed to respiratory viruses earlier in the pandemic due to masking and social distancing.

“All of these infection control measures protected us from all of these viruses. Now everyone has relaxed these measures and these viruses are back with a vengeance,” Boney said.

Doctors say they have seen many young children contracting RSV from an older sibling, who in turn became infected at school or daycare. This is how the Light family thinks Aesop got sick: they have a daughter in first grade, a son in pre-kindergarten, and a 2-year-old daughter at home. The whole family had cold symptoms last week.

“It’s really a contact disease,” Cunningham said. “Hand hygiene is really key. The main way it disperses is actually through direct contact, rather than someone coughing on you.”

Doctors said parents shouldn’t worry about every cough or runny nose, but should watch for signs that a child is lethargic or breathing hard or fast.

“If your child, especially under age 2, has his nostrils dilated, growls, bobs his head, or you see sucking around the collarbones or ribs, that’s much more concerning,” Koster said.

Kamath said many children who present to hospital cannot eat or drink because they are breathing so rapidly. If your child can’t get fluids, Joyner said, “that’s a warning sign that you need to bring them in and have them evaluated.”

Aesop Light showed many of these warning signs, Corey said. Doctors told the Enlightenment that their son needed oxygen and tubes inserted into his nostrils to suck mucus from his airways.

On Thursday, Aesop was finally able to breathe on his own.

Children hospitalized with RSV typically recover in two to three days, although “a small minority end up in intensive care and then sometimes even on a ventilator,” Kamath said.

Intensive care patients tend to recover within a week, according to Joyner.

RSV vaccines and treatments are on the horizon

Other than breathing tubes, ventilators, and supportive care like steroids or fluids, doctors don’t have many ways to treat RSV.

“There is no Paxlovid-like drug for RSV. There is no Tamiflu drug like we have for the flu,” Boney said.

One drug, a monoclonal antibody called Synagis, is approved for babies at high risk of severe RSV, such as those born premature or with chronic heart or lung problems. But doctors said they gave this treatment sparingly.

However, Bradley said his San Diego hospital is expected to participate in a clinical trial of an RSV antiviral from Pfizer later this year.

“I’ve told Pfizer before, ‘Hurry up, get the study started,'” he said. “We’re overwhelmed with RSV, so it would be easy to study the drug right now.”

Pfizer is also test a vaccine candidate against RSVwhich has been shown to be nearly 86% effective in preventing serious disease in a elderly advanced stage trial. Another RSV vaccine candidate, from pharmaceutical company GSK, has been shown to be about 83% effective against the disease in adults 60 and older, according to Data released Thursday.

Bradley predicted that it will take a few more years for an RSV vaccine to become available. In the meantime, he said, the oxygen supply is very effective.

“It’s purely a lung infection. This virus doesn’t go anywhere else in the body like the flu does,” he said, adding that “once they get oxygen and the lungs are working, the children feel really good”.

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