The respiratory syncytial virus (RSV) typically is common in children two and under, but it’s not common to see a surge like Connecticut is this time of year.
“What has changed now, is from those seasonal normal patterns of distribution, it's all shifted into late summer, early fall in a way that I've never seen before,” said Dr. Juan Salazar, physician-in-chief, Connecticut Children’s. “And I think that's the effect of COVID 19.”
He said the pandemic has affected the way respiratory viruses are transmitted, and “RSV has become really the dominant virus for pediatric respiratory infections, far more than COVID.”
Connecticut Children’s ER had 17 kids with RSV waiting for an in-patient bed, Wednesday. The hospital is seeing 30 or so patients with RSV daily, and Salazar said one hypothesis is a previous COVID-19 infection.
“There’s some evidence that the virus SARS-CoV-2, even in asymptomatic, mild cases, may suppress the B cell, which is responsible for antibody production,” he said. “We know that about 85% of the kids have had COVID at some point, could have had a mild decrease in their B cells and perhaps that set him up for more severe RSV, severe rhinovirus, severe adenovirus, and potentially severe influenza.”
Prior to 2020, physicians saw RSV begin to circulate in the mid-to-late winter, and early spring. “And that was sort of the classic,” Salazar said. “[This year] in the months of June, July, August, September, now October, we have seen a very high number of children, and it really [is] manifesting in a dramatic increase in kids in the last four weeks that have required hospitalization, sometimes ICU care.”
The hospital’s ER is under severe strain, and has opened two additional units to accommodate these patients.
The surge is creating a cascading effect as the unusually high influx of children needing RSV emergency care, means patients coming to the emergency department for any other kind of care have longer wait times. "So we have to look for alternatives," said Salazar, also professor and chair of the Department of Pediatrics at UConn. A make-shift tent is a standby option, he said, if the surge intensifies.
At Yale New Haven Children’s Hospital, Dr. Thomas Murray, associate medical director for Infection Prevention, said the pandemic mask-wearing, hand hygiene, and social distancing kept respiratory infections low. As families have been relaxing those COVID-19 generated precautions, it’s exposing a population of children who previously had minimal exposure to respiratory viruses of all kinds.
“Virtually every child by the age of two would have had RSV,” he said. “And now we have children who are probably close to 3 years old who may never have had RSV. So the total number of kids that are getting RSV for the first time is likely to be much higher.”
Salazar said he expects an influenza outbreak next, and advises parents to vaccinate their children.
