In recent weeks many children have returned to in-person learning and resumed after-school activities and sports. Some public health measures used to mitigate the spread of COVID-19 such as masks and social distancing, which are also effective against other respiratory viruses, have been lifted in many schools across the United States. While all of this has brought back a much-needed sense of normalcy for children and their families, it has also come with some challenges, including a significant increase in respiratory illnesses among kids.
Children’s hospitals in major U.S. cities have been reporting unusually high numbers of sick patients with respiratory illnesses caused by viruses other than the coronavirus. These include respiratory syncytial virus (RSV), enteroviruses (EV) and rhinovirus (RV), which mostly cause coldlike symptoms such as a runny nose, coughing, sneezing and fever.
Normally, these viruses emerge in the winter months. During this time, also known as respiratory viral season, pediatricians and hospitals are prepared to deal with an influx of patients sick with these viruses. However, this year the season started sooner than expected, and the number of children needing hospitalizations has been so high that in some areas hospital systems are already overwhelmed.
“In general, pediatric hospitals operate relatively close to their capacity,” Dr. Michael Chang, a pediatric infectious diseases specialist at UTHealth Houston and Children’s Memorial Hermann Hospital, told Yahoo News. “So when you see patients needing hospitalization for respiratory viruses at unusual times of the year, then it's easy to kind of reach capacity for hospitals.”
In September, the Centers for Disease Control and Prevention alerted public health departments and doctors treating pediatric patients about some of these respiratory viruses. The agency issued a health advisory warning about an increase in the number of pediatric hospitalizations for severe respiratory illness where patients were testing positive for rhinovirus and/or enterovirus, including enterovirus D68 (EV-D68) — which has been linked to a rare but serious condition called acute flaccid myelitis, or AFM. The main purpose of the advisory, the CDC said, was for doctors to keep this information top of mind when diagnosing and treating respiratory illnesses in children, as some of these viruses “can have clinically similar presentations” and be “indistinguishable from one another.”
Chang said his home state of Texas is in the middle of “a big RSV surge” right now, which started a couple of weeks ago and wasn’t expected until at least late October. “We have something like 20% of our tests for RSV are positive, which is well above the 10% threshold that we consider kind of the epidemic level of RSV,” he said.
Cases of enterovirus D68 have also gone up and are “at a higher rate than baseline,” according to Chang. He noted that the numbers for enterovirus are not as high as those seen in previous surges. However, he said doctors are not exactly sure how far into the surge they are because this is happening at an unusual time.
In addition, doctors in the state have started to see a number of flu cases — again, earlier than expected. COVID-19 cases, however, are going down, Chang said.
Why are these respiratory viruses surging right now?
The COVID-19 pandemic disrupted not only people’s lives but also historical seasonal patterns for other common respiratory viruses. Chang said these patterns have completely changed, and while it’s unclear why, it likely has a lot to do with human behavior.
“We were really focused on those infection prevention techniques, which again, not only do they work for SARS-CoV-2, but they really work for most of the respiratory viruses,” he said. “We knew that those infection prevention techniques could work for the flu and RSV. It's just that we never executed them on such a global scale, right? Like we never did it in such a widespread fashion where so many people were wearing masks, so many people were isolating, so many people were physical distancing. So we never got to see the impact that those types of preventions on such a large scale could have for RSV and flu, but were obviously very effective.”
Chang explained that the past two winters were among the mildest influenza seasons on record. Similarly, doctors didn’t see much RSV in the winter of 2020-21, when the country was facing a COVID-19 surge and there were tight public health restrictions in place. However, as some of these pandemic restrictions were loosened last summer, there was a major surge of RSV. He said two things were unusual about it: how early it happened — well before winter — and how severe some of the cases were.
This year, RSV is once again surging earlier than usual, and flu cases have also started to increase in some parts of the country, particularly the Southeast and South Central U.S. According to health experts, we could face a severe flu season that coincides with a winter surge of COVID-19.
Another explanation for why these winter respiratory viruses are affecting us more now, experts say, is not necessarily because they’ve changed but because we have less immunity against them.
“Basically for two years, two winters where kids and adults would have been infected by RSV or by the flu, they didn’t have it, and so some of that immunity that we would have had from infection before, we don't have now,” Chang explained.
Which symptoms should parents be on the lookout for?
For most parents, “all these viruses are pretty much going to be indistinguishable,” Chang told Yahoo News. Common symptoms are a runny nose, sore throat and coughing. These, the pediatrician said, can last three to five days, sometimes peaking on day five, just before they start to subside.
Most children, he said, recover fully from these viruses with no long-term complications. However, parents of children with asthma or reactive airway disease (when asthma is suspected but not confirmed) need to be more cautious about these viruses, particularly enterovirus D68, which can cause more severe disease.
“Certainly any time that you notice that they’re having difficulty, like with shortness of breath at rest, or if they’re having trouble completing their sentences, if they’re wheezing a lot, coughing is more severe, any type of shortness of breath and then any type of chest pain, you are going want to ... seek medical attention,” Chang said.
Infants and younger children, particularly if they were born premature or have a history of underlying congenital heart disease, are at increased risk of severe illness from RSV, he explained.
“The main things you want to look out for are difficulty with feeding, difficulty with catching their breath if they're taking a bottle or breastfeeding. Certainly decreased feeding, decreased appetite,” he said.
How can parents best protect children right now?
There are currently no vaccines available for RSV, enterovirus D68 or rhinovirus. But Chang said the best way to protect children this winter is to make sure parents and children are vaccinated against those viruses that we do have vaccines for, such as flu and COVID-19.
“Everybody who qualifies for [a] flu shot, which is pretty much everyone from 6 months to adult, should go and get their seasonal flu vaccine as soon as possible,” Chang said.
He also urged those who have not been vaccinated against COVID-19 to get their shots.
“The best way to minimize the risk of severe illness and hospitalization, whatever your age, whatever your underlying conditions, is to get vaccinated and be fully up to date on your SARS-CoV-2 immunizations, including the new bivalent boosters.”
Cover thumbnail photo: Peter Cade via Getty Images