Respiratory syncytial virus (RSV) has hit the US harder and earlier than usual this year, and while children have primarily been affected, older Americans are also seeing a rise in hospitalizations from the illness.
As of the week ending Nov. 12, data from the Centers for Disease Control and Prevention (CDC) shows adults ages 65 and older are being hospitalized at a weekly rate of 2.4 per 100,000. During the same period in 2021, the weekly hospitalization rate for seniors was 1.5 per 100,000—and in pre-pandemic times, it was even lower than that.
“COVID has not respected any of the traditional respiratory virus seasons and as a result, it has really turned RSV upside down,” John Sellick, DO, professor of medicine in the division of infectious diseases in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, told Health. “With that much RSV in the kiddie population, we’re seeing the spillover into the older population.”
So why are older adults also seeing RSV infections—and ultimately, hospitalizations—in higher numbers too? Here's what experts have to say about why that population may be more likely to experience severe illness, and how to manage and prevent the illness—without a vaccine or targeted treatments.
During typical years, RSV still disproportionately affects children and, to some extent, older adults; but the virus usually peaks between late December and early February. The COVID pandemic, however, has altered the virus' normal patterns.
“All bets are off this year,” Jonathan D. Grein, MD, infectious disease specialist and director of Hospital Epidemiology at Cedars-Sinai, told Health. “This is a unique experience we’re going through after two years of relatively low flu and RSV activity. Going into this season, with a lot of the precautions for COVID being taken away, it’s really going to be hard to predict how the season will pan out.”
This has led to high RSV cases for all age groups, seniors included—RSV hospitalizations in general have more than tripled as compared to this point in 2021.
As for why cases are so high right now, experts said the answer likely lies in part with the fact that masking, social distancing, and hand washing measures have been largely deemphasized this fall, Dr. Grein said. People likely also have less “intrinsic immunity” to RSV now because they weren’t exposed to RSV during the worst months of the pandemic, he added.
For people over 65 specifically, they’re likely catching RSV from the younger people that have it.
“I think it has something to do with the kids also going back to school, because, as you know, RSV is traditionally considered a pediatric disease,” Daphne-Dominique Villanueva, MD, transplant infectious disease physician and assistant professor at West Virginia University Medicine, told Health. “But [they] can spread it to older adults, especially when they visit grandparents.”
And with cases as high as they are now, Dr. Sellick is concerned that the coming weeks could bring even more opportunities for sick children and adults to spread RSV.
“We tend to see a lot of RSV after the holidays and we've always presumed that this means that you've got multi-generational family events between Thanksgiving and the New Year,” said Dr. Sellick. “You’ve got little kids with RSV who are more than happy to share it with mom and dad and grandma and grandpa.”
But there is somewhat of a silver lining: The high numbers of hospitalizations are more a reflection of how people are behaving, more so than the virus itself becoming more transmissible or deadly, according to experts.
Though RNA viruses like RSV do mutate in minor ways fairly frequently, Drs. Sellick and Grein agreed that there’s no evidence to suggest that this year’s high number of hospitalizations and cases are linked to any new kind of RSV variant.
For the majority of people, RSV presents as a mild cold, with coughing, sneezing, a runny nose, and fever. But in some cases, particularly for older people, young infants, or the immunocompromised, the virus can become dangerous.
“It will usually start as flu-like symptoms,” said Dr. Villanueva. “However, their symptoms can progress to more severe pneumonia such as shortness of breath, wheezing, those other symptoms. So those are signs that they need to go to the hospital.”
These more severe RSV symptoms can strike seniors especially hard because many may have underlying health conditions that make it more difficult for their bodies to recover from the virus.
“As you age, your immune system weakens a bit. Also as we age, we tend to collect more medical comorbidities,” said Dr. Grein. “So with RSV we know, for example, people with underlying heart disease or chronic lung disease are certainly at high risk of poor outcomes.”
RSV can make conditions like asthma, COPD, or congestive heart failure worse, and in some cases, can cause death. The CDC estimates that each year, between 60,000 and 120,000 older adults are hospitalized with RSV, and between 6,000 and 10,000 will die from it.
Treatment for RSV is yet another hurdle for those over 65. RSV care in general is supportive, Dr. Villanueva explained, and people of all ages will receive hydration, rest, and breathing assistance if they're hospitalized for RSV.
Young infants who are at risk of developing severe RSV can be given a monoclonal antibody treatment called Synagis (palivizumab) to prevent serious symptoms, but no such medication exists for older children or adults.
Though researchers are making progress on a vaccine for RSV—and it could be available “within the next two years,” Dr. Sellick said—we’re not there yet. And in the face of high case numbers, prevention is the only tool available to stop RSV from increasing to even more dangerous levels.
“The good news is the pandemic has taught us all the tools we need to keep ourselves safe,” said Dr. Grien. “All of those measures like wearing masks, staying away from others who are ill—those things work very well for pretty much all respiratory viruses, including RSV.”
This doesn’t necessarily mean the US needs to go back to full-scale preventative measures like we saw in 2020 and 2021. Instead, Dr. Villanueva said, it’s best to “evaluate your own risk,” and decide if masking up or other preventative tools are a good idea to implement.
It’s impossible to predict if this current RSV surge is an early peak, or if it’s a precursor to even more hospitalizations to come in the following weeks or months, experts said. But prevention is one sure way to keep seniors safe from RSV.
“Our main strategy is really to prevent people from getting it in the first place,” Dr. Villanueva said. “We know that it works, right—masking and hand hygiene works because RSV is basically transmitted the same way as COVID is.”