While COVID-19 hospitalizations remain low, Houston’s largest pediatric institutions are preparing for a more concerning wave of summer infections already prolonging ER wait times at some hospitals.

The rate of respiratory syncytial virus, or RSV, has doubled throughout Texas over the last month, based on results from antigen and PCR tests tracked by the Centers for Disease Control and Prevention. Texas Children’s Hospital is reporting about 50 children hospitalized with the virus, four times the number it hadin mid-April, and doctors at Children’s Memorial Hermann say they’ve experienced a similar exponential increase.

No vaccine or at-home tests exist for RSV, a seasonal respiratory illness that generally affects children younger than 3. It can present itself through nasal congestion or coughing but may be more severe among infants, who face a higher risk of developing bronchiolitis, an inflammation of the small airways in the lungs, and pneumonia.

Traditionally, RSV waves hit in the fall and winter, but COVID’s arrival changed the picture. Mitigation measures helped stave off a major wave in 2020, and the summer of 2021 saw a massive spike in RSV infections that peaked in July.

“To me, right now, the increase in RSV is going to be a bigger problem than the (COVID) surge for pediatrics,” said Dr. Michael Chang, UTHealth Houston pediatric infectious disease expert affiliated with Children’s Memorial Hermann Hospital.

Chang noted that COVID cases are still rising dramatically. The 14-day average positivity rate in Harris County is 18 percent, more than triple the rate in early May. The true infection rates are likely much higher with the prevalence of at-home testing. But anecdotally, more recent COVID strains have caused less severe symptoms often confused with allergies. Some hospitalized children are testing positive for COVID, doctors say, but that virus often is not the reason for their visit.

RSV is more commonly the primary illness for children seeking emergency care, as it can lead to wheezing and other signs of difficulty breathing, said Dr. James Versalovic, chief pathologist at Texas Children’s Hospital. Nearly 30 percent of children hospitalized with RSV wind up in the pediatric ICU, he said.

If last summer’s RSV data is a predictor of this year’s trend, the wave of infections is still in the early stages.

In 2021, Texas reached the height of RSV infections in July before it tapered off, according to the CDC. Different tests — antigen and PCR — hit their own peaks on different days, with 46 percent of the state’s antigen tests coming back positive on July 3, and 29 percent of PCR tests returning positive results on July 24. The most recent data available this year, for the week of June 4, shows a positivity rate of 12 percent for antigen tests and 13 percent for PCR tests.

“We are concerned about the rest of June,” Versalovic said.

Chang said Children’s Memorial Hermann wait times are already fluctuating at unusually high levels for this time of year. Hospitals still have adequate bed capacity, but a significant rise of RSV admissions could become a major strain, he said.

Dr. Brent Kaziny, medical director of emergency management at Texas Children’s, said children with signs of breathing problems — sucking in the belly and the area around the clavicle, head bobbing, or grunting — should be taken to ER immediately. But more common symptoms of RSV, such as congestion, can be addressed at home, he said.

He said parents should first check for a fever. Often, treatment of the fever will cause symptoms to subside. Nasal suctioning is also effective at relieving RSV symptoms at home, and primary care pediatricians are a good resource for parents dealing with a persistent infection, he said.

There are no solid answers for why RSV season has now shifted to the summer, Chang said, but the timing of relaxed COVID mitigation measures likely played a role. He questions whether the virus will ever return to its normal habit.

“I think it’s possible that everything I learned about RSV ... could be completely upside down now,” Chang said.

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