Respiratory syncytial virus (RSV) cases have skyrocketed across the country, leading to record pediatric hospitalization rates and straining healthcare systems already overwhelmed with COVID-19 and influenza patients.
RSV Hospitalizations Hit Multi-Year Highs
RSV is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be dangerous for infants and older adults. This RSV season has seen an unprecedented spike in severe cases requiring hospitalization.
As this table of data from the Centers for Disease Control and Prevention (CDC) shows, RSV hospitalization rates among children 0-4 years old have exceeded any seasons since 2010:
| RSV Season | Hospitalization Rate per 100,000 |
|---|---|
| 2022-2023 | 98.1 |
| 2021-2022 | 50.6 |
| 2020-2021 | 0.8 |
| 2019-2020 | 55.9 |
| 2018-2019 | 59.8 |
Seasonal RSV hospitalization rates normally peak in January or February. However, this season’s early and dramatic surge has smashed records two months sooner than expected.
“I’ve been doing this a long time. I’ve been at Children’s for 32 years taking care of kids with infections, and I’ve never seen this level of surge specifically for RSV coming into our hospital,” said Dr. Maggie Hansen, interim chair for the Department of Pediatrics at UPMC Children’s Hospital of Pittsburgh.
Triple Threat With COVID-19 and Flu
RSV is not the only virus causing problems this winter. High levels of COVID-19 and influenza are also circulating. Together, this triple threat of respiratory illnesses has overwhelmed children’s hospitals nationwide.
“We are seeing record numbers in our emergency department,” said Dr. Hansen. Emergency room volumes at UPMC Children’s are 40-50% higher than average for this time of year.
COVID-19 hospitalizations have increased more than 15% in the last month, per the Department of Health and Human Services. Simultaneously, seasonal flu activity continues to rise. About 9.2% of patients visiting healthcare providers last week were exhibiting flu-like illnesses.
As seen in this map from the CDC, Oklahoma has some of the highest rates of flu and COVID-like illnesses in the country right now:
With multiple respiratory viruses circulating at such high levels, there are concerns about continued surges lasting beyond the typical ends of RSV (April) and flu (May) seasons this spring.
“Our teams are already exhausted and overwhelmed after operating at such sustained intensity for almost three years through the pandemic waves of COVID,” explained Dr. Jason Newland, a pediatric infectious diseases physician at St. Louis Children’s Hospital. “I’m very worried for them as this intense RSV surge layers on top of yet another COVID-19 wave and early flu season, that we might break our healthcare system unless prevention measures improve quickly.”
Lead Up to the Surge
Several factors created a perfect storm for this unprecedented RSV surge.
The last two RSV seasons were much milder than average due to COVID-19 lockdowns and restrictions. Less virus circulation means many young children have no immunity. RSV infections usually happen early on to build antibodies.
With society opened back up in 2022, an extremely virulent strain of RSV emerged against many immunologically naive babies and children.
“Because there were essentially two seasons worth of births that did not have that first exposure to RSV during the pandemic, they didn’t get that initial immunity. Now that everything is open, kids are back together, masks are down, families are traveling, that virus is circulating aggressively,” summarized Dr. Christina Canody, a pediatric infectious disease specialist with St. Jude Children’s Research Hospital.
Additionally, COVID-19 countermeasures like masking and distancing protected against other respiratory viruses. Their sudden removal enabled simultaneous surges not just in RSV but other threats like flu.
Finally staffing shortages, limited bed space and overcrowded emergency departments left children’s hospitals unprepared for such a volume shock.
“Our health care system runs at 100% capacity or more all of the time now,” noted Dr. Newland. “Then when enter an early and aggressive cold & flu season with these other drivers – we have the perfect set up for a crisis in pediatric health care delivery.”
What Happens Next?
There are unfortunately no signs of relief on the horizon in the near-term. RSV and flu activity will likely remain high for months. Another possible COVID surge looms as well with new subvariants emerging.
Still, experts agree this crisis underscores the need for more research and innovation focused on these pediatric respiratory threats.
“The fact that RSV remains so uncontrolled even 65 years after discovery speaks to the urgent need for acceleration in development of vaccines and monoclonal antibodies against viral threats in newborns and infants,” said Dr. Octavio Ramilo, chief of Infectious Diseases at Nationwide Children’s Hospital in Columbus, Ohio.
Several RSV vaccine candidates targeting pregnant women, young infants or older adults are currently undergoing clinical trials. Additionally, an experimental monoclonal antibody shot was recently approved that could protect vulnerable newborns during peak seasons. However, none of these interventions will impact the current 2022-2023 surge.
In the meantime, health officials advise caution and common sense measures to slow virus spread like hand washing, masking around immunocompromised individuals where appropriate, and keeping children with symptoms home from school if possible. They also recommend getting the latest COVID-19 bivalent booster and annual flu shots to prevent further compounding the pediatric healthcare emergency.
We must support doctors, nurses and facilities on the frontlines caring for seriously ill children. Policymakers need to take action as well to improve capacity, staffing and access to meet both current demand as well as prepare pediatric health systems to endure future seasons. Our youngest and most vulnerable deserve nothing less.
To err is human, but AI does it too. Whilst factual data is used in the production of these articles, the content is written entirely by AI. Double check any facts you intend to rely on with another source.
