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Why the RSV surge is so serious, and what to know about symptoms and treatment

What to know about the RSV surge and its impact on kids versus adults.
/ Source: TODAY

With the arrival of cold and flu season, and COVID-19 still infecting and killing thousands weekly, many hospitals have been straining to keep up with demand. What's more, an unprecedented surge of cases of respiratory syncytial virus (RSV), a common virus, have compounded matters, causing pediatric hospitals in some regions to hit capacity and creating reduced and delayed access to care.

“RSV hit earlier and harder this year,” Dr. Elizabeth Mack, head of the pediatric critical care unit at the Medical University of South Carolina, told TODAY. “And it hit on top of multiple other respiratory viruses.” 

Dr. Sage Myers, a pediatric emergency medicine physician at the Children’s Hospital of Philadelphia (aka CHOP), previously told TODAY that at her hospital, “There’s no space anywhere.” 

Is RSV on the rise? 

RSV was on the rise for much of the late summer, September and October; in late October, rates were more than 500% higher than those in early September, according to data from the Centers for Disease Control and Prevention. But the most recent week for which data is available, Nov. 5, shows a decline in rates to levels from a few weeks ago.

In addition to the high number of cases, the current RSV surge is also unusual because many children are showing up at hospitals much sicker on average than compare to previous years.

“The majority of the children are coming in pretty sick. They’re requiring higher levels of oxygen (than) they normally would,” Erica Setzer, Yale New Haven Children’s Hospital clinical program director of pediatric critical clinical care services, told NBC News national correspondent Gabe Gutierrez in a segment in October.

Dr. Juan Salazar, executive vice president and physician-in-chief at Connecticut Children’s, previously told TODAY that he's never seen this level of transmission or "need for hospitalization in kids" due to RSV in the 25 years he's been at his hospital.

It's not exactly clear why RSV has been surging, but some experts have theorized that it started with pandemic restrictions, which reduced kids' exposure to the virus over the past few years. So now, more kids are susceptible who otherwise wouldn't have been, and they're getting infected after much of the country suddenly dropped pandemic-era precautions, like masking and social distancing.

In addition to a surge of RSV cases, Myers told TODAY that other common respiratory viruses, including rhinovirus and enterovirus, are also circulating at higher levels than usual. At the same time the U.S. is experiencing the highest rate of flu hospitalizations for this time of year in a decade — with young children among the group hardest hit, as TODAY previously reported

 What month does RSV typically peak? 

Salazar told TODAY that in his experience RSV peaks in the middle of January or February. According to the CDC, this is how RSV season typically plays out:

  • RSV season onset usually goes from mid-September to mid-November.
  • RSV season peaks late in the month of December to mid-February.
  • RSV cases trail off from mid-April to mid-May.

But the RSV surge started much earlier this year. “We’re seeing an explosion of RSV cases unlike anything we’ve had,” Dr. Phoebe Yager, the medical director of the pediatric intensive care unit at Mass General for Children, previously told TODAY.

Almost all children are infected with RSV by their second birthdays, per the CDC, but recent RSV seasons have been anything but typical. 

“The past two years, people were still social distancing and masking, which made the first RSV season of the pandemic virtually nonexistent and last year’s significantly diminished,” Yager said. “But now that kids are back in school and many people have abandoned preventive health measures, RSV cases are blowing up again.”

Why is RSV so serious? 

The current RSV surge is serious because of the virus's impact on infants, young children and adults over 65. RSV cases are usually mild in healthy adults and older children.

“In older adults, RSV can cause pneumonia, worsening of heart failure and worsening of lung disease,” Dr. Andrew Pavia, a pediatric infectious disease epidemiologist at Intermountain Primary Children’s Hospital in Salt Lake City, previously told TODAY.

RSV is so serious in young children because creates a lot of mucus and congestion, and babies struggle to expel the congestion on their own, which can make breathing and nursing from a bottle or breast difficult. Babies' smaller breathing pathways also come with a higher risk of inflammation due to the virus, which can be life-threatening. Some young children develop pneumonia (an infection in the lungs) or bronchiolitis (an infection in the small airways in the lungs).

The CDC estimates between 58,000 and 80,000 U.S. children under 5 are hospitalized with RSV every year, resulting in 100 to 300 U.S. kids under 5 dying, though other estimates are much higher. An estimated 60,000 to 120,000 adults over 65 are hospitalized as a result of RSV every year, contributing to 6,000 to 10,000 deaths.

RSV may also be considered especially serious because it shares an attribute with COVID-19 that made the pandemic especially difficult to contain: Both viruses can be transmitted before an infected person shows symptoms. According to the CDC, people with RSV are contagious one to two days before the start having symptoms and are contagious for three to eight days in total.

What are the RSV symptoms in babies, toddlers and children? 

Common RSV symptoms in toddlers and children during the current RSV surge include:

  • A stuffy or runny nose
  • Decrease in appetite
  • Cough
  • Fever
  • Wheezing or difficulty breathing

The CDC noted that symptoms “usually appear in stages and not all at once.”

Infants and young children may show fewer symptoms, such as:

  • Irritability
  • Decreased levels of activity
  • Breathing difficulty
  • Diminished appetite and number of diapers

As a parent taking care of their sick kid a home, you won't be able to tell which virus your child has. But since there's currently an RSV surge, know these signs your sick kid needs medical care right away:

  • Difficulty breathing. With each breath, you might notice the child's chest caving in, ribs becoming visible, nostrils flaring or grunting (in the case of infants) — all signs of difficulty breathing.
  • Irritability to the point that they're not consolable.
  • Resistance to or trouble speaking, especially if it's because they're struggling to breathe.
  • Lethargy, meaning they're hard to wake up, staring off and struggle to pay attention.
  • Tinge of blue around the lips, a life-threatening sign that oxygen is severely compromised and merits a call to 911.

What are the RSV symptoms in adults? 

RSV-infected adults typically have mild, cold-like symptoms only. These include:

  • Congestion or runny nose
  • Dry cough
  • Low-grade fever
  • Sore throat
  • Sneezing
  • Headache

RSV is especially worrisome among immunocompromised adults. The CDC warns that people with preexisting conditions, such as asthma, chronic obstructive pulmonary disease (COPD) and congestive heart failure, should be especially cautious during RSV surges. 

How is RSV treated? 

There's "no magic medical treatment for RSV,” Yager told TODAY. “At a hospital, all we’re able to provide is supportive care such as IV hydration and supplemental oxygen.” These “mainstay therapy treatments” usually work against RSV, Yager said, but in serious cases, “an antibody (treatment) might also be administered.” 

The vast majority of RSV cases, however, don't require treatment and go away on their own within one to two weeks. Most adults and healthy children, “will do just fine at home,” Pavia explained.

To treat RSV at home, the CDC recommends:

  • Over-the-counter fever reducers, like acetaminophen and ibuprofen. (Do not give children aspirin.)
  • Staying hydrated.
  • Expelling congestion by blowing the nose, using suctioning or saline drops.

There is also an antibody treatment to prevent severe RSV in premature infants and other babies with heart and lung conditions, called palivizumab. It's given during RSV season via monthly shot.

Is there an RSV vaccine?

There is no RSV vaccine currently available to the general public. Two companies, GlaxoSmithKline and Pfizer, have an experimental RSV vaccine undergoing late-stage clinical trials, with Pfizer recently announcing that its RSV vaccine for pregnant women reduces risk of severe illness in babies for at least six months after birth.

Without a vaccine, it's especially important to prevent the spread of RSV. To do so, practice good hand hygiene, clean high-touch surfaces (like doorknobs and counters) often, cover coughs and sneezes with a tissue (and not your hands), stay home when sick and avoid close contact with sick people, including kids.