RSV: What's behind the surge, and how to contain it

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Children’s hospitals across the U.S. are being overwhelmed by the respiratory infection: RSV.

"The surge of patients, the influx of patients, the patients waiting to get beds, the demand on the system. It feels very much like 2020," Dr. Meghan Bernier says.

And it's not slowing down.

"I unfortunately suspect things will get worse before they get better," Dr. Bernier adds.

But can it be contained and how?

"This is a story not so much about a virus out of control, but a health care system ill equipped to handle it."

Today, On Point: What we know about respiratory syncytial virus. Why is this illness overwhelming pediatric hospital units now?

Dr. Meghan Bernier, medical director of the pediatric ICU at the Johns Hopkins Children's Center.

Saad Omer, infectious disease epidemiologist. Director of the Yale Institute for Global Health. (@SaadOmer3)

Caitlin Laycock, mother from Raleigh, N.C. who’s 3-week-old baby was hospitalized for RSV.

Lauren Zaleski, mother from Chicago who’s 17-month-old has been hospitalized twice for RSV.

Caryn Just, ICU nurse at Johns Hopkins Children's Center.

CAITLIN LAYCOCK: It's pretty terrifying to see your baby struggling to breathe and showing signs of distress.

MEGHNA CHAKRABARTI: This was Sunday, October 23rd, just one day before Caitlin Laycock had noticed that her infant son, just three weeks old, wasn't breathing quite right.

LAYCOCK: We took him Saturday morning to the doctor and his lungs were clear. Everything was fine. By Sunday morning we started to see some of those signs, RSV signs, you know, you're looking for the labored breathing and retractions with their stomach and you can see it in their neck and flared nostrils is a pretty big sign of labored breathing.

CHAKRABARTI: RSV is a well-known, extremely common virus, so common that the Mayo Clinic says almost every child gets infected with RSV by the time they turn two. And most of the time parents hardly notice because RSV usually behaves much like the common cold. And Caitlin, by the way, has had all sorts of normal experiences with runny noses and fevers and mild coughs.

She's also got an older son, a toddler who's two and a half, and she's a first grade teacher, too. But an RSV infection behaves differently in newborn babies and older adults. For them, it can be dangerous. Each year in the United States, 58,000 to about 80,000 children under the age of five are hospitalized from RSV and up to 300 die. But again, that's known and normal for this disease. But this year, RSV seems like it's anything but normal. A Saturday turned to Sunday in the Laycock household. Little Cope got very sick.

LAYCOCK: At about 5:00 Saturday morning we started to see some of those and then we went to our pediatrician by about 9:15 and when we got there, they ended up calling an ambulance and putting oxygen on him right away because he was having such a rough time breathing. Obviously really frightening at first. Never in an ambulance before, I didn't think it would be with my three-week-old.

CHAKRABARTI: Caitlin, her husband and Cope were taken to wake Med Children's Emergency Department in Raleigh, North Carolina. It was packed.

LAYCOCK: The hospital was just so overwhelmed with cases right now that we were in the emergency room for about 24 hours before we were actually able to be moved to the pediatric floor of our hospital, because they just didn't have any rooms there. From what the nurses and the doctors told us, they're just totally overrun with cases, mostly RSV. I think when we got to the emergency room, our nurse told us they had 22 patients in the emergency room at that time and 15 of them were RSV cases.

CHAKRABARTI: They waited 24 hours, as you heard, and Caitlin and her husband were not alone. So many other families were also waiting.

LAYCOCK: I know when we were in the emergency room, we saw there were patients in the hallway, I mean, on beds in the hallway. And, you know, you think about something, you might go to the emergency room that you need to be seen right away. And then you get there and there's a five hour wait time. I mean, I know obviously they take based on need, but it has to be scary to get the medical care you need and you're sitting in the emergency room for hours waiting to be seen.

CHAKRABARTI: Little Cope was hospitalized for three days. He was released and just had his one-month regular well baby visit this week. His doctor says he has some residual congestion, but Cope has pretty much fully recovered from RSV, and that is welcome good news. But what's really going on here? Why is a well known, common and usually mild disease that just about everyone gets suddenly overwhelming America's pediatric hospitals?

I'd like to just start off with some basic but important education for all of us here on RSV. Can you tell me, are you seeing a surge of it at Hopkins?

Dr. Meghan Bernier: We are. More cases, just like Caitlin said, patients waiting for beds. And in our region, we think of Baltimore sort of in between D.C. and Philadelphia and this ... area is certainly having a rise in RSV cases earlier than normal. And it seems to be more than normal.

Can you tell us some of the basics of the disease itself? What is it caused by?

Dr. Meghan Bernier: So it's a virus. Super common, circulates every year. Some places in the south where it's warm, Florida, it'll circulate all year round. Places that have more seasons, the mid-Atlantic and the North. It's very seasonal. It's one of the main reasons for the common flu. You and I get it, and we're totally fine. Younger infants, who've never seen RSV before, it's their first year of cold and flu season. They'll be more affected by it.

"The overwhelming majority of them are cranky, coughing, stuffy babies who maybe see their pediatrician once and do just fine. A smaller subset of them need to spend some time in an emergency room or an inpatient floor. And an even smaller set of that smaller set require hospitalization and an ICU. And then, unfortunately, as was in the introduction, a few children every year die from RSV.

Am I right by saying it looks like it behaves kind of like the common cold?

Dr. Meghan Bernier: "Absolutely. And it is one of the ways for the common cold. That's one of the viruses that causes the common cold. But particularly in younger infants and those with chronic medical conditions, it can cause really some difficulty with breathing. It infects the lining of the airways, and it causes sloughing of those cells.

"And you get the distress that comes with that. You're already breathing through little tiny baby airways. And if they're filled with mucus that the babies can't mobilize that easily, it makes it even harder. So that's why you see the things like nasal flaring, retractions, tugging, like Caitlin said, that her child had."

On the signs parents should look for

Dr. Meghan Bernier: "So we'll start at the beginning. An ounce of prevention is worth a pound of cure. RSV and a lot of the respiratory viruses are actually spread by droplets. So if someone coughs or sneezes, those larger droplets of mucus will have the active virus in them. So covering coughs, frequent washing of hands and even washing of surfaces, we call those fomites in medicine. Commonly use toys, cell phones, remote controls, countertops. RSV can live on those for some period of time.

"So it's important to keep those surfaces clean when you have either yourself sick or a child that's sick. Prevention in the form of staying up to date on recommended vaccinations, the flu vaccination, the COVID boosters. Anything you can do to prevent other illnesses is certainly warranted right now. And then if you do have a child that starts to fall ill, trying to keep them hydrated with water and Pedialyte and fluids of that sort, monitoring them and keeping them comfortable if they develop a fever and they're a little cranky with it, trying to give them fever-reducing medicines to help with that.

"Fevers make children breathe harder and work harder to breathe. So, if you can take out that factor, appropriately using those medicines versus based on weight-based dosing. And then monitoring your child for difficulty breathing. Nasal flaring, breathing faster than normal. There's recommended numbers based on the age of children. And then distress when they're sort of sucking in or pulling in between their ribs or their bellies. And reeducating yourself on what these look like. There's a lot of very reputable social media websites, the American Academy of Pediatricians, who can help educate families on what these signs and symptoms like."

Has something changed about the pathogen itself that's driving these bigger numbers this year?

Dr. Meghan Bernier: "No, I don't think so. I don't think anything has changed with RSV itself. I just think we have, you know, a large cohort of children, sort of the four and unders, the three and unders, who during COVID times were more sheltered and didn't have exposure to the pathogen. And so they're just seeing their first couple of cases of it right now. And so instead of having just one year's generation of RSV naive patients, we have three years' generations and four years' generations of RSV naive patients.

"And so we're seeing children who are much older and older, preschool, who've usually already had this illness, now getting it for the first time. Some of my friends with children, they're mentioning that their third child is three and a half years old and it's the first time they've ever had a fever. And prior to 2020, you know, kids would have a cold a month. And so it's a different landscape."

Why are hospitals overwhelmed right now?

Dr. Meghan Bernier: "Regardless of what anyone says at the CDC or on NPR, you know, if it's your baby that's sick in front of you, it's the most precious and important thing to you. And so what's happened over the past couple of years, and this was pre-COVID, is that smaller community sites with wonderful pediatricians and wonderful staff who are experienced and capable of caring for children with RSV and other colds and flus, they've been slowly shutting down and whittling away.

"Pediatric care is just not as lucrative as adult care. And so hospital system, looking at their bottom line, may say, you know, there's another community hospital ten miles away that can care for this. We're going to transition this pediatric unit into something else. And then when COVID happened, that potentially further escalated cases of of hospitals, closing pediatric units and seeing that they can transition them to adult COVID spaces and and take care of patients. And these places haven't reopened.

"And so whereas we used to have a lot of smaller community hospitals that could care for five or six infants with RSV for a couple of days, do a spectacular job at caring for them. We don't have those those community pop off sites anymore. So patients are limited in where they're able to go and that that means larger centers and larger academic centers and quaternary hospitals that in addition to providing community pediatric care, asthma, dehydration, RSV, you know, they're providing open heart surgery and trauma care and chemotherapy and complex neonatal services for premature infants.

"And so children are still getting cancer and car accidents are still happening. And those patients need the quaternary care that places like Hopkins and Wake Med can provide. And then the babies with RSV, who just need a couple of days in the hospital, also need to find someplace to have care. And so it's balancing all of those demands on the system at once when there are simply less beds."