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RSV infection hitting children hard this season
Lingering threat of COVID-19, flu presents dangerous combination

By Kevin Damask

GREEN BAY – Another flu season is upon us, but unlike past years, residents in the Green Bay area will have to brace for a triple threat of viruses that’s even more potent in children: Influenza, COVID-19 and RSV.

The flu bug is nothing new, and COVID-19 has been part of daily life for almost three years, but not many people are familiar with RSV, otherwise known as respiratory syncytial disease.

In recent weeks, hospitals across the nation have seen a rise in RSV cases, especially among young children.

However, RSV, a common cause of respiratory illness, can affect people of any age.

Dr. Ashok Rai, president and CEO of Prevea Health in Green Bay, said RSV has been around for decades.

“I think people are a little less familiar with it because when it comes to dealing with severe disease, such as being taken to the emergency department at the hospital, that brings the population down to really small children, newborns, premature babies or babies with heart and lung issues,” Rai said. “But we all have probably had RSV — it’s pretty common in adults, too — but with us, it’s just a bad cold. For a kid, it’s a lot more significant.”

In his blog, Dr. Michael Meyer, medical director for the Pediatric Intensive Care Unit at Children’s Wisconsin, said most children have already contracted RSV by age 2.

While it’s somewhat early in the flu season to see such a rise in RSV cases, Rai said it’s not unheard of as viruses tend to rise and fall in unpredictable patterns.

RSV can affect any child, hitting some harder than others. In early 2019, Press Times sports editor Greg Bates had two of his daughters come down with serious cases of RSV and were both hospitalized. Braelyn, pictured here, was hit the hardest. She was on ECMO, a heart-lung bypass, for two weeks and spent 65 days at Children’s Hospital of Wisconsin before recovering. Kristyn Bates Photo

“The real issue is all three happening at once because that’s when you start to stress the healthcare system,” Rai said. “Think of it as a stacking process. A lot of your pediatric beds are being used by RSV and then you have five children with influenza and two with COVID. Where are you going to put them, because RSV is occupying so many beds. Then, on the adult side, you have some patients with both COVID and influenza being admitted at the same time. It’s important to remember, viruses aren’t the only thing we see in the hospital and then when you have all three of these viruses at the same time, that’s stretching the healthcare system.”

In children, Meyer listed three warning signs to spot potential RSV infection:

• Difficulty breathing. More troubling signs include being able to see your baby’s ribs when they are breathing, the area beneath their Adam’s apple collapses, or their lips are more pale or blue.

• Difficulty nursing or finishing their bottles. If a child has a significant decrease in the number of wet diapers in a day. This can lead to dehydration, making their snot and congestion even worse, and making it even harder to breathe.

•Increased temperature. An increase in temperature shows the body is fighting an infection.
Similar to colds and flus, RSV is often transmitted to others through sneezing and coughing as particles disperse through the air.

But, according to Rai, the respiratory illness is stronger than other transmittable diseases as it can live on surfaces.

“A lot of transmission through RSV is a child touching a door handle where another child with RSV has touched,” Rai said. “Infants and small children put a lot of things in their mouths, especially with their hands, so you kind of see the transmission happening just as much that way as through the air.”

Small children with RSV tend to struggle to breathe because they’re producing sticky secretions that get stuck in small airways.

These obstructions prevent a normal flow of oxygen to the lungs, making breathing more difficult.
Oftentimes, a child with RSV needs time in the hospital with oxygen to fully recover.

“We don’t have treatment for it other than time and that supportive care,” Rai said.

Common sense precautions

Making sure surfaces are clean and wearing masks can help prevent the spread of RSV, according to Rai.
He pointed to an outbreak of RSV back in the late 1980s that was curtailed after healthcare workers began masking up.

A lot of the same sanitizing practices to reduce the spread of COVID-19 can also apply to RSV: thorough hand washing with warm water and soap, along with wiping down surfaces with dependable cleaning products will help stop the viruses’ spread.

“All of that will help our most vulnerable — the kids who can’t fend for themselves — healthy,” Dr. Rai said. “In COVID, we did really good for the first six weeks then things kind of fell off when we realized COVID doesn’t live on surfaces as long as other viruses, but we do know RSV is pretty hardy and can live on surfaces. If you can touch it, wipe it down.”

Adults can chip in to keep themselves and children from getting sick.

Rai said it’s important people stay home when they aren’t feeling well.

“You might be carrying RSV and you don’t want to infect a child. If you have a cold, stay home, that includes right before the holidays,” Rai said.

While the odds of acquiring all three viruses at the same time are rare, Rai said the combination can be fatal.

In children, death from RSV is fairly uncommon, but the risks are enough to keep parents up at night.
“It’s very scary,” Rai said. “Nobody wants to see their child on oxygen or on a ventilator.”

Rai said the triple virus surge will likely get worse before it gets better as the winter months creep in.
Since there isn’t a vaccine for RSV, the doctor said it’s vital for adults and children to get shots to safeguard against both COVID-19 and the flu.

“Through common sense thinking, we could try to quell this. Unfortunately we are still going to see a good amount of disease activity through the next couple months,” Rai said. “What the rest of the winter and spring looks like, that’s pretty hard to predict right now, but we’ll definitely be watching it over the next three to six weeks.”

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