Many different respiratory viruses are circulating throughout the United States, but the flu is responsible for a “significant proportion” of that circulation, according to CDC, all while many hospitals are dealing with surges of pediatric respiratory syncytial virus (RSV) patients.
Flu cases continue to surge
According to CDC, 15 states reported very high activity of influenza-like illnesses (ILI) for the week ending in Nov. 5, while eight states reported high activity and six states reported moderate activity.
In addition, for the week ending in Nov. 5, 6,465 lab-confirmed flu patients were hospitalized, according to CDC, and the current percentage of outpatient provider visits for an ILI was 5.5%, above the national baseline of 2.5%.
So far this season, CDC estimates there have been at least 2.8 million flu cases, 1.4 million flu medical visits, 23,000 flu hospitalizations, and 1,300 flu deaths.
Three pediatric flu deaths occurred during the week ending in Nov. 5, bringing the total number of pediatric flu deaths for the 2022-23 season up to five.
While flu cases may be surging early, Lynette Brammer, an epidemiologist who leads CDC’s domestic influenza surveillance team, said there’s no evidence yet that the flu virus circulating is causing more severe cases than normal.
“The picture is pretty consistent across our different pieces of surveillance. There’s nothing there that makes me think that this virus is really different and causing more severe disease than we see typically with flu,” she said. “Flu can cause severe outcomes, but it’s not out of proportion this year compared to previous years. It’s not like we’re seeing a lot of hospitalizations without a lot of illness.”
In addition, Samuel Scarpino, director of life sciences at the Institute for Experiential AI at Northeastern University,said this year’s flu vaccine, “is a good match, which isn’t the case every year.” So, if considering whether or when to get a flu shot, “Now is a great time to do that,” he added.
Hospitals deal with surges of RSV patients amid rising flu cases
As the flu surges nationwide, many pediatric hospitals are dealing with surges of RSV patients. According to federal data, more than 75% of pediatric hospital beds and pediatric ICU beds have been in use for the past few weeks, up from an average of roughly two-thirds full over the past two years.
Brian Cummings, medical director of the Department of Pediatrics at Mass General for Children, said they’ve seen around 2,000 RSV cases in October and more than 1,000 in the first week of November.
“It’s been escalating and been quite severe,” he said, adding that, as of Thursday, his hospital’s pediatric ICU is full and seven patients are waiting to be transferred in.
Most RSV infections have been treated in urgent care facilities and the ED and patients are sent home, Cummings said. “But even if just 10% of those need hospitalization, it creates a lot of stress on health care facilities, and so what we are seeing is we’ve had over 250 hospitalizations for RSV alone on top of the other circulating viruses.”
Many doctors’ offices have started asking parents to treat their sick children at home if they’re otherwise healthy.
“The things that would lead to us encouraging a family to come in would be the very young children, particularly under the age of 2, specifically under the age of 6 months with high fevers,” said Rhonda Patt, from Atrium Health. “If the child is lethargic, isn’t able to eat or drink very well, or if they see any signs the child is having a hard time breathing.”
Patt added that families should visit their doctor if a child gets better and then spikes with another fever or starts having other symptoms.
“With the flu, there’s a risk for secondary infection, meaning ear infections or pneumonia or things that would need antibiotics,” she said.
I began to wonder if this trip to a pediatric urgent care with my son was even necessary.
Sure, he had been diagnosed with pneumonia a week ago and didn’t seem to be getting better. His cough sounded uglier. But here Ethan was in classic two-and-a-half-year-old mode: running in big circles around the waiting room chairs and causing the kind of ruckus only a toddler can.
He’d stuff some Pirate’s Booty I had hastily thrown into my purse in his mouth, before returning to his wild banshee ways and dashing around in circles again.
Our pediatrician said their office was too swamped with sick kids to see us, and referred us to this place. We had been told the wait to see a doctor would be a minimum of an hour. We struggled to find a seat in the packed waiting room as far as possible from other coughing kids.
We finally graduated from the waiting room to the doctor’s office, only for Ethan to continue his marathon by scooting a rolling chair back and forth, roaring with laughter every time it hit the examining table. When the physician walked in, I felt like I needed to defend wasting her time with this visit with my seemingly A-OK, albeit destructive, son.
But Ethan wasn’t OK.
The doctor listened to his chest with her stethoscope and didn’t like what she heard: wheezing, some crackling.
She showed me how Ethan’s Pirate’s Booty-stuffed stomach moved heavily each time he inhaled and exhaled.
They had Ethan complete a nebulizer treatment in the office, which meant slipping a device on his face that resembled an oxygen mask, while medicated air meant to open up his lungs flowed through a frightfully loud machine. I held him in my lap while the nebulizer was on, scrambling to find 100 different versions of “Wheels on the Bus” videos on YouTube to try to distract him from the vacuum-like whirring of the machine.
The doctor listened to his lungs again. His breathing still didn’t sound great, but she said the hospitals were too inundated right now.
I knew all too well what she meant. A few days before our urgent care visit, I had flagged a report for editors at The Hill that said children’s hospitals in the Washington area were at capacity, flooded with young kids suffering from RSV, a potentially life-threatening respiratory illness that has no vaccine.
After a three-hour visit, she gave Ethan a steroid and told us to follow up with his pediatrician the next day.
By the time we got to the pediatrician’s office the following morning, my happy-go-lucky, playful little guy was anything but. He curled up in my lap, as we went through a similar routine that the urgent care doctor had done just the night before. His oxygen levels were too low, and our pediatrician had him do another nebulizer treatment.
“Our goal is to keep you from going to the hospital,” our pediatrician told us.
It seemed like an unusual “goal” from a doctor, but I understood her reasoning. But after Ethan’s oxygen levels dipped lower still after the nebulizer, she said we should rush him straight to the hospital after all.
My “Blue’s Clues” and vehicle-obsessed son, usually the epitome of toddler “I can do it myself!” independence, wouldn’t let me put him down for even a moment as we waited in the emergency room lobby. Surprisingly, a separate waiting area in the ER just for children wasn’t completely full, and I wondered if maybe news reports of endless waits were overblown.
Not so.
“He’s so cute,” a young mother in the waiting room told me, as she motioned to Ethan’s head of curls. She cradled her two-month-old in her arms, patiently rocking the baby after telling me she had waited three hours so far.
I held Ethan as my husband rushed from work to the hospital, meeting us there and with us as we were brought to an ER triage area. They ran more oxygen tests on Ethan, got some of his history, and then sent us back to the waiting room.
Finally, they called Ethan’s name and we were in the ER. My vibrant, otherwise-healthy kid was lethargic, laying on me with a glazed look in his eyes. We struggled to fit the two of us on an exam table meant for a single adult. They draped a lead apron over me and Ethan as they took X-rays of his tiny lungs. The nurse placed a cannula in Ethan’s nose for supplemental oxygen and put an IV in his arm to give him fluids, before wrapping it with a diaper so he wouldn’t try to take out the tube.
My husband and I, loopy from what was happening, laughed at the sight of a diaper being used MacGyver-style. “Hey, it works!” the nurse said, explaining that he’d done the maneuver with kid after kid in recent weeks.
The ER doctor finally came in our room and delivered a crash course in what might be to come. “Everywhere is full. The entire Eastern seaboard,” he said of hospitals.
“We’ve been airlifting kids to Pittsburgh, sometimes to Richmond,” he added. This hospital had a pediatric unit, but not an intensive care geared towards kids. So if Ethan’s condition became even more dire, they wouldn’t be able to treat him there. Our only hope was that the pediatric unit, which had just a few remaining beds, accepted him.
It was a gut punch. As the doctor left, my husband looked at Ethan, who had fallen asleep with a mask on as the nebulizer loudly buzzed away for another treatment.
“He’s just a baby. He’s not supposed to be here,” my husband said, defeated.
The pediatric unit doctor finally came into our room. She examined Ethan, and briefed us on how they’ve been dealing with case after case of the same thing: RSV.
But she offered us hope: he could head to the pediatric unit at the hospital. We wouldn’t need to travel for his care, as long as he didn’t worsen. Ten hours after we first entered the hospital, we had a bed for Ethan.
We’re among the lucky ones. We were told beyond airlifting, plenty of families had been spending multiple nights in the ER because there were no beds.
In Maryland, Gov. Larry Hogan (R) announced last week that that hospitals would receive $25 million in additional funding from the state to prioritize pediatric intensive care unit staffing. Children from birth to age two comprised 57 percent of hospitalizations last week, according to Hogan’s office.
Next to the ghost decorations for Halloween adorning the doors of the pediatric unit, room after room had the same notice taped up: isolation guidelines. The rooms were all filled with kids facing the exact same thing as Ethan. RSV was everywhere.
There’s no cure for RSV. Every two hours on the dot, the nurses would give Ethan the nebulizer treatment.
A monitor affixed to his foot would alert nurses if his oxygen dipped dangerously low, which it did several times throughout the first night. I thought at one point to ask what happens if Ethan stopped responding to the treatments, but then didn’t ask because I didn’t want to know the answer.
The goal was to get him going without the need for additional oxygen, and breathing well for at least four hours between treatments, two times in a row.
That seemingly simple goal proved elusive for two full days. I originally thought it would be a nightmare trying to get a two-year-old to stay in a hospital bed for more than five minutes, but Ethan was in such bad shape that he barely made a fuss. Then, after midnight on our second night in the hospital, Ethan suddenly perked up.
He sat up and rolled over in the hospital bed. Then, he rolled onto my head, spreading his arms and legs out as far as he could stretch, and giggled.
“Should I sleep here?” he said, cracking himself up.
It was like someone hit the power button on my kid, and suddenly he snapped back to himself. I didn’t care that it was midnight and we needed to get some extremely interrupted sleep before the next nebulizer treatment. My son was back.
A nurse later told me that she enjoyed working with kids because for as quickly as their health can deteriorate, they can just as speedily bounce back.
After that, the doctor advised us to try stretching out his time between treatments. Finally, we were told he was stable enough to go home. I somehow hadn’t shed a tear the entire time we were at the hospital, but when the doctor signed off on us leaving, I bawled.
As nightmarish an experience as it was, I realize how incredibly fortunate my family is.
My husband and I have jobs that allowed us to drop everything when our son needed help, we have health insurance policies, and resources to get through spending days at the hospital.
Perhaps most importantly, we had access to an incredible team of doctors and nurses and the sheer fortune of being able to get a bed for our son during an unprecedented and unthinkable time for hospitals.
At the risk of repeating one of those parenting cliches that I would’ve rolled my eyes at a week ago, I’m thankful that I trusted my gut. Even when Ethan was being a wild child at urgent care, I knew something just wasn’t right. What I didn’t know was how much he had been struggling to breathe.
At the hospital after being discharged, Ethan and I waited in the lobby as my husband went to get our car from the parking lot to pick us up. Ethan spotted some empty wheelchairs in the corner of the lobby, and immediately ran over to them. He giggled as he tried to roll one of the chairs into the automatic opening and closing doors. As I looked on as he laughed and laughed at the pint-sized commotion he created, I breathed a sigh of relief.
Respiratory syncytial virus, more commonly known as RSV, sends thousands of children to the hospital every year in the U.S. But during September and October 2022, health professionals across the country have watched an unprecedented spike in the number of cases of this usually mild, but occasionally dangerous, respiratory infection in children.Jennifer Girotto is a pharmacist who studies pediatric infectious diseases. She explains how RSV infects the human body, who is most at risk and what might be causing this year’s outbreak to be worse than normal.
1. What is respiratory syncytial virus?
RSV is a common, RNA respiratory virus that affects about 2 million children under 5 years old annually nationwide. Researchers think that most children have been infected by age 2. Like the flu, in most areas of the U.S., RSV usually circulates from November through March and then mostly disappears during the summer months, with only sporadic cases being seen.
For most people, especially those who have had an RSV infection in the past, the virus only causes mild symptoms like cough, runny nose and fever, with instances of wheezing and decreased appetite more common in young children.
But young infants, especially those under 6 months old, born prematurely or with congenital heart, lung or other health issues are at increased risk for more severe symptoms. The U.S. Centers for Disease Control and Prevention estimates that 1% to 2% of infants younger than 6 months who get infected with RSV require hospitalization. In an average year, around 250 children die from the disease.
The main reason RSV sends babies and young children to the hospital is because the virus infects and kills surface cells within small sacs of the lungs. The body responds by increasing the production of mucus and fluid in these areas. But the extra mucus can plug up and obstruct these parts of the lung and make it so that an infant doesn’t get enough oxygen.
A second common cause for hospitalization due to RSV is pneumonia, where a person’s lungs fill up with fluid. The pneumonia can either be triggered by the virus itself or by a secondary, bacterial infection. Finally, some infants get so sick that they struggle to eat and are unable to take in sufficient nutrients, eventually landing them in the hospital.
Health officials aren’t yet sure why the outbreak is so bad this year, but the COVID-19 pandemic may have something to do with it. Some research has shown that seasonality of RSV has shifted. In 2021, RSV infections started much earlier than normal, and over the summer of 2022, they never quite went away. One theory as to why RSV season is starting earlier and hitting harder is that, due to social distancing measures since 2020, an unusually high number of infants and children are experiencing their first exposures and infections at once.
5. How can you protect against catching RSV?
Like colds and the flu, RSV infections spread when people touch dirty surfaces or from respiratory droplets, when an infected person coughs or sneezes.
If someone is sick with symptoms that look like a cold, it may be best to avoid close contact until they feel better, especially if you have young children or high-risk people around.
Early into flu season, nationwide flu activity is ten times higher than at the same point last year. Meanwhile, cases of respiratory syncytial virus (RSV), a virus most severe in young children and the elderly, have tripled in the past two months, with some children’s hospitals reporting “unprecedented” admissions for the virus. And most experts expect at least some winter COVID surge, possibly involving several different variants. The combined threat of these viruses circulating together has been labeled a potential “tripledemic.”
The Gist: Across the past two winters, the widespread adoption of COVID prevention measures, including masking and social distancing, kept the spread of other viruses at bay. But with return to normal life for most Americans, other viruses have returned to circulation—and with a vengeance, as population immunity toward flu and RSV has weakened.
While it’s hard to predict when and where local surges will occur, hospitals struggling with staffing shortages may be forced to hire more contract labor to care for an influx of patients—making this a potentially challenging winter for already stretched facilities.
HENRY KOTULA 
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