When two-year-old Mila started coughing occasionally in early May, her parents thought she had caught a summer cold. But after her symptoms worsened until she could not stop coughing, the visit to the pediatrician sent them directly to the emergency room. “His oxygen levels weren’t even recorded,” said his mother, Kalee Dionne, a Dallas WFAA television meteorologist.
Mila had contracted a respiratory syncytial virus, a common pathogen that usually fills children’s hospital beds every winter. Mila only needed to stay one night in the hospital, but the cough persisted for another month, until she was taken back to daycare and developed pneumonia. Although she recovered, Mila now needs to use a steroid inhaler twice a day for at least the next six months as her lungs recover.
For most children and older adults, RSV causes little more than a common cold: “a runny nose and congestion, and maybe a little fever,” Dr. doctor at Children’s Memorial Hermann Hospital in Houston. However, older adults and very young children, especially babies under six months, do not support RSV as well. They are the ones who will probably end up in the ICU.
According to the Centers for Disease Control and Prevention, relatively few U.S. children die from RSV infections (between one hundred and five hundred a year) and hospitals have come to expect cases to begin in the United States. circulate annually in late fall. These cases tend to peak in December or January before falling in the spring. It’s like a clock every year. Until 2020.
“Last winter, we didn’t see essentially any RSVs, and that was not only true for Dallas Children’s, but also for Dallas County and many other places in the United States,” said Dr. Jeffrey Kahn, chief of Children’s Infectious Diseases. Health and professor at UT Southwestern Medical Center in Dallas. He and Flores suspect that the absence of RSV, like the lack of last year’s flu season, is due to the combination of mask use, social distancing, e-learning for many children, and other measures implemented to stop the transmission of COVID-19.
“Initially, everyone was waiting, sure RSV was coming and waiting,” said Dr. Lara Johnson, a professor of pediatrics at Texas Tech University Health Sciences Center and chief of staff at Covenant Children’s Hospital in Lubbock. Then they saw CDC data showing few cases anywhere. The RSV season never came.
Johnson worried that this would mean the next winter season would be twice as severe, with two birth cohorts of children suffering from their first infections at once. But the virus had another surprise. Sometime between late May and early June 2021, Covenant Children saw one RSV case come in, another and another. And it didn’t stop. “All of a sudden, we’re looking around and they’re saying, ‘Wow, this is winter,'” Johnson said. “I never imagined we’d have a real RSV season in the summer.”
This has been the reaction in all children’s hospitals in Texas and the rest of the United States. A recent CDC report found several unprecedented trends in respiratory viruses during 2020. They disappeared almost completely in March 2020, but their return was staggered in a way that scientists are just beginning to try to understand.
“We didn’t see many of the typical fall-winter-spring illnesses, but now that we’re back to our kids and socializing again, we’re certainly seeing these illnesses increase, including RSV,” Dr. Nicholas Rister, Cook Children’s Pediatric Infectious Disease Specialist in Fort Worth.
Dr. Jaime Fergie, director of infectious diseases at Driscoll Children’s Hospital in Corpus Christi and an expert on RSV, said the first small wave of RSV cases was just a coincidence. “But then, hey, it overwhelmed us,” he said.
As at other Texas hospitals, Driscoll’s intensive care unit is now strained by the unexpected surge in RSV and by “a higher rate than ever” of pediatric COVID cases. Fergie says the hospital has been trying to bring in more nurses, but it has been difficult to recruit enough. Covenant Children faces the same problem in trying to find enough nurses, respiratory therapists, and other staff members to cover the hardships that don’t normally occur in the summer.
“It’s no different than what we see in the winter, but I think it feels a little worse because we didn’t anticipate it,” Johnson said. He adds, a similar trend is developing in outpatient pediatric clinics. Colleagues often spend the last months of summer doing visits and exercise for children in preparation for the new school year, but instead of waiting rooms full of healthy children, they are invaded by dry noses and coughing pirates. .
Children’s hospitals are well equipped to cope with RSV rises in the winter, but many are running out of pediatric beds as they see an increase in pediatric COVID cases at the same time. Since the law does not report cases of RSV in Texas, there are no reliable statewide figures for its prevalence. But several of the state’s largest pediatric hospitals shared it Texas Monthly what they have been seeing. Driscoll of Corpus Christi had no positive results for children’s RSV in 2020, but last month the hospital tested 963 children and just over a third had RSV. Most of these children were not hospitalized, but the Driscoll ICU has recently been admitting four to ten patients a day with RSV. Meanwhile, Children’s Health in Dallas had 191 positive cases of RSV during the week of August 8-14 and 109 of those children were admitted to the hospital. Cook Children in Fort Worth said he had more than two hundred positive cases of RSV per week. The Texas Children’s Hospital in Houston has diagnosed more than 1,600 cases of RSV in the past three months, compared to less than 30 cases a month during a typical summer.
Meanwhile, Texas makes an average of 38 to 43 new hospitalizations each day of children with COVID-19. When Dallas ran out of pediatric beds in the ICU last week, Dallas County Judge Clay Jenkins made clear the seriousness of the situation when he said any child in need of a bed for ICU “will expect another child dies “. As of Aug. 16, pediatric hospital beds in the Dallas-Fort Worth area were 93 percent full and Texas Children’s Hospital had about 30 children with RSV and COVID-19 infections.
“It’s like a very busy RSV season, and we’re very good at it,” Kahn said. “The big challenge now is that we’re starting to see a lot more cases of COVID in children, and that’s starting to stress the system.”
Unlike the rise in RSV, which has been similar to hospitals across Texas, pediatric COVID hospitalization rates vary by state. In Corpus Christi, almost all children hospitalized in Driscoll with a respiratory virus had RSV in early June, but now the hospital only has a few more cases of RSV than cases of COVID, Fergie said. In Lubbock, COVID is not even a distant second from RSV to Covenant, but Houston is “being crushed by” COVID, he tweeted Dr. Heather Haq, an assistant professor in the Department of Pediatrics at Baylor College of Medicine and a pediatric hospitalist at Texas Children’s Hospital in Houston. Dallas child health continues to experience far more RSV than COVID, but COVID cases continue to rise, Kahn said.
“This is a horrible combination of having the most RSV activity as we start to see another wave of COVID,” he said. “There are certain things we can do to relieve stress in some parts of the hospital, but for the most part, the number of beds we have is the number of beds we have. The big concern is that we run out of beds ”.
Despite the rise in RSV, COVID is the biggest concern among doctors at several Texas pediatric hospitals.
“COVID affects a much wider age range with diseases that will allow you to be admitted to the hospital,” Rister of Cook Children’s said. “I’m very concerned about RSV in infants, especially premature babies, because these cases can be serious and even fatal, but COVID is usually the most serious infection.”
Kahn says hospitals are already expecting the inevitable wave of multisystem inflammatory syndrome in children (better known as MIS-C) that has occurred about a month after each previous increase in COVID. And while RSV testing data voluntarily reported by some Texas labs to the CDC suggests that the peak of this latest RSV outbreak may have just passed, the start of a new school year could revive schooling rates. infection. That is, it is not clear when things will slow down.
“We are sending children back to school in an environment with at least two highly transmissible viruses. It’s a potential recipe for disaster, ”Rister said.
The usual pattern is for older children to take RSV to school and take it home to their younger siblings, especially infants and younger children, Fergie said, so she expects that pattern to continue as the school year begins. school. This also worries Johnson, but he stressed the importance of keeping children in school for their well-being.
“I know parents are anxious, which I totally understand,” Johnson said, but encourages people to focus on getting vaccinated, vaccinating children 12 and older, and practicing routine infection prevention measures, including Frequent hand washing, stay away from others. who are sick and have children wearing masks at school.
“There is a lot of data to say that if we adhere as best we can to masking, social distancing, hand hygiene, ventilation, all these things that mitigate the spread of COVID, we can keep children in school. for sure, ”Flores said. “We have all the tools to do it. We just need to be able to use them. ”Even that is uncertain, however, as school districts fight Governor Greg Abbott for masked terms.
“The question is: will we have, as usual, the usual four to six months, and then we will die? Or will we have something that started in June of this year and goes on until March or April of next year, something that had never happened? Fergie said. “What we’re seeing now has never gone down in history.”
What worries him most is how a prolonged season of RSV can complicate the ability to mitigate RSV symptoms among babies at higher risk of dying. Monthly injections of palivizumab — a laboratory-made antibody — can prevent serious RSV-related illnesses. But the drug is expensive, so the American Academy of Pediatrics only recommends its use in premature babies and those born with heart disease or other serious health problems. Most insurance companies require prior authorization for palivizumab and only cover it during the five months of the RSV season. The AAP recommended on August 10 that babies at risk be receiving the drug now, but if this strange summer wave of RSV continues until next year, it is unclear whether there is enough medication available (or whether insurance will cover it) to ensure as much as possible vulnerable infants can continue to get it until the cases run out.
“The other joke of all this is that over the last year and a half or so, we haven’t seen any flu, and that would be a nightmare scenario if the flu lifted its ugly by now and started to spread.” , said Kahn dit. “Fortunately, that hasn’t happened right now, but if that happened now, it would be a real catastrophe.”