Experts are predicting that Americans will grapple with three viruses this winter–COVID-19, influenza and RSV, which many are just learning about for the first time, but for pediatricians it’s been a well known threat to children. “It’s not a new virus, and that’s what’s puzzling us is why is it appearing earlier than usual,”  Dr. Ilan Shapiro, FAAP, chief health correspondent and medical affairs officer at AltaMed Health Service tells us. Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital adds, “This is a highly transmissible respiratory virus. You can get it more than once in a season (as there are several serotypes). It typically affects young kids and those over 65, often with severe respiratory illness.”

Dr. Shapiro emphasizes how alarming the situation is. “Simply, there’s been a lot of viruses circulating lately. In the last two years, there was a lot of mask wearing that has simply just done away, exposing children to more viruses. RSV attacks children below the age of 5 and those who are adults with chronic diseases. Pediatricians are especially worried about children who are born premature or under the age of one,  who can be attacked easier and can experience trouble breathing and even sleep apnea and we should be concerned about it.”

The New York Times reports, “Worldwide, R.S.V. led to about 3.6 million hospital admissions in 2019, and more than 100,000 deaths in children under 5, mostly in poor countries.” But there is a concerning death rate here in the U.S. According to the Centers for Disease Control and Prevention, “Over 57,000 hospitalizations, 500,000 emergency department visits and 1.5 million outpatient clinic visits among children <5 years of age are attributed to respiratory syncytial virus (RSV) infections each year in the United States. RSV-associated deaths among children <5 years of age are thought to be uncommon, estimated at 100-500 per year. Among US adults, an estimated 177,000 hospitalizations and 14,000 deaths associated with RSV infections occur annually. However, these are likely underestimates of RSV-associated deaths.”

Eat This, Not That! Health spoke with experts who share what to know about the virus and symptoms to watch out for. As always, please consult your physician for medical advice. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Melissa St. Germain, M.D., Vice President and Medical Director of Children’s Physicians and Urgent Care (Children’sHospital & Medical Center in Omaha, Neb.) tells us, “Respiratory syncytial virus, or RSV, is a common respiratory virus that infects the upper and lower respiratory tract – the nose, mouth, throat and lungs. It spreads from one person to another by direct contact and respiratory secretions (snot) about 4-6 days after exposure. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.6254a4d1642c605c54bf1cab17d50f1e

According to the CDC, RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States. The reason for this is that babies have smaller lungs that are still developing and have less capacity for reserve when a virus like RSV causes inflammation in the lung tissue. Babies with other health conditions like prematurity, chronic lung disease or heart or immune system problems are especially at high risk, and some of these high-risk babies qualify for a medication designed to prevent illness from RSV. Babies who have a low birth weight or are exposed to secondhand smoke are also at risk.”

Dr. Akua Ampadu, board-certified Internal Medicine says, “Respiratory Syncytial Virus, also known as RSV is a lower respiratory tract illness common amongst children ages 5 and below, with most children becoming infected by age 2. It most often causes bronchiolitis, or inflammation of the bronchioles which are the small airways within the lungs. Infants and toddlers tend to be impacted more as their airways are very small and can become clogged with mucus, making it more difficult to breathe. Though it is commonly considered a pediatric illness, cases also occur amongst older adults, the immunocompromised, and those with chronic lung and heart diseases. It most often appears in the fall and winter months when people are mostly indoors which increases the chance of catching and spreading the virus.”

Bernadette Boden-Albala, MPH, DrPH, Director and Founding Dean, University of California, Irvine Program in Public Health says, “Respiratory syncytial virus (RSV) is a common virus that affects the lungs and breathing passages, which symptoms are like the flu. But there is no vaccine to prevent RSV yet so infants, young children, and older adults must be cautious to avoid close contact with sick people, wash hands often and avoid touching your face with unwashed hands.” 

Muzna Atif MD FAAP Medical Director/ Pediatric Hospitalist PVHMC explains, “As compared to Influenza , RSV generally affects the younger children more severely and can present in respiratory distress sometimes requiring oxygen or even mechanical ventilation to help support the respiratory distress.”

Dr. Nachman explains, “Typically the flu causes more muscle complaints and fatigue, while RSV causes significantly more lung issues. They both cause runny nose, cough and fever, but those are symptoms typical of all of our respiratory viral illnesses.”

Dr. St. Germain says, “RSV presents with cold symptoms of runny nose and cough, sometimes also with wheezing and difficulty breathing. Influenza is more likely to present with high fevers, muscle and joint pains and headaches.” 

Dr. Boden-Albala adds, “Though symptoms are similar between RSV and the flu, the most serious RSV symptom is difficulty breathing. RSV can also make chronic health problems worse.” 

Dr. Ampadu states, “RSV and influenza can sometimes be confused as they both frequently occur in the fall and winter months and are both very contagious. While respiratory symptoms dominate the main signs of RSV, the flu is usually associated with more general symptoms like body aches, fatigue and malaise, nausea/vomiting and diarrhea.” 

Dr. St. Germain says, “We usually see more RSV in the winter, but that hasn’t been the case over the last couple of years. We saw surges of RSV in the summers of 2021 and 2022, and currently we’re seeing extremely large numbers of cases. Many feel this is attributed to our strategies to prevent COVID-19 – lots of babies didn’t attend day care and older siblings wore masks or were socially distanced from other children. Now that normal routines have resumed, viruses that didn’t spread as freely are now “catching up.”

According to Dr. Ampadu, “The COVID-19 pandemic and the national use of masks and social distancing may have caused the immune systems of children to not be very prepared to fight viral illness. They may not have come into contact with common viruses at the age where they would have likely been exposed and thus their immune system is now being exposed at an older age.”

Dr. Boden-Albala tells us, “RSV is very contagious like the flu because it is a virus that is spread through droplets released into the air or touching a contaminated surface. The best steps to avoid the RSV are to wash your hands often, avoid touching your face with unwashed hands, clean and disinfect surfaces, avoid close contact with sick people, cover your coughs and sneezes, and stay home when you’re sick.” 

Dr. St. Germain explains, “RSV is very contagious and spreads quickly in places like daycare or in classrooms. Older children and adults who get RSV frequently have mild cold symptoms – this is important to know too, because an older sibling with a cold can transmit the virus to a high-risk newborn.

The steps to prevent RSV are similar to that of any virus. If you are experiencing cold-like symptoms, you should:

•       Cover coughs and sneezes with a tissue or your upper shirt sleeve, not your hands.
•       Wash hands often with soap and water for at least 20 seconds.
•       Avoid close contact, such as kissing, shaking hands and sharing cups and eating utensils with others.
•       Clean frequently touched surfaces such as doorknobs and mobile devices.

Dr. Ampadu tells us, “RSV is as contagious as the common cold and can be spread through respiratory droplets and secretions. So coughs, sneezing, and touching of hands with secretions can all cause it to spread. Viruses can also live on hard surfaces as well so contaminated surfaces can also be a nidus for spread. It is highly contagious during the first 3-7 days so it is best to cover coughs and sneezes during that time and wash hands frequently and thoroughly. Hard surfaces should also be kept clean and disinfected. If your child has RSV try to keep them at home and out of school or daycare so they don’t spread it to others.”

Daniel Ganjian, MD, pediatrician at Providence Saint John’s Health Center in Santa Monica, CA says, “RSV has a range of symptoms from being asymptomatic, slight fever to runny nose, cough, difficulty breathing, wheezing, and high fevers. Patients commonly start off with cough and runny nose that peak on days 3-4 and then start improving. To test for the virus, We do a test with a nasal swab – similar to COVID and flu tests. Once we have a correct diagnosis, then we know what to look out for and when patients should come back in or go to the Emergency Department.”  

Dr. Ampadu says, “RSV is often mistaken for other respiratory infections due to the fact that symptoms can overlap. Most common symptoms include wheeze, cough, runny nose or stuffy nose, increased mucus production, sore throat, fever or earache. It can also cause increased breathing effort (like nose flaring and breathing fast) and even apnea (pauses in breathing) in infants. You may also notice that your child has less of an appetite or is more cranky and irritable.”

Dr. Ganjian tells us, “If your baby starts breathing more heavily, using abdominal muscles, wheezing, or nostrils are flaring, go to the emergency room to check oxygen levels and make sure the child does not have pneumonia and does not require additional oxygen.”

Dr. Ampadu says if your child has the following symptoms, take them to the ER. 

-“If you notice your child is having difficulty breathing, persistent wheezing or coughing to the point of vomiting. 

-Your baby is eating less because they struggle to breathe while eating or you notice a decrease in the number of wet diapers.

-Your child looks quite ill, pale or blue in the face, lips or hands

-If using a pulse oximeter at home, oxygen saturations are less than 90 percent

-High fevers not improved with fever reducers like Tylenol/acetaminophen

-If you see your child taking long pauses/ stops breathing while asleep

-If your child has a history of asthma and their asthma has been triggered and not improving with nebulizers or inhalers.”

Dr. St. Germain tells us, “For most otherwise healthy kids with mild to moderate illness, we recommend treating the symptoms – ibuprofen or acetaminophen to reduce fever, removing mucus from the airway with a nose sucker or saline and increasing fluids to thin the secretions. However, some children with more severe symptoms need supplemental oxygen or IV fluids to get them over the hump – these are the patients who we watch in the hospital.”

Dr. Ampadu shares, “As RSV is a virus it usually goes away on its own within 1-2 weeks with supportive care. This includes helping to break fevers with cold compresses, acetaminophen or ibuprofen (but remember many of these should not be taken if the child is less than 2 years of age unless directed by a doctor). Keep your child hydrated with water, fruit juices and oral rehydration solutions like Pedialyte. Help your child keep an open airway by suctioning your baby’s nose if it is clogged and propping your child up on pillows to make it easier to breathe while asleep.”

Dr. Atif says, “For children with milder symptoms of RSV, treatment is mainly supportive care. Giving them fever reducing medications, plenty of liquids to keep them hydrated, saline nose spray/drops, steam inhalation to help with congestion. Avoid using over- the- counter cough and cold medications as they have no proven benefit and can have harmful side effects.”