Why children get RSV, the flu, and flood ambulances
- There are many reasons why so many children are sick right now.
- The idea of an immune “debt” is not entirely correct – children’s immune systems are fine.
- Testing, personal stay and work, fewer hospital beds, previous COVID and other factors play a role.
Children with viral illnesses including RSV, influenza and COVID-19 are ER flood and emergency centers. Federal labor data show a record number parents in the US are skipping work this fall to care for sick children.
Doctors, nurses and epidemiologists say there are several things contributing to the big viral soup — and they’re wary of dismissing it with any simple explanation, like “long immunity.”
In the past two years, the term “immunity debt“, a phrase that had never before been used in the scientific literature, gained momentum. In the academic position papers, on TVand even in PediaSure pamphlets“immunity debt” has quickly become a catchphrase used to suggest that some sort of “gap” in infections caused by pandemic masking and isolation is to blame for the current wave of respiratory illness.
But in conversations with eight leading infectious disease experts, Insider uncovered five complex and intertwined factors that may be driving viral trends — none of which can be easily summed up as immune deficiency.
We are testing and paying attention to RSV more than ever before
Ask any doctor, nurse or public health professional and they’ll tell you: One of the key reasons we’re seeing more RSV this year is because providers are looking for it.
“We’re definitely testing for RSV more than we used to,” pediatrician Manuela Murray, medical director of the University of Texas Medical Branch’s Pediatric Emergency Center, told Insider. “Before the pandemic, even though the RSV test was available, we didn’t use it as much,” mostly because “knowing it’s RSV really isn’t going to change anything we do.”
There is no specific drug that can treat RSV, i there is no vaccine anyway.
When COVID appeared, viral testing became ubiquitous.
“There may have been many children in earlier years, years before the pandemic, who had RSV — we just didn’t know,” Murray said.
RSV has always been a difficult disease for young children and the elderly. It is especially dangerous for infants under six months of age, whose tiny airways can quickly become clogged with mucus and inflammation.
RSV has long been ” number one cause of hospitalization for infants,” Dr. Pedro Piedra, a professor of molecular virology and pediatrics at Baylor College of Medicine, told Insider. “That hasn’t changed.”
The pandemic threw off the typical seasonal patterns of RSV
RSV usually spikes in December, January and February, but has not done so since the start of the pandemic.
In 2021, “we saw RSV in the summer, which is completely off,” Murray said.
dr. Meredith McMorrow, a medical officer at the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, says RSV rates were 30% higher than usual for children under five in 2021. People just didn’t notice because the season was distributed on a light “simmer” from July 2021 to January 2022.
“Because it was such a long season for us, it never caused the hype and all the things that this season has caused,” she told Insider.
The good news, McMorrow said, is that much of the U.S. appears to be turning away from RSV. The South looks like it’s just past its peak, and the Midwest and Mid-Atlantic states seem to be peaking now.
Children live again in the ‘hot fire’ of the virus
The current wave of illness is also the result of more schools, daycares and offices reopening, masks being removed and people mingling more than at the height of the pandemic, before vaccines were available.
But fewer masks and less distance don’t fully explain the current trends.
“Florida, Texascountries such as Sweden that actually had public health measures in place for a very short period of time, they also see similar spikes,” public health PhD student and pharmacologist Sabina Vohra-Miller, founder of the blog “Unambiguous Science“, he told the Insider.
Regardless of when children enter kindergarten or school, they generally suffer from “two years of illness,” Murray said. This has always been true, but the pandemic has made this issue more universal by bringing children of all ages together at once.
Dr. William Schaffner, professor of preventive medicine at Vanderbilt University Medical Center, says there is an “exposure debt” at work, not an immunity debt.
While it is true that people avoided getting many viral diseases during the darkest days of the pandemic, this does not mean that our immune system is carrying a “debt” or that it has degraded to the point where it can no longer effectively deal with new infections.
“Children’s immune systems are just fine,” Schaffner said during a recent Infectious Diseases Society of America press briefing. “Now that they’re exposed, they have to deal with this virus, and the virus has a lot more opportunities to spread.”
Piedra thinks of the way viruses circulate “kind of like putting kerosene on wood – you have a really hot fire.”
But the current wave of illness is not a sign that toddlers should have been exposed to their peers’ pathogens earlier in life, or that we were wrong not to let them get sick.
Infants who are exposed to RSV at a very early age have a higher risk of short-term and long-term complications of RSV infections, such as asthma. Because newborns generally don’t develop a good defense against RSV until they’ve passed second or third infectionthey may suffer multiple hospitalizations.
“There is no advantage to a young child, a young baby, being exposed to RSV at an early age,” Vohra-Miller said.
Her newborn son was rushed to the hospital with RSV in 2017, aged 10 weeks, and then again less than two years later, with the exact same illness.
“The idea that our poor immune system is going to sit there and atrophy because we weren’t exposed to RSV in childhood, I find that completely ridiculous,” she said.
Even after childhood, immunity to RSV is still there transitoryand it is possible (although rare) to get RSV twice in one season.
“People shouldn’t be upset that they didn’t get it last year, they should be thrilled,” Dr. Aaron Glatt, an infectious disease specialist who chairs the Department of Medicine at Mount Sinai South Nassau.
2021 health authorities in Stockholm, Sweden, even recommended parents keep their young children home from preschool if they have newborns in the house, just to avoid bringing home a potentially devastating case of RSV.
Vaccines RSV vaccines are in the works with federal regulators and could be available for pregnant women and the elderly by the end of next year. It is possible that recordings for young children are not far behind.
until then, research suggests almost every child in the US will contract RSV at some point before their second birthday.
There is a general lack of capacity in hospitals
There is a lack of capacity for all kinds of sick people who are currently in hospitals, especially for children. Responding to higher demand for patients with COVID and mental health issues, hospitals have been closure of pediatric intensive care unitsand reducing the number of beds reserved for children i expectant mothers.
“I’m really concerned about our health systems,” public health expert Katelyn Jetelina, author of the popular “Your Local Epidemiologist” newsletterhe told Insider.
Part of the reason there isn’t enough room for everyone who needs care is that health care workers are quitting their jobs en masse during the pandemic because combustion it comes from long hours, low to payand even in the workplace violence.
“The beds are still there closedand they’re closed due to lack of staff,” registered nurse Martha Kuhl, secretary-treasurer of National Nurses United, told Insider, referring to UCSF Benioff Children’s Hospital in Oakland, California, where she worked until September. “Unfortunately, every unit in the hospital is very, very short staffed.”
COVID infections may have disrupted children’s immune systems
Many public health experts believe that young children who have recently had COVID may be more sensitive and susceptible on viruses right now. This idea is called “immune dysregulation” or dysfunctionand this is a phenomenon that can be caused by various infections – not only COVID.
Recent research suggests that people who have had even mild COVID can experience this type of sensitivity for a period of about eight months after infection. It’s not hard to imagine the millions of young children across the US recently had an Omicron infections may be more vulnerable than usual to RSV or influenza. This could be one of the reasons why more hospitalized school-age children have co-infections with multiple viruses at the same time. But the science is not final.
Regardless of the reasons behind our current predicament, the playbook is clear: Get vaccinated against diseases like the flu and COVID, wash your handskeep babies away from sick people and remember to exercise and eat right to keep your immune system up hum along.
“If you have fewer respiratory illnesses, your body will be healthier,” Piedra said. “These viruses, whether it’s influenza, RSV or human metapneumovirus, can have significant consequences for our health.”
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