Triple threat: Flu and RSV cases could worsen COVID winter wave

A respiratory virus and flu are swamping hospitals, raising the specter of three viruses circulating simultaneously

By Troy Farah

Science & Health Editor

Published November 3, 2022 12:52PM (EDT)

Baby was sick as Respiratory Syncytial Virus (RSV) in kid hospital (Getty Images/graphixchon)
Baby was sick as Respiratory Syncytial Virus (RSV) in kid hospital (Getty Images/graphixchon)

A virus that attacks the lungs and airways is rapidly spreading across North America, especially infecting kids — and hospitals are so overwhelmed that many have no beds available. No, it's not COVID causing this surge of illnesses. It's respiratory syncytial virus (RSV), a virus that's been known to doctors since 1956, and is one of the most common childhood illnesses.

In most cases, the virus causes a cold-like sickness that sometimes develops into bronchiolitis or pneumonia. Every year, it hospitalizes an average of 1 to 2 percent of children younger than 6 months. In some cases, it's even fatal, killing about 120,000 children across the globe annually. Older adults and those with compromised immune systems are also at increased risk from the virus.

Normally, hospitals can sustain a surge in RSV cases, but this year has been putting unusual strain on pediatric wards in the United States and Canada. From Nevada to Texas and Connecticut to Oklahoma, RSV is forcing hospitals to scramble for solutions as beds are rapidly filled. At Boston's Children's Hospital, RSV cases have forced cutbacks on elective surgeries and on October 31, Orange County, California officials declared RSV a public health emergency. In some cases, children have even died, such as a 6-year-old boy from Macomb County, Michigan. The Atlantic described the situation as "the worst pediatric-care crisis in decades."

Experts recommend that we can fight RSV using the same mitigation methods used to battle COVID: wearing masks, washing hands and disinfecting surfaces. In fact, this surge in RSV cases can be attributed to following those procedures the past two winters. Masking and social distancing, working remotely and school closures also contributed to an enormous drop in flu and RSV infections over the past two years.

"When the pandemic hit the U.S. in March 2020, we saw the rates of all viruses plummet," Dr. Vandana Madhavan, director of advanced pediatrics at Mass General Brigham in Boston, told NPR. Now, as precautions against COVID are loosened, both flu and RSV are roaring back — and much earlier than previous seasonal waves.

And, of course, COVID hasn't disappeared either, with a potential "variant soup" of multiple strains of virus arising at once this winter. There are vaccines against COVID and flu, of course, but not RSV — at least not yet, but that may change in the near future.

The symptoms of all three infections can overlap. With RSV specifically, it can start as a runny nose, cough, sneezing or fever. These symptoms can worsen, developing into wheezing, bluish skin and struggling to breathe. If your child is experiencing labored breathing, seek medical attention.

Access to treatment is critical for weathering severe RSV. "You survive RSV if you get access to care, to breathing support and to oxygen," Dr. Keith Klugman, who directs the pneumonia program at the Bill & Melinda Gates Foundation, told the New York Times. "In the absence of those, babies will die."

But as more hospitals fill up, it could make certain medical care more scarce. If, as many experts predict, flu and COVID also surge this fall and winter, these issues could compound into an even bigger disaster. Some are calling this the "tripledemic."

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We have a few defenses against RSV. There's Palivizumab (brand name Synagis), an injectable synthetic antibody that can be given to premature infants or infants born with certain lung disorders or heart disease. It's not usually given to most children, however. Over-the-counter drugs like acetaminophen and ibuprofen can also help (but avoid aspirin), according to the Centers for Disease Control and Prevention. It's also especially important to stay hydrated, as the loss of fluids can worsen infection.

While vaccines exist for both flu and COVID — and should be strongly considered for anyone older than six months — the same isn't true for RSV. A few vaccines are in development, however, including one from Pfizer Inc. On Tuesday, the biotech company announced positive results from a Phase 3 clinical trial called MATISSE (MATernal Immunization Study for Safety and Efficacy.)

The results, which have yet to be peer-reviewed, are promising, demonstrating 82 percent efficacy against severe disease with no safety concerns for both vaccinated individuals and their newborns. If approved by the Food and Drug Administration, the vaccine may not be available until late next year and it would only be for pregnant people.

Still, this is a significant pathway for immunizing infants younger than six months, as we already do with tetanus, diphtheria and pertussis vaccines, for example. And other companies, including Moderna Inc. and Johnson & Johnson are also developing their own RSV vaccines.

Attempts to formulate an RSV vaccine have been underway since at least 1969, but for various reasons, these vaccines haven't worked out. It's not clear if Pfizer or these other companies will hit a dead end, either. But thanks to all the research and attention generated by COVID, experts are looking at other viruses to squash. RSV has long plagued humanity, killing hundreds of thousands of children every year, but its days could finally be numbered.

By Troy Farah

Troy Farah is Salon's science and health editor specializing in drug policy and pandemics.

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Covid Flu Health Pandemic Respiratory Syncytial Virus Rsv Science Vaccines