Nationwide this year it’s a case of RSV, COVID, flu oh my.
In Odessa, there has been an uptick in RSV in the last month to six weeks, but pediatrician Dr. Stephanie Villareal said it hasn’t overwhelmed the hospitals and clinics.
COVID and flu are also out there, along with some other respiratory illnesses, Villareal said.
“… I would say this RSV season we’re seeing a lot more RSV than we have in the recent past,” she added.
Any age group can get Respiratory Syncytial Virus (RSV), said Villareal, who also is an assistant professor at Texas Tech University Health Sciences Center.
“However, we are mostly worried about the younger populations, so I would say less than 2 years old. Those children are at a higher risk for increased complications or having bad side effects for RSV that may lead to RSV bronchiolitis. RSV is an infection that can cause RSV bronchiolitis,” Villareal said.
“Once you add that RSV bronchiolitis component, that means that the RSV infection has … made it down into the lungs and is causing inflammation of the small airways called bronchioles and it’s causing a lot of mucus development, a lot of inflammation and it’ll present with kiddos having difficulty breathing. These are the complications we fear and so a lot of kids, if it gets bad enough, they will require oxygen support. They may be breathing so heavily and so hard that they don’t have energy to eat,” Villareal said.
Children may also become dehydrated. Usually children are hospitalized due to difficulty breathing, decreased oxygen or secondary infections on top of RSV, such as pneumonia.
The younger the child, she said, the higher the risk for more complications and any underlying comorbid conditions.
“So if they were premature, or they suffer from other illnesses then they, too, are at increased risk for RSV bronchiolitis,” Villareal said.
She added that they have seen increased severity of RSV since the pandemic started and there was a change in pattern.
“… We saw also a lot of RSV during the summer which we typically do not and we saw a lot of our older kids, so more toddler kids older than a year, who were having more severe cases of RSV. We think it had to do with the COVID pandemic and the masking, so perhaps they were not exposed to RSV. Now that they’re getting exposed, they were having more severe cases of RSV. … I do feel like it’s been more severe than it had pre-pandemic,” Villareal said.
If a child is having difficulty breathing, or if they seem to be breathing very fast — having what they call retractions on their chest —, if they’re not eating the same amount and decreased wet diapers, she said she would have their child seen by a doctor.
“… That being said, any time a parent thinks about having their child evaluated then they should listen to that instinct and take their child in. RSV typically worsens between day three to five of illness, so they may be fine for the first one to two days; by day three, they may notice this is worsening and then day four it’s worse; day five it’s even worse, so if it’s a progressive illness and every day they’re getting worse instead of getting better then they should go ahead and bring them in so we can evaluate them,” Villareal said.
Like other viral illnesses, RSV can last about seven to 10 days with the peak of symptoms being day three to day five.
“… RSV it takes a little bit for kids to get over it, specifically the cough. The cough can linger on … Their body produced a lot of mucus those first few days and it’s going to take a while for the body to clear that. That’s why we say about seven to 10 days; with a lingering cough, sometimes it’s up to two weeks,” she said.
There is not a whole lot that can be done medication wise.
“Viral infections, specifically RSV bronchiolitis, we treat symptomatically. What that means is that we treat the symptoms. There is not medicine that we can give to make the RSV go away, so if they are dehydrated, we give them fluids. If they’re having a fever, we give them antipyretics like acetaminophen and ibuprofen. If they’re struggling to breathe, we check their oxygen. If they need oxygen, we give them oxygen so it depends on what symptoms a child is having how we treat (them),” Villareal said.
“A lot of children may require breathing treatments. However, that depends on their specific history. RSV does not respond to Albuterol. However, if a child has underlying asthma then we may prescribe Albuterol because the RSV can exacerbate their asthma. So there’s not a specific medicine, we just support the symptoms, and depending on what’s going on, we may be able to help the symptoms with certain medications. It would be a case by case situation to evaluate,” she added.
Medical Center Hospital Director of Public Relations Trevor Tankersley said they are seeing cases of RSV, COVID and flu at their urgent care clinics, but not a lot of hospitalizations. As of Dec. 21, there were nine COVID cases, but it has decreased this week and there have been a couple of RSV cases hospitalized.
Villareal agreed that they have not been overwhelmed, but there has been an increase in volume.
It can be initially difficult to tell the difference between RSV, COVID and flu.
“… RSV can start off just as an upper respiratory tract infection and so just by symptoms it may be a little bit difficult. But as RSV progresses, if it’s progressing to RSV bronchiolitis, it may be (easier) to identify that … There is rapid point of care test that we can do in the clinic to identify RSV. Other viruses can also start off as a URI (upper respiratory tract infection) and make their way down to the lungs and cause bronchiolitis. That’s the no. 1 cause that we’re seeing currently is RSV,” she said.
If a child is having difficulty breathing; they seem dehydrated; they’re not eating well; they’re not awake and active as they typically are, those are things of concern, Villareal said.
“I would say take your child in to be evaluated — whether that be in a clinic setting or an emergency room setting. In the emergency room, we try to save those spots (for) when we truly believe it’s an emergency so if they feel like their child is lacking oxygen … hasn’t had a wet diaper in more than six hours, they should typically be taking them to the emergency room,” she added.
“If they feel like their child is getting more ill, but are unsure if it’s an emergency then I would suggest reaching out to their doctors, to their clinics and getting them seen. If their doctors feel like they need to be hospitalized, then the doctor can help them with that transition from the clinic to the hospital if that’s what they see fit,” Villareal said.
Her advice would be if your child is feeling ill, you should reach out to your doctor for any recommendations and get tested “so we can help them give them an answer and guide them on what to expect.”
“… Timely healthcare is the key to everything, so it’s better to be seen earlier vs being seen later. That can help sometimes prevent complications,” she added.
The holidays and cold weather bring people together in crowded areas.
“That’s what’s been shown to increase the transmission of these infections. So it’s the perfect time of year for us to have any of these infections, especially kiddos. … It may be easier for parents to get in to see their primary care physician vs waiting in a crowded ER room,” Villareal said. “My advice would be if you have any concerns or questions, reach out to your doctor so they can do the appropriate testing and give you the appropriate advice.”
As for prevention, she recommends good hand hygiene, trying to continue those recommendations of adequate distance between people if you can and avoiding crowded areas. If you are ill, she advises wearing face masks so you can decrease the transmission to other people, which helps the community and avoid overwhelming hospitals and clinics.
