Health care workers are bracing for a triple threat ahead of winter: with the beginning of flu season, rising cases of respiratory syncytial virus and continuation of COVID-19.
All are respiratory viruses, although the first two have been common and treated by physicians for decades. The ongoing COVID-19 pandemic, meanwhile, takes a turn as more immune-evasive variants emerge and gain a foothold across the globe.
An early spike in RSV among younger children is keeping hospitals busy in several regions of the U.S., pushing some to near capacity in mainland cities.
Hawaii is also experiencing a concerning rise in RSV cases, according to Dr. Shilpa Patel, pediatrician and chief quality officer at Kapiolani Medical Center for Women & Children, but the state’s primary children’s hospital is managing the caseload well.
Here, the earlier-than-usual rise in RSV cases started in September, she said, along with other types of viruses that cause upper respiratory infections, including rhinovirus and enterovirus.
“These viruses are common viruses that we’ve been seeing for decades,” she said. “These are viruses that are very well known to us and nothing to panic about.”
Cases are still quite high here, she said, and the public should be aware of them and take preventive measures where possible.
RSV is a common respiratory virus that usually causes mild, coldlike symptoms, according to the Centers for Disease Control and Prevention, but has driven an increase in emergency room visits and hospitalizations in multiple U.S. regions.
Most children get an RSV infection by the time they turn 2 years old. Most recover from RSV in a week or two, but the virus can be serious in some infants and young children if it causes pneumonia or bronchiolitis, inflammation of the small airways in the lung.
An estimated 58,000 children under 5 are hospitalized every year due to an RSV infection, according to CDC. Premature babies, infants 6 months and younger and those with weakened immune systems are at greatest risk.
The early symptoms include a runny nose, decrease in appetite, and cough, which can progress to wheezing, CDC said. For infants there may be irritability, decreased appetite and breathing difficulties.
The most concerning ones to watch for include difficulty breathing or trouble staying hydrated, said Patel. This includes signs children are not urinating as often as usual, or for infants, not breastfeeding or drinking their formula as usual. A high fever also can be concerning for younger infants.
Parents who are concerned should call their pediatrician or family physician for consultation, she said, and advice on whether to go to urgent care or an emergency room.
Fortunately, most RSV illnesses can be managed at home, and it is only the more serious cases requiring assistance with breathing that end up hospitalized.
Hawaii’s hospitals, fortunately, are not currently overwhelmed with RSV patients like some on the mainland, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.
Hawaii’s hospitals, however, are full, with an average of 2,400 patients per day, without relief in sight. Raethel said there are many non-COVID-19 patients ending up in hospitals who are sicker and staying longer.
As has been the case for some time, some are waiting for discharge to a skilled nursing facility but unable to due to unavailable beds and staffing shortages.
“Right now we’re doing OK,” said Raethel. “But given the fact how full our hospitals are, the overall situation is concerning.”
Hawaii also continues to suffer from a staffing shortage of health care personnel, and has 400 to 600 traveling nurses filling in on any given day.
The triple threat
Health officials are bracing for Hawaii’s winter because flu season soon will get underway, and more immune-evasive variants of COVID-19 such as BQ.1 and BQ.1.1 that have been detected in Hawaii are likely to grow.
Nationally, the proportion of these two variants combined are rising rapidly, from about 11% two weeks ago to 27% on Friday, according to CDC.
The symptoms of all three — RSV, flu and COVID-19 — can seem similar.
Patel recommends that eligible children get their flu and COVID-19 vaccine shots, available to those as young as 6 months old, to prevent severe illness. There is no vaccine for RSV yet.
“My advice would be to get vaccinated,” she said, “to continue to be really good hand washers and teach our children to be good hand washers — washing hands before touching our faces, our eyes, nose and mouth, because that’s how viruses like to enter our bodies.”
Those who are sick should stay home from school or work so that they do not spread the viruses and get others sick. Additionally, wearing a mask that covers the mouth and nose is an effective way to prevent the spread of respiratory viruses.
“We know that mask wearing prevents us from getting respiratory viruses,” she said. “We know that works.”
What is driving the early rise in RSV cases?
Patel said protection measures taken during the pandemic, such as lockdowns and mask wearing – which are all important — meant that children’s immune systems were not exposed to the world in the same way as usual.
So their immune systems are being exposed to RSV and other viruses for the first time, resulting in illnesses. What’s concerning for hospitals is to have so many cases occurring at once.
Kapiolani has enhanced its after-hours clinic with extra staff, said Patel, and streamlined its emergency room so patients can be triaged and seen expeditiously, and is confident overall it can manage any spikes this winter.
The state Department of Health is also urging residents to get the bivalent COVID-19 booster and flu shots.
DOH said flu cases in Hawaii tend to peak from November through March, although the state experiences flu year-round due to its tropical climate and high volume of tourism.
CDC’s FluView report on Friday showed early influenza activity across the U.S. continues to increase, with the highest levels in the southeast and southeast-central regions.
Hospitalizations continue to rise, and the first pediatric flu death of the season was also reported last week.
While it is too early to tell whether Hawaii will have a particularly bad flu season, DOH said, it is a great time to get a flu shot.
“We saw very few flu cases during the pandemic,” said state Epidemiologist Dr. Sarah Kemble in a statement. “People were wearing masks, maintaining social distance and avoiding crowds. That kept flu from spreading. But as COVID-19 mitigation measures have relaxed and masks have come off, we are seeing more flu circulating.”
There are early indications this year’s flu shot matches the strains well, she said, and will offer significant protection.
Average COVID-19 case counts per day have remained fairly steady for the past two months, but more immune-evasive variants have recently been detected in the isles.
“Getting a bivalent booster now will help protect you in the event case counts climb this winter,” said DOH in a weekly e-blast.
Raethel advised the same, saying Hawaii hospitals are bracing for a rise from all three threats.
“We would encourage people get their flu shots and their booster shots for omicron, and we would encourage them to continue to wash their hands,” said Raethel. “Eat well, drink well and make sure to keep themselves healthy to reduce the load on our health care delivery system.”
What you should know about RSV
>> Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, coldlike symptoms.
>> Early symptoms include runny nose, decrease in appetite and cough, which can progress to wheezing. In infants this can include irritability, deceased activity and appetite. Fever is a symptom but might not always occur with RSV infections.
>> Most RSV infections go away on their own in a week or two.
>> Almost all children will have had an RSV infection by their second birthday.
>> There is no specific treatment for an RSV infection, and no vaccine for RSV.
>> Infants younger than 6 months may need to be hospitalized if they are having trouble breathing or dehydrated.
>> RSV can spread when an infected person coughs or sneezes, or virus droplets end up in your eyes, nose or mouth. People infected with RSV are usually contagious for three to eight days. Children are often exposed to RSV in school or child care centers and can transmit the virus to other members of the family.
Ways to prevent RSV
>> Cover coughs and sneezes with a tissue or your upper shirt sleeve, not your hands. Wash your hands often with soap and water for at least 20 seconds.
>> Avoid close contact, such as kissing, shaking hands and sharing cups and utensils with others. People with coldlike symptoms should not interact with children at high risk for severe RSV.
>> Clean frequently touched surfaces, such as doorknobs and mobile devices.
Visit cdc.gov/rsv for more information.
Source: CDC
