RSV spikes among young, old

As the spread of coronavirus dominates the world spotlight, hospitals in Northern Colorado and across the nation are dealing with a major spike in another more common respiratory ailment that’s getting far less attention.

A stark warning by the Centers for Disease Control and Prevention on Feb. 25 that coronavirus — now officially called COVID-19 by the World Health Organization — soon would start spreading across the United States sent stock prices spiraling downward as government and private entities considered its potential effects on public health, productivity and global supply chains. The worldwide death toll from the virus was nearing 3,000.

Meanwhile, health experts around the country say this year is one of the worst in decades for the spread of respiratory syncytial virus. RSV affects children most but also seniors and — this year — more adults than normal. Adults more prone to coming down with RSV are predominantly seniors, pregnant women and those with special medical needs such as asthma or a chronic illness.

SPONSORED CONTENT

Select your Republic Services residential cart now!

In preparation for Republic Services becoming the primary provider of residential recycling, yard trimmings, and trash, residents should now select the best cart size and service schedule for their household needs.

Medical professionals also are stressing RSV’s possible impacts on businesses.

“There have been twice the amount of cases and deaths related to the flu this winter” in the United States, said Dr. Brian Money, chair of pediatrics at Banner Health’s North Colorado Medical Center in Greeley. “Couple that with RSV and it’s been a very hard year.”

In his career that spans 35 years, Dr. Dan McGee, a pediatric hospitalist at Helen DeVos Children’s Hospital in Grand Rapids, Michigan, told NBC-TV’s “Today” show, “I don’t know that I have ever seen RSV come on so strong so early in the season.

Not to make people panic, Money doesn’t downplay concerns over coronavirus.

“I open up my news app, and I see five articles a day about coronavirus, and a lot of hysteria and worry about that,” he said. “I see how it’s affecting the stock market and global trading and things like that.

“But here is RSV and flu. Both of these viruses have had a particularly bad year, affecting us here. And when you look at the total number of patients getting infected with this, we see a number count going up with the coronavirus but RSV and flu are in the millions per season. RSV is not one that has as much name recognition as the flu does or ones that kind of get worked up in the media like the coronavirus or the SARS virus or Ebola. When you look at the number of cases that we see, though, it pales in comparison to these yearly recurrent viruses like RSV and flu.”

Among children younger than age 5, he said, American health-care facilities usually see about 2 million outpatient visits for RSV a year, and about 60,000 hospitalizations. Older adults account for nearly 175,000 hospitalizations a year and more than 14,000 deaths. In comparison, he said, flu claims about 81,000 lives a year.

“These two viruses far outpace the frequency and severity of coronavirus,” Money said. “It’s been a particularly bad year for RSV in our area. RSV happens every year and anecdotally certain years are worse than others. You never know until it hits.”

Banner Health facilities saw a 40 percent increase in RSV-related cases in 2019 compared with 2018, with an increase in severity as well.

“Talking with my respiratory therapists here, they’re talking about how many more adult cases we›re seeing this season, how many people are up in the ICU on ventilators or pressure support because of these viruses,” Money said. “We’re seeing the same thing on the pediatric floor, and a lot higher acuity — meaning a lot sicker patients, a lot more needing to be transferred to ICUs.”

In the first two years of life, according to the CDC, RSV is the leading cause of pneumonia and bronchiolitis — a swelling of the small airways — and may be associated with wheezing.

For healthy adults, he said, “it’s more like a common cold, with headache, chest cold, body aches, fever and cough,” Money said, “but the younger you are and the older you are, the smaller your airways are and the more likely you are to have complications with dehydration and difficulty breathing.”

The highly contagious virus often starts similar to a cold, with a runny nose and maybe a low-grade fever. As it moves into the lungs, according to the CDC, breathing becomes more difficult and symptoms usually are at their worst on the illness’s third day. Our bodies never become immune to RSV; a person can catch it repeatedly during their lives, sometimes during the same season.

From a business standpoint, he said, RSV “can certainly decrease productivity at work and with sick days and job loss and the amount of time spent at home if you have kids that you have to take off to take care of them. I don’t have an exact number of dollars lost with sick days per year, but I’ve definitely seen statistics in the past, and the numbers are relatively staggering in terms of how much money can be lost at businesses based on illnesses like this.”

Health-care facilities especially feel the pinch.

“It definitely affects hospital staffing,” Money said, “not just because of the increased amount of patients so that you’re operating at a higher operational level, but then also our staff are on the front lines of taking care of the patients, so they’re a lot more susceptible to getting the infection themselves and then having sick days.”

Surveys show RSV patients had a higher use of health-care resources such as hospital stays, emergency room or urgent-care visits, ambulatory visits and outpatient visits than non-RSV patients across all age groups.

Prevention, Money said, just takes some common sense.

“The best way to try to prevent it is the traditional ways to decrease the spread of viruses: covering your cough, washing your hands, being vigilant around people who might be sick,” Money said. “We all kind of get a little lazy with hand washing, but these things are important, especially when we’re having a household member who has a fever or a cold.”

What sets RSV apart from influenza, he said, is that vaccines are available for flu but not universally for RSV.

“There’s one that exists,” he said, “but you have to be a premature infant or have chronic lung or heart disease to qualify for it” under specific criteria established by the American Academy of Pediatrics.

That drug is palivizumab, which was cleared for marketing by the U.S. Food and Drug Administration in 1998. Marketed as Synagis, it’s produced by Gaithersburg, Maryland-based MedImmune, which now is owned by AstraZeneca (NYSE: AZN), which produced pharmaceuticals at facilities in Boulder and Longmont until January 2019. The American Academy of Pediatrics has developed specific criteria for use of this medicine.

“That’s the problem with viruses; there’s no magic pill or drug that’s going to make them go away any quicker,” Money said. “Flu has an antiviral you can use, RSV does not. But even the effectiveness of the antiviral for flu is still minimal and has to be given within the first 48 hours of symptoms. So it’s important when people start to get sick to get to their doctor’s office to be evaluated. Or if they’re seeing signs of difficulty breathing, they need to get in.”

Businesses can help educate employees about prevention, Money said.

“The CDC has a lot of handouts and posters they can put up about proper techniques about handwashing and covering coughs,” he said, “but I think the main thing to do is the same thing I tell children going to school: If you›re sick, you need to stay home. If you›re going to work with fever and cough and flu and cold, that’s the best way to spread it to all your colleagues and co-workers, subsequently causing further loss of business days and revenue.

“I think from an employer standpoint, they need to understand and be lenient about these sick days. A lot of my patients and families worry about taking time off with their children when they’re sick because they might get a negative review at work or be at risk of losing their job. But if you’re coming to work sick or coming to school sick, you’re just perpetuating these kinds of viruses and ultimately making everybody sicker.”