Although Covid-19 is still very much a problem in our population, another potentially even more serious outbreak is surfacing earlier than usual, and to a much greater extent than usual, especially in kids. RSV.
Respiratory syncytial virus (RSV) is a common, contagious RNA virus that causes infections of the respiratory tract (nose, sinuses, throat and lungs). RSV is the single most common cause of respiratory hospitalization in infants and it’s been around for a long time. First identified in 1956, the origins of this virus are not clear but the most likely source is cows since there is a very similar virus endemic in the cow population.
Unlike other viruses like the ones which cause Chicken Pox or Mono, against which we develop lifelong immunity once infected, but similarly to the Flu or Covid-19 against which we do not, reinfection remains common with RSV, particularly in later adulthood. This virus spreads by droplets caused by coughing and sneezing, unlike SARS-Cov-2 which also spreads by simple aerosols and breathing. Outbreaks are seasonal typically being much higher during the cold, winter months. Outbreaks typically occur a little later in the fall season. This year, it’s come early and with a vengeance.
It causes bronchiolitis (inflammation of the smaller lung airways) in infants, common colds in teens and adults, and more serious respiratory illnesses such as pneumonia in the elderly and immunocompromised populations. Each year in the US, an estimated 177,000 older adults are hospitalized because of complications caused by RSV infection and 14,000 of them die. In a typical year, as many as 58,000 kids are hospitalized because of RSV and as many as 500 of them could die.
The most recent outbreak is concerning because of the sheer numbers of infections with 70% of pediatric beds in many hospitals in the US being filled with kids infected with this virus. Entire classrooms are home sick.
Presently, there is no vaccine against RSV and no antiviral treatment is available. Most improve with fluids, breathing treatments like those used in asthma, medications like steroids to reduce inflammation but some kids and adults need to have their breathing supported with a ventilation machine. With Covid we have learned that we need to prevent being put on a ventilator at all costs since this actually worsens outcomes, but that is not the case with RSV. Both vaccines and antiviral treatments are on the horizon.
Why such a significant outbreak? It is not clear but the Covid-19 pandemic has been implicated on a variety of fronts.
First of all, we have gone from masking, distancing and shielding, to basically nothing. Even overdoing it by completely ignoring all cold symptoms altogether. There is an unfortunate assumption that if it is not Covid based on a home test, don’t worry about it. Keep in mind that the latest variants of Covid are much better at evading the test, so if you continue to be ill, keep re-checking or go have a formal test at a lab, urgent care or other facility administering the test. Sadly, in some cases, people are so cavalier that even if they do have Covid, they ignore it and continue about their daily lives, continuing to go to work or sending their kids to school.
Not so smart and certainly not responsible!
As I have told many patients over the last few years, there are a lot of other concerning organisms out there other than just Covid. And you need to employ the same basic protection strategies for all of them.
Secondly, has the isolation during the pandemic impacted on our immune systems? Probably, especially the younger you are. When a baby is born, its immune system is functioning, but immature. Most of the circulating antibodies are from the mother, having been transmitted through the umbilical cord and breast milk. These levels wane over the first 6 months of life. With each exposure to a new microbe, the baby’s immune system learns to recognize it and the baby’s repertoire of immune cells (T and B cells) as well as the number and varieties of circulating antibodies expand. With the isolation of the pandemic, their immune systems did not have a chance for these exposures so they remain relatively immature. The same goes for all people, regardless of age. The immune system has ramped down and has become slow to respond to all forms of attack. This has been used as a reason not to isolate as well as a criticism of how we have dealt with the Covid pandemic thus far. I heard a debate just this last weekend about this topic. At the height of the pandemic, we were losing close to 4000 people a day. No one in their right mind was venturing out anywhere. Almost certainly, if there was no lockdown, many more people would have been really sickened and many more would have died. Just as a reminder, today, we are still suffering on average 375 Covid-related deaths a day in the US and it remains the fourth leading cause of death. It is easy to look back and criticize.
Thirdly, the general health of the population has deteriorated, making it more difficult for us to combat infections. Despite the clear relationship between one’s general state of health and the likelihood of SARS-Cov-2 infection and/or severity of Covid 19 disease, including potential for dying, the general population has become even heavier and more unhealthy in the last 3 years of the pandemic. This includes kids. In fact, a study of nearly half a million kids between the ages 2 to 19 years found the rate of body mass index (BMI) increase nearly doubled during the COVID-19 pandemic. The fastest increase was seen in children who were already overweight or obese as well as in younger school-aged children. When you consider that 20% of kids under 20 and nearly 10% of kids under 5 were already obese pre-pandemic, that BMI increase is worrisome. Obesity rates in 5 to 11 year old’s have also gone up during the pandemic from around 36% to just over 45%. As far as adults go, 42% of surveyed Americans have put on weight, with the average being 30 pounds since the start of the pandemic. Life expectancy was already dropping for 3 years in a row before the pandemic and today, life expectancy is the same as it was in the mid 1990’s. This is still pretty good, but after a century of yearly increases in life expectancy, to have it drop continuously for the last 6 years is sad. And in case you are wondering, that drop in life expectancy is not just due to Covid deaths. All causes of death, in all age categories have increased.
STRESSED HEALTHCARE SYSTEM
A big concern at these overwhelmed hospitals is what is going to happen as the fall/winter season progresses. With hospitals already stretched thin with beds filling up, in an environment with fewer healthcare providers and sicker, more at risk people, we are headed into another healthcare crisis. Particularly when the next Covid surge occurs. And it will occur. It’s already happening in Europe and Asia. In my own area, access to doctors and specialists is becoming more and more restricted. To see a local neurologist is a 6 months wait. To see a cardiologist is ~ 4 months. ER wait times are routinely more than 6 hours, often approaching 12 hours. Our local ER recently hit a record with 80 patients actively being treated.
Please continue to be careful out there and think about everyone around you. Although you can argue that you are more careful around elderly and sick people, when you look around at the general state of health of our population, just about everyone has at least one, if not many, significant risk factors.
It’s been a while since I’ve repeated my Covid mantra but it seems appropriate to start again (with some edits):
MASK UP. Wear a good one (preferably N95) and wear one where it makes sense. In a crowded grocery store – YES. Walking outside on a path or riding a bike – NO.
DISTANCE. At least have the common sense to stay away if you are sick, with ANYTHING.
WASH YOUR HANDS and DON’T TOUCH YOUR FACE. But don’t windex your bananas.
GET HEALTHY. There is no magic pill. There is no all-encompassing inspirational quote. There is no ideal, minimalistic exercise regimen. There is no secret, all-curing superfood (although broccoli sprouts and garlic come close). There is just hard work.
- NUTRITION. EAT MORE PLANTS – studies of thousands of healthcare workers revealed that whole food, plant based eaters had the lowest Covid risks and Covid deaths, and not by a few percentage points. Cut out the sugar, processed foods and minimize animal products. These all cause inflammation, allergic reactions and disrupt hormone function.
- MOVE MORE. Do whatever you like, just keep doing it. Exercise is good for the brain, immune system, mood… The benefits are endless.
- SLEEP BETTER. There is a ton of research on not just duration, but more importantly quality of sleep.
- STRESS LESS. When you figure it out, please tell me. I need some stress management myself. All joking aside, chronic stress is a real problem and we all need to figure out how to chill out.
- LOVE MORE. We are social creatures and need one another. Compassion towards others helps the giver much more than the receiver.
- VACCINATE. Science still supports this very important strategy. The most recent booster is less effective at preventing Covid-19 but it remains effective at limiting the severity of disease. In addition, please get your Flu shot (remember that in 2018, over 70,000 people died in the US from the flu). Get the shingles shot as well. For younger people, please get the HPV (Human Papilloma Virus) vaccine. I have seen a significant rise in head and neck cancers from HPV. All of these vaccines have proven to be very safe and effective. I’m about as granola-doc as you’re going to see and hate meds and have over the years even questioned our need for so many vaccines, but after doing all my own research as well as seeing what I do in my practice, I remain a firm believer in the overall benefits of vaccination.
Stay Safe and Be Well
AC