What parents can do as RSV spikes among children

A surge in cases of a common respiratory virus is filling up pediatric hospital beds around the U.S. The early and swift arrival of respiratory syncytial virus, or RSV, is stretching the limits of an already exhausted health care system. Layer on COVID and the flu, and you’ve got the makings of another unpleasant pandemic winter.

This isn’t the kind of triple threat anyone wants to see. But there are plenty of ways to lower the risk of each of these viruses — both in the short term and over the long term.

RSV is typically nothing more than an annoying cold or cough for most children, but it can be dangerous for others — particularly infants, babies born prematurely and kids with underlying medical problems or who are immunocompromised. According to the Centers for Disease Control and Prevention, some 58,000 kids under the age of 5 are hospitalized with the virus each year in the U.S. RSV is also risky for older adults, killing some 14,000 people over the age of 65 each year in the U.S.

This year’s RSV season has arrived about two months earlier than expected. Cases are growing sharply and follow two seasons with very little spread. Those two mild seasons mean most infants and young children have never been exposed to the virus, making a large population of kids particularly susceptible this year. And while most of those children won’t wind up in the hospital, they still become vectors for spreading it to others who could.

Meanwhile, some community hospitals that shifted pediatric beds to support adults during the early months of the pandemic permanently reduced or abandoned their services for children. As RSV cases rise, children are being shuffled to facilities with beds, sometimes in other states. One hospital in Connecticut is even reportedly talking with the National Guard and the Federal Emergency Management Agency to set up a tent outside to support more admissions.

All of this has made pediatric infectious disease doctors worried about what the next few weeks might bring. Stretched hospital capacity and a combination of a more conventional RSV season and a potentially severe flu season “worries me a lot,” says Larry Kociolek, medical director of infection prevention and control at Ann & Robert H. Lurie Children’s Hospital of Chicago.

In the short term, there are some things parents can do to lower the risk for their kids, while also helping to minimize the societal spread of the virus. RSV is often transmitted by droplets from someone who coughs or sneezes. It also can live on surfaces for several hours. As every parent can attest, small children love nothing more than to put everything within their reach into their mouths. Stay vigilant about cleaning surfaces, not allowing children to share utensils, and washing hands. Families who have an infant at home and a toddler at day care should be especially mindful of those tasks — and if the older child has respiratory symptoms, Kristin Moffitt, a pediatric infectious disease specialist at Boston Children’s Hospital, recommends trying to isolate them from their sibling.

In general, the same kind of common sense measures many people adopted to fight COVID also apply to RSV. This virus is contagious for 3—8 days after symptoms present, so if you’re bringing your littles to an event where you can’t be certain people will stay home if they’re sick, know that you’re putting them at risk of one of the myriad respiratory viruses floating around. Consider staying home, or urge attendees with any symptoms to opt out of the festivities.

For families with members who are particularly vulnerable to RSV, the flu or COVID, “now would be a really smart time to say, ‘I’m going to put that mask back on when I’m headed indoors,’ ” Moffitt says.

One other concrete thing that parents can do is get their children vaccinated for the flu and COVID. Not only will it reduce the risk from those illnesses, but it can help keep pediatric hospitalizations down overall.

Unfortunately, there is no vaccine for RSV. There’s just a decades-old preventive treatment called Synagis — it’s a monoclonal antibody that is given to high-risk infants to prevent severe illness. But it’s less than ideal. Because the antibody doesn’t stick around for very long in the body, infants need monthly doses to be protected throughout a typical five-month RSV season.

And while the overwhelming majority of children who get RSV come out of it with just a cold, vaccines and treatments are sorely needed for those most at risk. More and better options are getting very close to the market, but not in time for this winter.

After a long quest to figure out how to immunize people against RSV, Pfizer, GlaxoSmithKline, Johnson & Johnson, and Moderna all have late-stage RSV vaccines in development. So far, the two most advanced vaccines (from Pfizer and GlaxoSmithKline) look remarkably effective, but there’s a catch: They are initially being tested in older adults, who are also at risk of hospitalization from RSV. Pfizer is pursuing its RSV vaccine in pregnant women, who would then pass on protection to their newborns.

AstraZenca is developing a long-acting antibody that would allow an at-risk infant to get just one shot per season, and Pfizer and others are developing antivirals that are earlier on in development.

None of us has time or energy for the triple threat of RSV, flu and COVID. But if everyone does their part to lower their family’s risk, we can make this winter more manageable for us all.