What you need to know about RSV, flu and virus myths

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For the third winter in a row, we are facing the very real threat of our emergency departments and hospitals being overwhelmed. This year, however, things look a bit different, as the main virus behind this threat is not COVID-19 but RSV and the flu.

The first salvo was triggered by the rapid increase in cases of respiratory syncytial virus (RSV) and other viral respiratory infections in children. On Monday, Orange County in Southern California declared a state of emergency due to a record number of pediatric hospitalizations.

Influenza cases led by the Flu A (H3N2) strain also increased faster than in previous years, and a full two months earlier than usual, particularly in the southern and southeastern states. (Fortunately, our quadrivalent influenza vaccines this year include this strain, and early data from Chile show approximately 50% vaccine effectiveness against hospitalization.)

RSV, other viruses and immunity in children

As many children returned to full-time, in-person school without masks for the first time in three years, families have been hit hard with one viral infection after another.

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One popular explanation for the current rapid rate and high incidence of RSV and other viral respiratory infections is that children are paying an “immunity debt.” The theory is that three years of public health measures like social distancing, mask wearing and school closures, protecting them from COVID-19, significantly reduced their exposure to other common infections.

But this term is a bit misleading because it places the blame on public health measures that were put in place based on knowledge of the virus at the time. And the “debt” implies that the children’s immune systems are now weakened due to this lack of timely exposure.

In fact, what we are seeing is simply that children’s immune systems are naive or immature.

Why is RSV on the rise right now?

Babies born in 2020 or later did not experience their first season of RSV in a typical timeline. So there are now many children under the age of 3 experiencing RSV and other viral infections for the first time at the same time. The extraordinary absence of RSV during the previous winters gave rise to a high cohort of young children with no natural immunity who are now all susceptible to infection when they return to school and begin to resocialize after public health measures are lifted.

The pandemic certainly interfered and disrupted the natural timeline of exposure that we were used to. It will likely be years before it can be corrected, but we must also consider the possibility of a new normal.

Another potential game changer: Pfizer just announced that its bivalent RSV vaccine candidate showed 82% efficacy against serious lower respiratory tract illnesses in infants during the first 90 days of life. When it is likely to be approved later this year, it will be the first RSV vaccine.

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Confusion about the symptoms of the virus

As RSV, flu, and other viruses are on the rise, some people say you can self-diagnose which virus you have based on your symptoms.

you can not

COVID, influenza, RSV, and other respiratory viral infections trigger similar symptoms, particularly in adults.

The best way to find out which virus you have is to take a test. I recommend waiting 24 hours after symptoms before doing a rapid antigen test at home to rule out COVID-19.

For more comprehensive testing, go to your doctor’s office or local urgent care clinic where doctors can perform a test called a “viral respiratory panel” that looks for the presence of multiple viruses, including COVID, flu, RSV, rhinovirus, and others. common viruses. .

What should parents keep in mind?

Here is a list of concerning signs or symptoms to watch for in your sick child:

  • Irritability
  • Agitation
  • Lack of appetite, especially decreased fluid intake.
  • Decreased urination/amount of wet diapers
  • wheezing
  • Difficulty breathing
  • low oxygen level

I want to remind everyone that in the ER we do not distinguish between “low fever” and fever. The cutoff for fever is 100.4 degrees Fahrenheit. Period.

Fever by itself is not necessarily a “bad” thing. Fever is the body’s natural response to an infection, whether caused by bacteria or a virus.

Since I often talk to parents, I am more concerned about the child with a temperature of 101 who is cranky, not eating, and dehydrated than the child with a temperature of 105 running around me in the ER.

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Michael Daignault, MD, is a board-certified emergency room physician in Los Angeles. He studied Global Health at Georgetown University and has a Bachelor of Medicine from Ben-Gurion University. He completed his emergency medicine residency training at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps volunteer. Find him on Instagram @dr.daignault and Twitter @MichaelDaignau3

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