And now were also starting to see an uptick– absolutely an uptick– in COVID-19 infections in kids.
RSV is a typical virus, usually a winter virus, and it tends to run in tandem with flu season. This winter, for whatever factor, we had extremely mild flu and RSV seasons– most likely since individuals were masking, and many individuals were immunized versus influenza. But this summertime we have actually seen a really vicious resurgence of RSV.
On HoustonChronicle.com: Parents, teachers fret about in-person classes this fall.
Its at an unmatched level. The Texas Department of Health and Human Services generally stops tracking RSV information for the state in mid- to late June. If you go to their site and take a look at previous years, the charts actually cut off. Theres an end date. This year, it goes directly through today and will continue to enter into the fall
With COVID rates increasing, pediatricians and family doctors are back on the healthcare frontlines. What are you seeing?
Were seeing, unfortunately, a merging, a perfect storm of COVID plus a really unmatched rate of infection with RSV– respiratory syncytial virus.
Weve had a substantial rise in hospitalizations of babies and toddlers in particular with RSV infections– RSV pneumonia, with breathing distress and breathing failure– requiring extensive care stays.
Christina Propst is a pediatrician at a personal practice in Houston, in addition to a member of the American Association of Pediatrics Council on Kid and Disasters, and of the Texas Pediatric Society Committee on Contagious Diseases and Immunizations. This week, she weighed in about whats on her mind.
Is COVID somehow connected to RSV?
Lets talk now about COVID.
I d state that RSV is slightly less popular to the basic public than influenza or the flu. However it is extremely well understood among pediatricians and among households who have kids with cardiopulmonary disorders or parents of children with premature infants or early kids. There are extremely specific requirements that premature infants have to meet to be able to qualify to get immunized versus RSV, and early infants do get a monthly injection with a vaccine throughout RSV season. There is not a vaccination for RSV that is offered extensively and extensively offered.
RSV has been around far longer than SARS-CoV-2 in terms of viral etiology. Theres an RSV season, just as theres an influenza season.
That, plus a genuinely virulent variant distributing really extensively today, and children being susceptible.
I understand that there have been kids hospitalized who were positive for both infections. I can not envision how awful they should feel. What it puts their household through it is just horrendous.
Some biologists think that viral crowding or viral competition could have suppressed RSV this winter season. For that reason it was essentially lying in wait or lying inactive, and has actually now come back with a vengeance. If that is the total explanation, I do not understand.
Its a mix of the delta variation and of the infection looking for the susceptible. Ages 12 and under are not eligible to be immunized, and regrettably, a fair number 18 and under are not immunized. In that way, again, its a perfect storm.
In the past week, Ive seen a significant uptick. I was on call this weekend, and we had even more positive test results for COVID-19 amongst our patient population than I had an any other call weekend of this whole pandemic.
I would state this weekend alone, I probably dealt with 15 to 20 who either were COVID-positive or recuperating from COVID and established problems. And theres certainly a higher number for whom theres a COVID suspicion, and I directed them to get testing.
On HoustonChronicle.com: Rush for vaccines as COVIDs fourth wave techniques
So RSV definitely predates COVID-19 tremendously, and is not always causally associated to COVID-19. Why it is raving here in the summer right now no doubt has something to do with COVID-19. But what that is, is unclear.
My suspicion is based on the truth that were not seeing flu right now– were not seeing Influenza A or Influenza B. Yes, we attempt to vaccinate extremely commonly against influenza. It is uncertain to me why were seeing this substantial uptick in one specific infection, RSV, as opposed to influenza A or B.
You stated that in your practice, youve seen the most clients test favorable this past weekend out of the entire pandemic. How numerous would that be?
Theres a coalescence of vectors. Kids are coming back to town. Theyve been taking a trip all over the place. In most cases, children or infants have been on flights, and clearly, theyre unmasked, because children under 2 can not be expected to use a mask. Plus, preseason sports is starting to get underway, school is about to start.
In the past 2 months, I have hospitalized more children– particularly infants under 3 years of age– than I had in the previous three years. Its been incredible, the quantity of morbidity today– from RSV, especially RSV, however also COVID, and now a mix of the two.
I assume that youre highly advising families to immunize the kids who are eligible to be immunized?
Are they usually following your recommendations and immunizing?
I attempt not to overwhelm them with the information. But I attempt to share a few of the more basic information, especially present data on kids and hospitalizations and COVID-19, in addition to some of the prospective issues from even a “mild to moderate” COVID-19 infection such as MIS-C or PASC (long-haul COVID).
If their kid has issues or has certain pre-existing conditions that put them at high risk, I talk about with them my issues for their kid in specific. I definitely have kids who have intricate congenital heart disease, who have moderate to extreme asthma, or who have elevated body mass indices. Theres a large at-risk pediatric population.
They are. I am blessed with a really informed, science-trusting, science-believing, caring and responsible client population. The families in our practice are terrific and are extremely receptive.
Naturally they have concerns, and I dont blame them. I anticipate that. There is hesitancy even in our practice, so its important to speak and take the time with those parents and those families.
What suggestions do you offer the moms and dads of kids 12 and under who cant be vaccinated?
You stay up to date with a great deal of other medical professionals. What are you hearing from them?
RSV started rising in May, got much worse in June, then got significantly worse in July. We saw this coming: An RSV surge in June and July does not bode well for a healthcare infrastructure that currently been challenged, that has major weaknesses and that honestly requires some upgrading.
But moms and dads require to take this really seriously today.
This doesnt imply they cant see their pals and they cant connect. Theres plenty that kids can and need to do. We have to be very cautious right now.
In previous surges we had the ability to utilize the childrens medical facilities to deal with grownups. However the previous rises did not include RSV infection that is just a tsunami driving child hospitalizations today.
And its July. Its not flu season. There arent as lots of individuals on the roads, entering into cars and truck wrecks, as there will be when school begins and everyone comes back to work.
This is a dire situation right now, and the forecasts for the Texas Medical Center actually are frightening.
The recommendations Ive provided is, No. 1, to rewind and return to their peak time of issue– to return to the period of time when there was a great deal of uncertainty about COVID. Rewind to that mentality.
On HoustonChronicle.com: Delta alternative like absolutely nothing weve seen before,” says Dr. Peter Hotez
The healthcare facility is full, so they can not move her. Her physician has actually put in the demand, but shes on hold. Shes waiting. Shes on standby. Thats where we are right now.
Given the number of COVID infections that were seeing, we anticipate hospitalizations to keep increasing. Are nurses and medical professionals bracing for this?
Masking is a big and simple component in preventing the spread of COVID-19 and mitigating infection among the vulnerable. The American Academy of Pediatrics provided a declaration rather unquestionably based upon the information that children two years and up need to be masking inside your home in school this coming school year, and the CDC just made a comparable recommendation.
So I advise to my households, if they can, remain in a school that follows the science, that advises or even needs masking for children 2 and up. I certainly have clients who are seriously considering homeschooling again. Regrettably, obviously, thats not a choice for everyone. That requires time and resources, and some kids truly can not tolerate that. And some moms and dads cant: I would not have the ability to endure that with my kids. Its hard.
I dont desire to yell fire in a congested theater. I smell smoke. This is a remarkable problem. This is not January. This is July. This should not be happening now. There need to not be this many sick kids today. If the childrens healthcare facilities are at or near capability, which they are right now in the Texas Medical Center, that implies that the adult medical facilities, which now are also either complete or almost complete, have no pop-off valve.
I was simply looking for care for someone who is in a health center system elsewhere in Texas and is looking for an ICU bed here in the Texas Medical. However there are no ICU beds at the hospital in medical center that this client was wanting to be moved to– the medical facility where she has in the past gotten all of her care. None.
This is a defining moment. It really is. I dont know where these patients are going to go.
What should Houstonians be considering now? How should people be living their lives?
There are very specific criteria that early babies have to meet to be able to certify to get immunized versus RSV, and premature infants do get a month-to-month injection with a vaccine during RSV season. RSV definitely predates COVID-19 greatly, and is not always causally related to COVID-19. It is unclear to me why were seeing this huge uptick in one specific virus, RSV, as opposed to influenza A or B.
I hear people saying, “I just desire things to return to typical. I want my kids to have a regular academic year.” I definitely do as well. Then theyre doing things that are detrimental or straight inconsistent to that goal. That degree of cognitive dissonance is extremely aggravating for a number of us in healthcare.
Individuals require to get immunized. People who are eligible to get immunized requirement to get vaccinated.
Lets talk now about COVID. RSV started rising in May, got much worse in June, then got considerably even worse in July. We saw this coming: An RSV surge in June and July does not bode well for a health care infrastructure that currently been challenged, that has major weaknesses and that honestly needs some upgrading.
Just as Houstonians came together after Hurricane Harvey, I would hope that theyll really come together now for the higher good– that theyll think of their next-door neighbors, their buddies, their friends kids, their teachers, their medical professionals, firefighters, nurses and authorities. Thats truly the only method we are going to get through this.
This interview has been edited for length and clarity.
Individuals over the age of 2 who do not have particular developmental or medical conditions need to use a mask, whether theyre immunized or not, especially inside your home.
People need to look around and think about others.