York at risk of 'tripledemic' with rise of respiratory syncytial virus, experts warn

Noel Miller

York County hospitals are preparing for what medical experts are calling a "tripledemic" following a surge in cases of RSV — short for respiratory syncytial virus — among children.

"With COVID, and social distancing and closure of schools, the normal time course or time period for when we would see RSV has been completely shifted," said Chris Russo, WellSpan Health's director of pediatrics. "So we have seen an earlier rise in RSV cases, both in our outpatient offices at WellSpan and also in our emergency departments, urgent cares and hospital units."

The combination of RSV, seasonal flu and COVID-19, which is still infecting the public — albeit at lower rates than the height of the pandemic — has led to concern by medical professionals about all three peaking around the same time.

RSV, a common upper respiratory infection that most children have by age 2, is particularly dangerous for infants and young children since it can impact their breathing, according to the Centers for Disease Control and Prevention. The surge of infections is two months earlier than normal, as RVS peaks in December or January most years, Russo said.

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RSV cases fell dramatically two years ago as the pandemic shut down schools, day cares and businesses. With restrictions easing in the summer of 2021, doctors saw an alarming increase in what is normally a fall and winter virus. Now, it's back again. And doctors are bracing for the possibility that RSV, flu and COVID-19 could combine to stress hospitals.

John Goldman, a UPMC infectious disease specialist, said the recent increase in COVID cases and a potential lack of flu immunity from social distancing and masking could make for a troubling combination.

Doctors think cases are surging because infants and young children do not have pre-existing immunity to fight the infection because of social distancing and lockdowns from the pandemic, Goldman said.

U.S. Air Force Senior Airman Veronica Alverez, a respiratory care practitioner at Brooke Army Medical Center assigned to 959th Medical Operations Squadron based out of Joint Base San Antonio, Texas, does an inline suction maneuver on a patient for airway clearance in the cardiac intensive care unit at WellSpan York Hospital.

In anticipation of a surge, Goldman said the local hospital system is lining up as much staff as possible while trying to get word to the public about the importance of both COVID and seasonal flu vaccines or boosters.

If an infant or young child gets RSV, it is important that parents suction out mucus from their nose so their breathing is not impaired, Russo said. Most children with RSV are admitted to hospitals after becoming dehydrated because they can't breathe through their nose and are having trouble feeding.

Among U.S. kids under age 5, RSV typically leads to 58,000 hospitalizations and up to 500 deaths in a year. For adults 65 and older, RSV causes 177,000 hospitalizations and 14,000 deaths yearly.

In 2022, however, the virus has hit early and hard. According to the CDC, doctors found more cases in each week of October than any week in the prior two years.

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The CDC estimates that 1% to 2% of infants younger than 6 months who get infected with RSV require hospitalization. In an average year, around 250 children die from the disease.

Infants and children with RSV who are hospitalized are usually treated in pediatric intensive care units. However, UPMC Memorial Hospital and WellSpan York Hospital do not have PICUs.

There's no specific treatment, so it's a matter of managing symptoms and letting the virus run its course. Doctors may prescribe oral steroids or an inhaler to make breathing easier.

In serious cases, patients in the hospital may get oxygen, a breathing tube or a ventilator.

WellSpan York's pediatric unit does provide intermediate care, a step below PICU level care, Russo said. Only 5% of pediatric patients with RSV need to be transferred from York to Hershey Medical Center or Johns Hopkins, he said UPMC Memorial Hospital transfers children with RSV who need a PICU to UPMC Harrisburg, Goldman said.

Infected people are usually contagious for three to eight days. Babies and people with weakened immune systems can spread RSV for up to four weeks. There is no vaccine for it, though several candidates are in testing. Knowing how it spreads and using common preventative measures can help keep children healthy.

"It spreads like most respiratory viruses are spread," Russo said. "By cough, secretions [and germs left on] surfaces."

Russo, like other health experts, advises parents to ensure children are washing their hands, staying away from anyone who's sick and staying out of school when they're sick.

For more information about RSV, prevention and treatment, visit www.cdc.gov/rsv/index.html.

— Reach Noel Miller at NMiller3@yorkdispatch.com or via Twitter at @TheNoelM.

— Associated Press/Report for America reporter James Pollard contributed from Columbia, South Carolina. AP Medical Writer Mike Stobbe contributed.