Expert: ‘don’t panic’ but know dangers

RSV hospitalizations jump 31% in a week, stoking ‘tripledemic’ fear

As doctors battle COVID and flu, they are also facing fast-spreading Respiratory Syncytial Virus, in apparent knock-on effect of pandemic

Nathan Jeffay is The Times of Israel's health and science correspondent

A sick baby with an inhalation mask to treat Respiratory Syncytial Virus (RSV) on a hospital bed. (GOLFX vis iStock by Getty Images)
A sick baby with an inhalation mask to treat Respiratory Syncytial Virus (RSV) on a hospital bed. (GOLFX vis iStock by Getty Images)

A trio of viruses is on the rise, causing some experts to warn of a “tripledemic” of COVID-19, flu and the far lesser known RSV.

Respiratory Syncytial Virus is an upper respiratory virus, and cases in Europe, America and Israel are growing fast. The Health Ministry reported on Thursday that in the last week, the number of patients hospitalized with RSV jumped 31 percent. Since the beginning of October, 696 people have been hospitalized with RSV, including 229 in the past week.

Most children catch RSV in their first two or three years, but parents normally don’t give it a name and just say their children are “feeling unwell” or “have a virus.”

As with COVID, the concern is when it hits the vulnerable. For young babies, the elderly, and those with health complications, it can cause more severe illness such as infection of the lungs, bronchiolitis, an inflammation of the small airways in the lung, and pneumonia. RSV causes more cases of bronchiolitis and pneumonia before age 1 than any other pathogen.

Normally, morbidity is spread out, and hospitals can easily handle the flow of serious cases that filters through. But there is currently a sudden rise, and it is coming during a winter when hospitals are also dealing with two other major respiratory diseases — COVID-19 and flu.

“Israel is now experiencing what we’ve already seen in North America and some other places, with the rise in RSV,” the leading pediatrician Prof. Moshe Ashkenazi, deputy director of the children’s hospital at Sheba Medical Center, told The Times of Israel. “It’s spreading more violently than in previous years.

“People shouldn’t panic, but they should be aware that it’s a virus that is dangerous to young babies, especially preterm babies, and to children with heart and lung diseases.”

RSV – a 3D rendering of the virus (CIPhotos via iStock by Getty Images)

What makes RSV the odd one out alongside flu and COVID-19 is vaccine availability. The latter two viruses have easily accessible vaccines that are cheap for health providers to source. “There is a vaccine for RSV, but it is only given to the most at-risk as it’s a special antibody injection given in five shots and costs $20,000 to $30,000 per person, per season.”

It’s not known for sure why RSV is spiking now, after declining at the height of the COVID pandemic. But there is a strong belief among medical experts that masking and social distancing meant people were exposed to fewer viruses than normal and therefore now have reduced immunity.

“There’s a theory that for a long time we were masked and we weren’t exposed to regular viruses as we normally would have been, and therefore immunity levels against general viruses are low,” Ashkenazi said. “Now that masks are worn less, RSV is spreading more.”

Science supports the theory that masks may have been keeping RSV at bay. Like COVID, it spreads largely via droplets from an infected person — normally their coughs or sneezes — entering the airways of somebody else.

Dr. Moshe Ashkenazi, deputy director of the children’s hospital at Sheba Medical Center (courtesy of Sheba Medical Center)

The World Health Organization and the European Centre for Disease Prevention and Control just highlighted the threat of RSV alongside COVID and flu. “RSV has been on the rise since October, with some 20 countries and areas experiencing intensified RSV activity,” they said in a joint statement.

“COVID-19 case rates, hospital and intensive care unit admissions, and death rates are currently low compared to the past 12 months, but this situation could change as new variants emerge, and the disease continues to strain health care resources,” the statement said.

“With the continued impact of the COVID-19 pandemic and the circulation and health impact of other respiratory pathogens, it is challenging to predict how the new winter period will develop.”

Ashkenazi said that RSV normally starts with a cough and a runny nose, sometimes alongside sneezing, fever and/or an impact on appetite.

“On a practical level, if people have anything more severe than a runny nose, they should stay home or protect their surroundings by wearing a mask,” he said.

By the time symptoms show, people may have been contagious for a day or two. They normally remain contagious for three to eight days — in some cases longer.

Ashkenazi said that when symptoms are mild, people who aren’t at elevated risk don’t normally need to seek medical advice. However, if there is a “red flag,” they should take a home coronavirus test to eliminate COVID-19, and go to the doctor if it is negative.

“Red flags include shortness of breath, inability to sleep because of a cough, coughing with a large amount of phlegm, or a change in mental state,” he said. “The best thing we can do is to vaccinate against the viruses for which we do have shots — flu and COVID — so that we reduce cases of respiratory illnesses wherever possible.”

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