Contagious RSV up in Michigan: Symptoms, treatment, vaccine answers

Contagious RSV up in Michigan: Symptoms, treatment, vaccine answers

The steady beep of a medical monitor droned in the background. Melissa Parker’s 3-week-old, chubby-cheeked youngest son, Owen, lay in a crib as high-flow oxygen pushed through a tube and into his nostrils.

“He started with just a runny nose at home on the weekend (of Oct. 22) and that kind of progressed,” said Parker, 34, of Shelby Township. “He started being a little less like himself. He wasn’t eating as much or as often, was falling asleep during his feedings, started having retractions — the sucking in underneath his ribs. And then, during one of his feedings, he was holding his breath and kind of turning blue around the mouth.”

Parker, who is a pediatric nurse, knew those were the warning signs that Owen wasn’t getting enough oxygen.

She took him to Corewell Health Beaumont Troy Hospital, where he was hospitalized Oct. 24 with respiratory syncytial virus, better known as RSV. Four days later, Owen was transferred to Children’s Hospital of Michigan in Detroit, where he was admitted to the neonatal intensive care unit.

Owen is among hundreds of Michigan children who have needed hospital care amid an October wave of RSV, which causes the most serious illness in babies, people with compromised immune systems and elderly people.

How serious is Michigan’s RSV outbreak?

RSV cases aren’t required to be reported to public health departments, so they can be difficult to track. However, Dr. Natasha Bagdasarian, the chief medical executive for the state Department of Health and Human Services, said it’s clear Michigan is experiencing an RSV surge.

“We are hearing from our partners in pediatric hospitals that they are seeing a lot of kids” who are sick with the virus, she said. “We are hearing that emergency departments are getting pretty full and we’re also hearing that pediatric ICU (intensive care unit) beds are approaching capacity.

“I’m not saying that we are in a critical point and that ICUs are over capacity,” Bagdasarian told the Free Press. “I would not say that things are dire at this moment, but it’s certainly something that we are keeping a very close eye on.”

How many Michigan kids are hospitalized with RSV?

Michigan lacks a statewide tally, but Corewell Health East, the new name for Beaumont Health, reports it has seen a 567% rise in the number of patients hospitalized with RSV in the last month. In October, the health system cared for 881 hospitalized patients (adults and children) with the virus — compared with 132 hospitalized with RSV in September.

Across the state in Grand Rapids at Corewell Health Helen DeVos Children’s Hospital, demand for pediatric beds driven by kids with RSV is up 385%, said Dr. Andrea Hadley, pediatric hospitalist.

In September, 40 children were hospitalized with the virus at DeVos. Comparatively, in October, 194 needed hospitalization for RSV.

At C.S. Mott Children’s Hospital in Ann Arbor, 119 children were hospitalized with RSV between Oct. 1-26 this year. That’s about 28% more than were hospitalized in the full month of October 2021, a health system spokesperson told the Free Press.

What is RSV?

It’s a very common respiratory virus that in most people causes mild, cold-like symptoms “typical of other respiratory diseases — runny nose, coughing, sneezing, fevers, all of those things,” Bagdasarian said. “Most people who have RSV infections, they get better on their own at home.”

A subset of the population — especially babies, toddlers, senior citizens and people with compromised immune systems — can have a harder time fighting the virus and can get very ill.

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 “We are particularly worried about those who are at the spectrums of age … children younger than 1 year of age, especially,” Bagdasarian said. “We’re talking about infants who are born premature or underweight. And then … older adults can also be at risk for more severe symptoms.”

When babies get the virus, it can cause wheezing and respiratory distress.

“The younger you (are), the smaller your airways are,” said Dr. Andrea Hadley, pediatric hospitalist from at DeVos Children’s. “All of that congestion can lead to difficulty breathing, high fevers, and dehydration related to difficulty feeding because of all the congestion.”

The congestion “irritates the smallest parts of the airway called the bronchioles and causes bronchiolitis — inflammation of the bronchioles,” said Dr. Rudolph Valentini, a pediatric nephrologist at Children’s Hospital of Michigan and group chief medical officer for the Detroit Medical Center. “That often causes breathing difficulty in babies. It actually can cause infants to have apnea, which means they actually can stop breathing with it.”

How does RSV spread?

“This virus spreads in secretions and through respiratory droplets,” Hadley said.

“The best way to prevent the spread is to wash your hands, wash your hands, wash your hands. Keep your kids home when they’re sick.

“It spreads like wildfire through day cares and preschools and elementary schools. People can bring it home to their infants; siblings spread it to one another. Try to minimize contact with infants and keep kids home when they’re ill.”

If you must go out when you’re sick, Hadley suggested wearing a mask to prevent spreading the virus to others.

“We are asking our community to do those things for us because not only does it protect them, but it helps to offload our extremely busy pediatrician’s offices, emergency departments and hospitals … so that we can be there to care for every single patient that walks through the door,” she said.

How are hospitals managing the strain?

Dr. Whitney Minnock, pediatric emergency center physician at Beaumont Children’s Hospital in Royal Oak, said the “abundance of patients with RSV” have been a challenge to manage.

“I think that all of the hospitals in the area are affected pretty significantly and are trying really hard to meet the demands … of the kids that are sick,” she said.

“We’ve been increasing our staffing and kind of looking (at it) day to day. We’ve had several meetings to try to figure out how we can take care of all the patients that need us to take care of them, and I think that we’ve done a really good job. But we’re all working really hard right now.”

Children’s Hospital of Michigan is juggling a high volume of patients with RSV as well, Valentini said.

“We’re all feeling the pinch,” he said. “The state of Michigan has not been as heavily impacted as some of the other regions of the country but it does appear as though it’s evolving and it could be upon us in the weeks ahead.

What happens if there’s a flu outbreak on top of RSV?

“If influenza were to come in close proximity of time to the RSV surge, that could really tip us over,” Valentini said, in terms of hospital capacity to care for all the patients who need it. “Right now, … Michigan is coping with the situation, but it is definitely putting a strain on us.”

Minnock said the coronavirus pandemic has taught hospital systems to be flexible and, if necessary, patients can be transferred from a hospital that’s overwhelmed to one with a better ability to take extra patients.

But, she said, the public can play a role in slowing the spread of RSV and other respiratory viruses to help ease the stress on hospitals.

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“We’re calling on all of our partners in the community to do everything that we can to keep kids safe,” Minnock said. “We are also calling on other hospitals that can take care of pediatric patients … to help the pediatric hospitals really take care of the sickest patients,” Minnock said.

Getting flu and COVID-19 vaccines also will help, said Dr. Kimberly Monroe, interim chief clinical officer at U-M Health C.S. Mott Children’s Hospital & Von Voigtlander Women’s Hospital.

“Please do get vaccinated because that can help the medical system,” she said. “It’ll decrease the number of cases … if there is overlap” with RSV, flu and COVID-19.

What are the signs that my child might need to go to the emergency room with RSV?

Infants can’t tell their parents when they’re struggling to breathe. Drs. Valentini, Hadley, Minnock and Monroe said caretakers should watch for the following symptoms:

  • Rapid breathing
  • Wheezing or grunting noise
  • Nostrils flaring and/or muscles in the neck, chest or abdomen are strained when trying to breathe
  • Not eating well
  • Excessive fussiness or excessive lethargy
  • Bluish coloration of the skin
  • Dehydration, which shows up in infants as fewer wet diapers
  • Apnea episodes

“When the respiratory rate is above 60, a lot of times they’re so busy trying to take a breath to get oxygen into their body that they don’t often eat well,” Valentini said.

“They’re vulnerable to dehydration. So if they’re not eating well, if they’re fussy, if they have a fever, if you see the abdominal breathing or the grunting, you need to get to a hospital,” he said.

“Not every cough or cold with a little bit of wheezing warrants a hospital visit. If your baby is feeding comfortably but seems a little bit uncomfortable, you could pick up the phone and contact your pediatrician for some guidance.

“But certainly when they have those symptoms of breathing difficulty where they’re grunting, or you see the abdominal breathing or they’re having trouble feeding, you need to get (medical) attention.”

Is there a treatment for RSV?

Because it is a virus, antibiotics are generally not used to treat it. However, Minnock said, some kids who have RSV also develop bacterial infections that require antibiotic treatment.

“Urinary tract infections, sometimes ear infections, and some will get a superimposed pneumonia. … They might need some antibiotics for whatever infection they have on top of the RSV.”

Most of the time, hospitalization with RSV means supportive care, ensuring children are hydrated and their oxygen needs are met.

“RSV typically gets bad on days three to five and, usually, once they get past that bad respiratory part of it, they get better,” Monroe said. “It’s just kind of supporting them until their body can do what it needs to do to get through the virus.

“Most of these children will just need (oxygen delivered through) a nasal cannula. And some of them might need what’s called a high-flow nasal cannula, which is sort of super-duper nasal cannula. … Some people need what’s called CPAP (continuous positive airway pressure), which people might be familiar with in hearing about sleep apnea management.”

A very small number of children will need to be put on a ventilator because of an RSV infection, she said.

Is there an RSV vaccine?

Not yet. However, researchers are working to develop one that could be available within the next two years, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told MSNBC.

“We don’t have tools for all viral respiratory diseases,” Bagdasarian said. “We don’t have vaccines for all of them, but we should use the tools that we do have as effectively as possible to prepare for this upcoming respiratory season.”

That means staying up to date on COVID-19 vaccines and boosters and getting an annual flu shot, Bagdasarian said.

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“With all of these diseases, our goal is not necessarily to stop every single infection, but we want to save lives,” she said. “We want to keep health care capacity open and we want to keep our vital infrastructure open. … By using the tools, we will be able to get through this respiratory viral season.”

How deadly is RSV?

A study published in February in JAMA Open Network estimated that from 1999-2018 about 100 babies under the age of 1 in the U.S. died each year from RSV. Among adults older than 65, the study found RSV remains “an important” cause of death, which, “in some seasons … is associated with more deaths than influenza.”

The good news for children, Monroe said, is that most survive and have no long-term complications.

“The vast majority fully recover,” said Dr. Monroe. “That does not mean it’s not absolutely terrifying for parents and we as providers recognize that. Just because we can provide care and support your child and after the illness is over, they’re fine doesn’t mean it’s not scary.”

Why does RSV seem to be so severe this year?

“Quite simply we have had two very unusual years when it comes to respiratory viruses,” Bagdasarian said.

Before the COVID-19 pandemic, RSV cases typically peaked in December and January, she said.

“What we saw was that in 2020 definitely and in 2021 as well, things were different because of all the mitigation measures that we’ve been using for COVID,” she said. “So when we look at the 2020 data, we were flat in terms of RSV. There was no RSV.

“Now what we’re finding is that most of the mitigation strategies that people have been using for COVID-19 have gone away and so we’re seeing respiratory viruses come back,” she said. “There are young kids who haven’t been exposed to the same types of respiratory viruses for the last couple of years and so there is a possibility that their immune systems will handle this a little bit differently.”

Valentini said people ought to take RSV seriously and do all they can to protect their infants and young children from exposure.

“RSV is for real,” he said. “It’s always been for real, but it seems like it’s coming out with a vengeance this year.

“Perhaps it’s because we have less immunity in our community due to the pandemic kind of keeping everybody distant. But if you have a baby, you have to be extremely careful with your infant.”

Contact Kristen Jordan Shamus: [email protected]. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.

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