Not just COVID: NC hospitals also seeing unusual spike in winter respiratory illness

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As North Carolina hospitals struggle with rising numbers of COVID-19 patients, they’re also seeing a surprising number of people, particularly children, sick with another respiratory illness that’s usually a problem in the winter.

Hospitals say they’re not used to seeing summertime cases of respiratory syncytial virus or RSV. The viral illness has symptoms similar to COVID-19 and influenza and is usually hardest on children under 5 and adults 65 and older.

RSV is common; almost all children will have an RSV infection by their second birthday, according to the Centers for Disease Control and Prevention. But serious cases can cause more severe infections such as pneumonia and a lung infection called bronchiolitis. About 58,000 children under 5 are hospitalized with RSV in the United States each year, according to the CDC, and as many as 500 die as a result of it.

But last winter, RSV cases were nearly non-existent, for the same reasons North Carolina and the rest of the country had a very mild flu season. The steps people took to avoid spreading COVID-19, including social distancing, working and studying from home and wearing masks in public, are thought to have reduced the spread of all respiratory viruses.

WakeMed’s children’s hospital saw no cases of RSV in January, normally the peak season for the illness, said Dr. Seth Brody, the chief physician director for WakeMed Health and Hospitals. But surprisingly, Brody said Wednesday, WakeMed has treated 180 children with RSV so far in August, helping to fill its pediatric intensive care unit.

The pattern, repeated elsewhere around the country, defies simple explanation, Brody said.

“I don’t know that anyone knows for certain,” he said. “Something has clearly happened here related to this pandemic that has shifted it.”

One theory, he said, is that children who were kept out of school and away from each other last year have been getting together this summer, spreading the virus to each other.

“That’s sort of the simplest and most direct explanation of why now,” he said. “But there could be other reasons.”

UNC Health hospitals are also seeing an unusual number of RSV cases, said spokesman Alan Wolf. UNC’s 20-bed pediatric intensive care unit in Chapel Hill is full, including a handful of COVID-19 patients and a half dozen with RSV.

“It’s scary because it’s unusual this time of year, because many of the symptoms are similar to COVID and because it can make kids really sick,” Wolf said.

The CDC began warning of the unusual number of RSV cases in the Southeast back in June. The CDC noticed an uptick in cases starting in late March and worried the numbers were actually too low, because doctors weren’t accustomed to testing for the virus during warmer months.

The agency said doctors should consider that children with respiratory illness who test negative for the coronavirus may actually have RSV instead.

The unusual summer spike in RSV has doctors worried about the coming flu season. During most winters, hospitals are busy treating flu patients, so last year’s extraordinarily mild season was a blessing for hospitals who had their hands full with COVID-19.

If RSV is circulating again, the flu virus may well do the same in the months ahead, Brody said.

“If we’re already there in the summer,” he said, “we’re definitely worried about what’s coming.”

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