What Seacoast parents should know about wave of kids hospitalized by respiratory virus

EXETER — Seacoast doctors are seeing increases in respiratory illnesses in babies and very young children, part of a widely reported national wave of sick children being hospitalized this season.

The nationwide surge in respiratory syncytial virus or RSV cases led the Centers for Disease Control and Prevention to issue a health advisory warning last month to doctors and other health care providers about the virus, which can cause pneumonia, especially in young children and babies.

Adding to the worry is fall heading toward winter is the traditional season for colds and influenza and, of course, COVID cases are still here. Respiratory viruses are attacking babies and small children, some of whom are too young for a COVID-19 vaccine. The illnesses can all present with similar symptoms and children are being hospitalized with severe cases, especially of RSV.

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"We have seen a huge increase in RSV positive cases over the past few weeks," said Dr. Derek Trapasso, medical director of MassGeneral for Children at Exeter Hospital. "What we are seeing mirrors the national trends. We have had multiple pediatric patients admitted to our PICU (pediatric intensive care unit). Across the nation, we are seeing the numbers of patients resulting in a lack of pediatric beds. Last week we kept one child in the emergency department for 24 hours because there was not a PICU bed, anywhere, that was available."

Dr. Martha Wassell, director of infection prevention at Wentworth-Douglass Hospital, said traditionally, pre-COVID, most children contracted RSV by the age of 2.

"But the population of children who were born during the past three years of the pandemic really caught nothing, because they were exposed to nothing," Wassell said. "They were protected by all the precautions we took for COVID. As those measures are removed, those young children are susceptible and are being infected, many for the first time in their lives."

Wassell said Wentworth-Douglass has seen a significant increase, reflective of what the rest of the nation is seeing.

"In the last 14 days, we have seen 40-plus cases," she said. "It has settled a bit. We are averaging 10 to 15 inpatients at a time now. Unfortunately, the way the virus spreads, we are expecting a surge of illness. Two weeks ago, we tested 23 COVID-positive people. And we are coming into flu and respiratory illness season. I think it could be a rough winter."

Dr. Andrew Oliver, a pediatrician at York Hospital, said he tells parents of his patients about RSV every October because it has always been there. He said he is seeing an increase compared to the past two years when he virtually saw no cases of RSV.

"I think we may be getting back to where things were before COVID," he said. "Admittedly it seems to be coming back with a vengeance."

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Parents need to be aware the virus is circulating. While RSV is something seen every winter in children, Trapasso said what health care providers are seeing now is a resurgence of cases not seen over the last couple of years, primarily because the precautions taken by older children and adults were protecting babies and younger children from exposure to illness.

"An entire population of children 0 to 3 are the sick children we are seeing right now," said Trapasso. "These are kids who never got sick from this virus before and they are all getting it now. We are relaxing precautions, and younger kids at home are catching the virus from older siblings in school. Or they are getting it at day care."

Trapasso said the severity of the illness seems to be determined by how young a child is.

"It is hitting harder in children 2 and younger," he said. "They are developing bronchiolitis. We have already admitted multiple patients."

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Oliver said RSV is not the only respiratory virus that can give kids bronchiolitis.

"Colds can," he said. "Adults get bronchitis. Kids get bronchiolitis."

Wassell said RSV is a hardy virus.

"It can survive for hours on hard surfaces," she said. "So when we diagnose, or suspect RSV, we put the patient on contact precautions. Hand hygiene, as in COVID, is extremely important."

Because RSV is a viral infection, antibiotics are not an effective treatment. Trapasso said supportive care is used to give the child the chance for their body to fight off the infection.

"We need to assess the child's respiratory status," he said. "They might need oxygen support. They need to stay well hydrated, either on their own or with IV fluids. We can do fever control. There is no need for panic. The vast majority of kids will do exceptionally well with care. Parents, who know their own child, can watch, see how the child is acting, see that they are drinking enough fluid."

Oliver said if a child gets RSV, days three to five are traditionally the time when kids are sickest.

"It's important to watch the child's hydration," he said. "Without good hydration, all those boogers get nice and thick and it will impact the child's breathing. Watch they are peeing properly, and eating. In babies, especially those who are breastfeeding, the baby will instinctively choose breathing over eating. As secretions get thicker, breathing gets harder, and the child gets sicker."

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Oliver said babies and small children are considered "belly breathers."

"Watch for faster breathing," he said. "If you can see those little ribs having a difficult time, it's time to seek medical attention. Kids are frustrating in that their medical condition can change so quickly. Do not wait if you have a concern. Since there is no successful treatment, we are just buying time to allow their body to heal itself."

Even past three to five days, Oliver said there is no straight line to recovery from RSV or bronchiolitis.

"Kids will still be coughing a week later," he said. "They need to get all that junk out of their lungs and out of their bodies."

The good news, Wassell said, is that health care providers have plenty of the newer bivalent COVID-19 booster, and plenty of influenza vaccines, which can be given to children as young as six months.

"I recommend the entire family get the vaccines they need, as soon as they can." said Wassell. "It may be beneficial in protecting young children, may help to reduce disease transmission."

This article originally appeared on Fosters Daily Democrat: RSV sickens kids: Seacoast NH doctors warn parents