This winter, the U.S. witnessed a dramatic surge in respiratory infections. A potent combination of the Covid-19 JN1 variant, influenza and RSV (Respiratory Syncytial Virus) are driving the so-called “Tripledemic.” On January 5, medical experts Dr. Ben Neuman, Dr. Manisha Newaskar, and Dr. Jose Luis Perez joined an Ethnic Media Services briefing to explain how we can protect ourselves and our loved ones from these respiratory diseases.
They emphasized the importance of recognizing the warning signs for these infections especially for vulnerable groups like young children and older members of our communities.
While many Americans are familiar with the symptoms and treatment for COVID-19 and influenza, RSV is a relatively lesser-known but is equally potent. India Currents caught up with Dr. Manisha Newaskar to break down for our readers how this virus spreads, how to prevent infection, and its treatment. Dr. Newaskar is a pediatric pulmonologist with Stanford Children’s Health and operates practices in Walnut Creek and Emeryville with consultations at multiple hospitals.
Q. What is the RSV?
Dr. Newaskar: RSV stands for Respiratory Syncytial Virus and it is a type of virus or microorganism that spreads through airborne droplets. It causes symptoms ranging from a common cold, to full-fledged pneumonia, and even respiratory failure. So it’s a virus that mostly affects your respiratory system. October to March is when this virus usually spreads, so we’re definitely in the thick of it here in California at the moment.
Q. Who is most at risk, and why is that so?
Dr. Newaskar: Young children and older people are more at risk, so I would say that extremes of age are a high risk factor for RSV.
Among kids, infants who are below six months of age, and infants born prematurely are at the highest risk of contracting this disease. The same goes for toddlers and small children who have respiratory conditions like asthma, heart disease or neuromuscular disease. While children under two years of age are the most vulnerable, I have also seen older children hospitalized because of RSV.
Among older members of our communities too, those with co-morbidities like asthma, diabetes, obesity, lung disease and COPD (Chronic Obstructive Pulmonary Disease) are at greater risk. The reason why these two groups are high-risk is because they tend to have weaker immune systems.
Q. Does this mean that individuals between the ages of 18 and 60 may not catch the virus?
Dr. Newaskar: Anyone can catch the virus, so no one is completely safe from the virus, but if they are healthy adults, they will only get a runny nose, cold or a congestion – nothing serious. But then if you have a high risk individual at home, like a premature baby or an older person, it can spread easily to them as it is highly contagious. That is the most common setting in which RSV spreads.
Similarly, parents need to be wary of outbreaks in daycare centers for children and similarly, older citizens living in nursing homes or similar communal facilities are also at risk.
Q. Since the symptoms of RSV are similar to those of Covid, how do we distinguish between the two?
Dr. Newaskar: It is hard to distinguish initially whether it is Covid or RSV as the symptoms are very similar. Among infants if they have RSV, you can often see signs that the infant is struggling to breathe, like wheezing, flaring of the nostrils, and retractions, wherein the neck caves in with each breath. Sometimes, babies will act irritable and lose their appetite because their body has to do so much work just to breathe properly.
The best way to ascertain if it is an RSV infection is to take an RSV nasal swab PCR test, which is similar to a Covid test. This test is easily available at health centers. The test usually returns a result in about an hour.
Q. What is the recommended treatment for RSV infections?
Dr. Newaskar: Unfortunately, there are no antiviral medications for RSV, so there is nothing that you can give specifically for RSV and the treatment is mostly supportive. So for example medication like Tylenol can help in bringing down the fever, saline drops and suctioning the nose can help with nasal congestion, and in more severe cases, supplemental oxygen might be necessary if the blood oxygen levels drop. Infants and children often require an IV drip because their respiratory track has to put in more work to breathe, leaving them tired and dehydrated.
In some cases, RSV can lead to cases of bacterial pneumonia, which is pretty serious, but we have antibiotics for that.
Q. Is there an RSV vaccine?
Dr. Newaskar: Yes, there are a few RSV immunizations that are available, and the recommendations are different for different age groups.
For the past three decades, premature babies – who are considered most high-risk – are given a passive antibody treatment called Palivizumab, which is sold under the name Synagis. The immunization course is administered through monthly injections from October to March, and it has been very effective.
However, the FDA has also approved a new antibody treatment called Nirsevimab for premature as well as term infants, and it is really effective. It is just one dose, administered during the infant’s first RSV season.
There is also a maternal vaccine Abrysvo, which pregnant mothers can take 32 to 36 weeks into their pregnancy.
Finally, for people over 60 years of age, there are RSV vaccines by Pfizer and GSK. These are to be taken like one does a flu shot – one injection every RSV season.
The important thing to keep in mind is that much like Covid, you can still contract the virus even after taking the vaccine. However, vaccinations reduce the chances of the infection causing severe symptoms.
Q. Anything else to keep in mind about this virus?
Dr. Newaskar: An important detail is that children who get RSV might be more vulnerable to developing other respiratory problems later in life, like wheezing, or asthma. So as a parent, you need to be extra careful in monitoring your child’s respiratory health if they have contracted this disease during infancy or childhood, and watch out for any warning signs.
Also, it goes without saying that prevention is better than cure. We can protect ourselves against viruses like RSV by maintaining good hygiene, washing hands thoroughly and regularly disinfecting surfaces at home. Infants and toddlers often touch their face, rub their eyes, put toys in their mouths, all of which increases risk of infection.
Lastly, this virus spreads in the winter when we are mostly indoors, with the doors and windows shut. It can be helpful to increase ventilation within confined spaces, as this helps air out the virus to an extent. Essentially, it is crucial to follow all the best practices that we have learned as a result of the pandemic.
Read the CDC’s guidance on the RSV here.