What is RSV and Why is it Causing a Pediatric Health Crisis?

CHRISTIANE AMANPOUR, HOST: Now, from one front to another, front line workers battle an exponential rise in cases of RSV among young children. This respiratory virus is the latest that is wreaking havoc and filling up hospital beds in the United States. Our next guest details the dire situation that many hospitals are facing again. Dr. Daniel Rauch, chief of Pediatric Hospital Medicine at Tufts Medical Center is joining Hari Sreenivasan.

(BEGIN VIDEO TAPE)

HARI SREENIVASAN, CORRESPONDENT: Christiane, thanks. Dr. Daniel Rauch, thanks so much for joining us. You are the chief of Pediatric Hospital Medicine at the Tufts Medical Center. What are you seeing right now when it comes to cases of RSV?

DR. DANIEL RAUCH, CHAIR, AMERICAN ACADEMY OF PEDIATRICS COMMITTEE ON HOSPITAL CARE: We are seeing more than we have ever seen before. We are absolutely swamped with kids who are getting this. And the age distribution is a little bit different from prior years. We are seeing more older toddlers and preschoolers than the typical age group which are infants.

SREENIVASAN: For people who might not know what RSV is, what is it and what does it do?

DR. RAUCH: RSV stands for respiratory syncytial virus. In most people it causes just cold symptoms, upper airway congestion, snotty nose. The problem with little infants is that they breathe through their nose, they’re obligate nasal breathers. So, if they get cold and congestion, it’s hard for them to breathe. The other problem is it does crawl down into the lungs and causes damage to the lining of the lungs, which is where you change oxygen and carbon dioxide. So, that’s where it causes some significant breathing problems.

SREENIVASAN: So, why are we seeing so much of it this year?

DR. RAUCH: That’s a great question and I wish I had a good answer for you. RSV is around all the time. So, even in the summer, we see some of it. It typically peaks in early winter and lasts until about March. And last year and this year, we see — we’re seeing very early peeks where it’s starting in September and October. And we’re knee deep or shoulder deep in it already.

SREENIVASAN: So, give us an idea. It’s not just your hospital in Boston. It’s around the — I mean, how bad is it when it comes to ERs and pediatric beds around the country?

DR. RAUCH: It’s bad. They’re — it’s regularly now that there is not an available pediatric intensive care unit bed in all of New England. And we’ve called down in New York to see about availability. And we’re ending up taking care of kids in our community settings and in our emergency rooms that typically would have been transferred to children’s hospital or facilities that can do higher level of care. And our pediatric providers on the front line and the emergency medicine people and the nurses and the respiratory therapists are doing an unbelievable job in keeping these kids in the settings that they weren’t used to having them and making sure that nothing bad happens to them. The question is, how long can they keep that up? Different from the initial COVID surge, this is hitting the whole country at once. So, I can’t ask for help from providers from the south and the west and — to come to the northeast now and then promise them that I’ll return the favor later on in the year when it hits them, because it’s hitting the whole country at once.

SREENIVASAN: So, the American Academy of Pediatrics alongside the Children’s Hospital Association are — asked the Biden administration to declare, essentially, a national emergency. What would that get you? What are the gaps that need to be filled?

DR. RAUCH: So, we learned some things dealing with adults during COVID, that if you break down some barriers to providing care and community centers, like telehealth and credentialing issues and cross state issues, it improves the ability of people to share their expertise and to provide help. And we need to do that for our kids. We did it for our adults. A lot of those exceptions expired as the pandemic lessened a little bit, but we need to reinstate them to help our pediatric providers. It’s challenging to be in a community health center or emergency room and be dealing with a kid who needs ICU level care and not have that available. And then not have anybody be able to talk to you because there’s — the people you normally call are across the state border and they’re not licensed in your state, or they’re not credentialed in your institution, or there’s fear about malpractice issues. We need to break those barriers and make the care deliver easier.

SREENIVASAN: I don’t want to be alarmist, but the idea that the — you know, basically, pediatricians are asking the government for help about this. How close is the, I guess, the pediatric health care system close to a breaking point here? I mean, the — you’re asking for help that the beds are too full, that you’re not able to find the kind of resources necessary, this seems pretty dire.

DR. RAUCH: I agree. And as I said earlier, I’m scared for later in December, in January, in February when the staff just can’t keep up this pace any longer. We can’t make more people. We can make people more effective. So, again, the — ask for the emergency declaration was to help people be more efficient in their care and to get help via other methods than people just physically showing up. But — and hopefully, we will be able to figure out ways to extend the care that we deliver. People already being very resourceful in providing levels of care in emergency rooms and in community centers that they never did before. And I’m hopeful that’ll help us keep on top of this as the winter goes on. But I share your concern.

SREENIVASAN: You know, one of the things that people became acutely aware of is how tight, I guess, the supply and demand are balanced out. Meaning, whether it comes to hospital beds or ventilators, and then we have almost a just in time health care delivery system. Did we — you know, were there any changes that we could have made after having gone through this global pandemic that said, maybe we should keep a couple of free beds extra knowing that there could be surges of things?

DR. RAUCH: So, unfortunately, there has been a detriment in pediatric bed capacity over the last two decades. And it only accelerated during the pandemic because in institutions that had both pediatric beds and adult beds, when you needed those adult beds and they weren’t pediatric cases, the beds got transferred over to adults. And the adult volume hasn’t gone down a lot. So, a lot of those beds have not been transferred back to pediatrics. And the other trend that happened over that time was pediatric beds just aren’t, unfortunately, very profitable for hospitals. And so, for hospitals that have a small component of pediatric beds and have been under a lot of economic pressure, it just made sense over the last 20 years to convert those to adult beds where the reimbursement was better. On top of all that is we have a mental health crisis, and a lot of beds that would have been freed up for acute care are being filled now with children with mental health care issues and there’s no place for those kids to go. And they stay in those beds for days to weeks. Your RSV patient is hospitalized for a few days and there’s a lot of turn over. So, we can generally take care of that which we’ve done in past seasons. But if a lot of your bed capacity is with kids who cannot go anywhere else, that’s a real problem. So, it’s a combination of events.

SREENIVASAN: So, adults can get this, but why are children suffering in this way?

DR. RAUCH: So, it — the infants who gets it, it suffers for two reasons, as I explained before, they’re obligate nasal breathers. So, if you get all congested and you can’t breathe through your nose, you can’t feed, and it’s hard to open your mouth to breath. They’re also — because they’re younger and they’re not as well developed, it’s hard for them to cough and clear their lungs. It’s hard for them to have the stamina to keep up breathing fast for hours and days, whereas your — even the older child, your two-year-old typically do that and get through this without needing to be hospitalized.

SREENIVASAN: So, how long can this kind of congestion last? Because it’s hard for parents sometimes to figure out, is this something that I should take my child to the doctor for? Is this just a cough? Is this a runny nose that they may have gotten at school?

DR. RAUCH: That’s a great question. The things to worry about are if your child is having significant trouble breathing. There’s nothing we can do for your child once they’ve been infected to stop the progression. So, unless your child needs intervention, keep them at home. You’re better off at home. Your child’s better off at home. Talk to your doctor about things you can do like cleaning out your child’s nose and making it easier for them to breathe and feed. But there’s nothing that can stop the progression once they’ve had it.

SREENIVASAN: What about children who might already have different types of breathing conditions, say asthma? Are they at higher risk for this or does it not matter?

DR. RAUCH: It’s another great question. Typically, the age range of asthma is older children, two and up. And the age range that gets affected by RSV is under two years old. And that’s the surprise this season is we’re seeing those older, two, three, four years old get this. And there is some overlap in symptoms and things that are going on between asthma and RSV. Certainly, if your child has any underlying illness, getting RSV can make it a little bit worse. And the RSV can be a little bit harder for them to fight off. So, if your child is that risk, then definitely speak to your health care provider.

SREENIVASAN: You know, early on in the pandemic, we saw a disproportionate amount of number people of color that were impacted by coronavirus and had

COVID. Do we see any disparities in how RSV is making its way through the pediatric population?

DR. RAUCH: It’s persisted all the health inequity that we see in the United States. And communities of color, unfortunately. have very good reasons to be historically skeptical of the medical community and interventions that are suggested. Additionally, the closure of pediatric beds happens more in rural communities and lower socioeconomic stature communities. So, that getting to acceptable care is harder for people in those communities. And so, we need to do more to reach out to all the communities and explain to them, what to be worried about. When to bring your child in. And to get all the vaccines that are available to them.

SREENIVASAN: Considering we’re just coming off a pandemic where vaccines have been proven to be effective. Is there or has there ever been a vaccine for this? Are there people working on it? Is it even possible?

DR. RAUCH: There are people working on a vaccine. One of the interesting things about RSV, in particular, is it doesn’t promote a lot of immunity even from natural infection. So, your child could get RSV now and in March could get it again. That’s how poor the immunity is and that’s why we’ve struggled to get a good vaccine for this. I would tell people to get the other vaccines that are out there. It is worse to get RSV and another virus. The tripledemic that we’re looking at now of RSV, flu, and COVID is what we were afraid of when COVID first hit. Thankfully, COVID doesn’t seem to affect children as badly as it affects adults. And we didn’t see bad flu season the last two seasons. The flu is bad in Australia this year, and that predicts a bad season, typically in the United States. And we’re seeing spiking cases of flu now. And there’s a vaccine for that starting at six months old. Similarly, get your kid protected against COVID, that vaccine also starts at six months old.

SREENIVASAN: Is part of the lower number of flu cases and other respiratory illnesses over the past two years because at least for large parts of the country in the world, people were wearing masks.

DR. RAUCH: Yes, there’s no question that having people be protected from other sick people protects them from other sick people. So, if you are not circulating around with other people who are coughing and sneezing and blowing their nose and doing all the rest of that. You don’t get exposed to that and kids weren’t exposed to that. And now that everybody is up in about, that’s getting spread around like wildfire again which is what we used to see every winter. Epidemics of RSV and flu varying severity with the season. But we saw all of that, it’s all three of them at once. And for reasons we don’t understand a slightly different age group is getting hit this year.

SREENIVASAN: What about the frontline workers? I mean, they’ve literally been on one stress after another stress after another stress. And I’m just thinking about the people who are working the pediatric departments inside hospitals right now. It seems like there’s just no relief here because now there is another wave of illnesses keeping them very busy.

DR. RAUCH: Yes, I worry about that, too. I think this surge is going to continue through the winter. And we have a health care system for which the answer to surges is heroic efforts by people on the front line. And that works for a couple of days, maybe even a few weeks. But I’m very scared about going to happen in December, January, February, when people just can’t keep up this pace any longer.

SREENIVASAN: What are the things that parents should be doing to try to both get better care but also ease the strain? I mean, are you seeing people show up in the ER because of what they’ve heard about RSV versus taking your child to their pediatrician?

DR. RAUCH: Yes. So, we’re definitely seeing that. There’s a lot of worried — I don’t want to say, well, but there’s a lot of worry not sick enough to show up into the emergency room. Definitely call your health care provider. Your pediatrician or whoever else you are using for your child and run the symptoms by them. This is where a telehealth can really help because if someone can lay eyes on your child and help you through an exam in your home, you don’t have to go anywhere. And they maybe able to reassure you enough that you’re not going into the emergency room. We also need places that can see kids outside of the emergency room. A lot of pediatric practices limited their sick care visits during COVID and haven’t ramped up again. And urgent care also, if there’s a pediatrician available who is comfortable assessing your child can be another outlet rather than going to the emergency room.

SREENIVASAN: We’re heading into a holiday season, and for millions of people, if they didn’t have an opportunity last year or certainly the year before. This is one of the first times that they’re going to be able to gather with family and friends again. What would you advise parents about holiday travel given that you’ve got higher cases of flu than average, you’ve got RSV and COVID is still not over?

DR. RAUCH: Yes. So, again, get your child vaccinated and get yourself vaccinated for everything that’s available because vaccines work. That’s not going to help you over this coming weekend. But you should do that anyway. Standard precautions are important. Wash your hands, wash your hands, wash your hands. Be careful what you touch. Wipe down surfaces that other people have touched. And don’t think that just because the person next to you is going to look at you funny that you’re doing something wrong. No, wipe things down. If you are going to be in crowded areas, you’re going to be on an airplane, you’re going to be in bus stations. Masks work. And they don’t harm anybody. So, don’t be afraid about wearing a mask. And lastly, if you’ve got the sniffles in a cold, I understand you want to see your family. But it’s not fun to spread this stuff. You don’t want to be the person who gives grandpa the flu or you don’t want to be the person who gives the new baby that you’ve been waiting to see RSV. It — in no year was it OK to spread those illnesses and it’s not good this year either.

SREENIVASAN: How much do you think that vaccine hesitancy or at least the lower adoption rates of vaccines among children is contributing to any of this? I know we have — I’m specifically talking about right now COVID vaccines. But I don’t know how that will translate out to the normal flu shot that lots of kids used to get every year.

DR. RAUCH: Yes, I’m afraid about that. We don’t have good statistics on the uptake of the flu vaccine although we know in the last couple of years it has not been as high as it typically was. And the flu vaccine was never a particularly high uptake among the general population. Anyway, it’s not required for school like some of the other standard vaccines. And we saw drops in all the other vaccines. So, I’m afraid that people aren’t getting the vaccines that they need and should have. There is no RSV vaccine. So, RSV is not a consideration here. Flu definitely is and it’s — and we’re seeing, again, the flu cases really shoot up. And we are — and a lot of the providers are afraid that flu plus RSV or flu plus COVID is going to be really severe illness.

SREENIVASAN: Dr. Daniel Rauch, chief of Pediatric Hospital Medicine at the Tufts Medical Center, thanks so much for joining us.

DR. RAUCH: Thank you.