BETHLEHEM, Pa. — In her 25 years as a pediatrician, Dr. Jennifer Janco remembers only one year when she didn’t see a young patient with RSV.
"Covid. 2020," said Janco, chief of pediatrics at St. Luke's University Health Network and a practicing physician.
"No one went out. Everybody stayed home. So we know those things work. People have to decide. Understand the risks. Wash your hands. Minimize time spent together."
Respiratory Syncytial ("sin-sih-shul") Virus, or RSV, can affect anyone. There are about three million cases each year in the U.S., according to the state department of health. Most people recover in a week or two from symptoms like cough, sneezing, stuffy or runny nose, wheezing and fever, it says.
But for the littlest patients, symptoms can worsen quickly and often involve a trip to the emergency room. At this time of year, it's not unusual to see patients on stretchers lined up in the hallways receiving treatment, until a bed opens up.
Janco took a few minutes between seeing patients in the network's Monroe County offices Friday, helping to clarify what symptoms and signs warrant a hospital visit. One family anxious for an appointment even made the drive from Bethlehem to have their child seen.
Q: Why does there seem to be a surge of RSV cases right now?
Janco: It's what happens every year at this time. It has a seasonality to it, and this is the season. And we all recently spent the holiday sharing our germs with our loved ones. So we see an increase in cases.
Holiday gatherings, crowded shopping malls, the virus spreads through the air. It seems to be everywhere right now.
Q: What are the symptoms of RSV?
Janco: It looks like the common cold for most healthy adults. You can get it more than once. For those with compromised immune systems, it looks different. It hits hard with babies and first-timers.
Q: Why does it seem to be so much worse for newborns and older babies?
Janco: Yes, there are lots of cases in infants. The virus spreads and easily, and it's a susceptible population of young infants who are new to the Earth and haven't had the chance to build up their immune systems.
It's inflammation in a tiny airway, so physically, anatomically, size helps. In bigger children, lungs and airways have gotten bigger as well.
Q: What should parents look for, to know when it's time to bring baby to the hospital?
Janco: First of all, you know your child best. If you as a parent tell me something's wrong, that’s good enough for me. Visually, watch the way the baby is breathing. The cough is all over the place. They'll breathe faster, 2-3 times faster than normal, a panting quality, really using their muscles. You can see the outline of the entire rib cage as they breathe. They may use their nose to breathe, so you'll see nostrils flaring. Usually at that point, baby is too tired to smile, or eat or play. They're sleepy. They're losing color, getting dusty or gray or pale, as they’re having trouble keeping up with their breathing demands and oxygen levels. They may look dehydrated; not producing wet diapers, no saliva in the mouth, no tears, they're limp and listless.
Q: How do you treat RSV?
Janco: There's no special medicine, we just have to wait it out. For babies, say, 15 months old and full-term, it can take a day or two in the hospital if admitted. But as far as infants — the younger they are, and if premature, those are all factors. It all can take a long time and can be several days hospitalized, a week or more, waiting to get over the worst of it. This is one thing that antibiotics don't help. For infants, nothing over the counter is recommended. Some studies say over the counter medicines for age 6 years and up, some say 12 years and up. Definitely not underage 6. Generally at that point, it's usually just the common cold.
Q: What does 'the worst of it' mean in terms of being admitted to the pediatric floor?
Janco: Usually the things keeping them in the hospital are breathing support. Oxygen levels drop. They need to breath it into their nose, or they get intubated, hooked up to a breathing machine that will breathe for them. Then it's, 'Is today the day we get them off the machine,' and we try. If their oxygenation drops, then they go back on and are not sent home until they're ready. We have plenty of supplies, ventilators, respirators, IVs. No shortages this year like in other years. There's a special intubation or breathing machine to get over their illness. We have it.
Q: There was talk on social media this week of overflow to the point of treating those seriously ill in the hallways. How do you prepare for this kind of patient volume?
Janco: As a health care system, we know to expect it and plan for it. Everyone is on hand to help if and when it's needed. It's a team-based approach, from the doctors in the ICU, pediatric floor, emergency department. Nurses, managers, residents, it's all hands on deck. As many as we need to get the job done. Patients are still being treated even though they're in the hallway. I know it's not what we necessarily desire for everybody, but we will see that they get managed and are actively working to move patients through to get them to where they need to be.
Q: How do you know how many on-call workers to plan for?
Janco: We flex staff. We know how to do this. We huddle, plan for it ahead of time, and then we can start to tell as the cases start creeping up, and we figure out how to take care of each and every one of them.
Q: How can parents prevent themselves from catching RSV and thus, keep their children from getting RSV?
Janco: I implore people to please get the RSV vaccination. There is a 90% reduction in pediatric ICU admissions for babies who, either mom or baby got the injection. If I could give any message to people, this year, it's that most kids in the ICU or who are admitted, they did not get the meds or mom did not get a vaccine. It's there to help protect the worst cases of RSV. That medicine works, that vaccine works.
Q: Who qualifies to receive the vaccine?
Janco: It's available to pregnant mothers at end of pregnancy, to help transfer antibodies to the baby. Or if not, they can get it immediately after delivering, to reverse the lower respiratory disease. Sometimes they feel powerless, but there is something they can do. Also, please get your flu vaccine. It's never too late. Sooner would have been better, but it's not too late.
Q: What are the preventative medicines babies can receive?
Janco: Please, please, please get your child the monoclonal antibody. It doesn't take two weeks to develop immunity. It's effective immediately.
Babies under 8 months currently can go and get the antibody. It’s an injection. One time, and it lasts 8 months. We don’t encourage asking for an RSV test. It doesn’t change matters. We desperately want to prevent all babies from getting this kind of sick.
Q: What does home care for babies with RSV involve?
Janco: If home care, it's an upper respiratory infection, so it’s keeping them comfortable.
- If they have a fever, give them Tylenol. If they can’t blow their nose, put saline in the nostril and use the blue bulb suction and draw the congestion out of the nose.
- If they are flat on their back and struggling, change position. Hold the baby upright for some comfort.
- Feed properly. If they're breast- or formula-fed and their nose is congested, it's difficult for them to nurse, so try to clean their nose out.
- Vaporizers, and humidifiers can help. It’s dry everywhere right now.
Q: What is the light at the end of the RSV tunnel for all of us?
Janco: It's been ramping up probably the past two weeks for sure. It started a little after Thanksgiving. Around mid-December, we start seeing high numbers. It's been typically lasting through March or April, but typically between 4 and 8 weeks. Definitely the congregating around the holidays contributes.
Q: Any advice with New Year's Eve coming up?
Janco: If you don’t need to be around people, don't. Pick and choose gatherings appropriately. Avoid being around sick people. If you have a young infant, maybe say no thank you or not right now. It's one of the best things you can do. And I know that sounds horrible, but different people have different risk tolerance. If you have a low tolerance for illness, then stay home. I provide information, and they make decisions based on what I share with them.
Prepare to wait
If you do find yourself needing to head to the doctor or emergency room, Janco has a few small requests.
"In the middle of all of this, we still have children getting sick with non-RSV, non-seasonal illness or injuries, Diabetes, appendicitis," she said. "So take a deep breath. Keep in touch with your doctor's office.
"Pack a lunch and a healthy dose of patience.
Wait times are a little longer than you had hoped for, but we will see each and every person. Just be patient with us. We're here for you. We're going take care of you."
