Why Health Care Was Unprepared for the 2022 RSV Surge

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A pediatric emergency medicine physician discusses the epidemic factors that still perturb experts, and the status of vaccination and treatment strategies.

There have been more than 180,000 cases of respiratory syncytial virus (RSV) detected via PCR or antigen testing in the US since the beginning of 2022, per data from the Centers for Disease Control and Prevention (CDC). Since September alone, cases have neared 140,000 going into early December—generally the time at which cases of the common pediatric virus actually increase.

The terms “unprecedented” and “epidemic” have been unfortunately combined to described the presence or risk of numerous viral outbreaks since 2020. Even this year, continued challenges with COVID-19 control combined with early influenza burdens and the monkeypox outbreak highlighted the strain of circulating viruses in distinct patient populations and the corresponding hospital and emergency departments treating them.

But few pose as concerning a threat as RSV, the common young-age respiratory virus without a vaccine and impacting children with truly unprecedented reach this year.

In a This Year In Medicine 2022 recap interview, Steven Selbst, MD, pediatric emergency medicine physician at Nemours Children’s Hospital, discussed with sister publication Contemporary Pediatrics how the early onset of RSV has affected the flow and treatment of pediatric patients in hospitals.

“It’s unbelievable how many cases of RSV we’ve seen in the last few weeks since the end of the summer,” Selbst said. “I’ve been around for many seasons of RSV, but this is probably the worst we’ve had in terms of the number and severity cases.”

Many theories persist as to why RSV has been so particularly surgent in 2022; many experts point to COVID-19 as a co-driver. Selbst noted that children may have been previously less exposed to viruses and bacteria due to masking and social distancing during the pandemic, and thus may have weaker immune systems. Physicians have also been surprised by the timing of the RSV season, which is generally a winter-onset issue.

On the matter of prevention, Selbst has observed growing talk around RSV vaccine candidates—none of which are currently approved by the US Food and Drug Administration (FDA). He shared particular hope for Pfizer’s investigative vaccine, which in phase 3 data shared last month showed its efficacy in preventing RSV-borne respiratory tract illness in newborns when administered to pregnant moths. Unfortunately, the vaccine is a prospect for approval in 2023.

Selbst provided advice for his colleagues navigating the current epidemic, stressing the limited availability and capability of emergency departments during this wave.

“Our emergency departments are already overwhelmed across the country, and there isn’t much we’re going to be able to do for that baby who has a mild case,” he said. “There is no magic treatment for RSV; we recommend nasal suctioning and monitoring the baby, and certainly pediatricians can do that with their parents and family from home.”

Selbst also stressed stewardship for antibiotics, noting the national shortage on amoxicillin has been tied to the RSV epidemic—a correlation that confuses him. “Amoxicillin is not useful for RSV, so I would hope pediatricians are not overusing antibiotics during this epidemic,” he said.

Among infants ≤2 months old, he highly recommends parents and pediatricians look for signs of presenting and worsening disease: poor oxygen saturation, dehydration, low urine output, labored breathing, retractions, head bobbing and grunting.

“Be very careful with young infants,” he said. “Babies less than 2 months of age, I would not take any chances. If that baby has bronchiolitis, we want to see that baby in the hospital and there’s a good chance we’re going to admit them because those babies usually end up in the intensive care unit.”