A Surge in Pediatric Respiratory Viruses Is Straining Hospitals

RSV and other respiratory illnesses in children are climbing well before the typical winter busy season.

Physicians are reporting unseasonably high numbers of respiratory illnesses in children, straining many children’s hospitals before the typically busier winter months.

Juan Salazar, physician in chief at Connecticut Children’s Medical Center in Hartford, Conn., said a sharp increase in cases of respiratory syncytial virus, or RSV, has filled up hospital beds at his facility, creating capacity issues. 

Officials at the 187-bed children’s hospital are now considering setting up a field hospital outside of the hospital’s main facilities in the event the surge of cases gets worse, he said. 

“We aren’t there yet, but we obviously have to be prepared,” Dr. Salazar said.  

RSV is an easily transmissible virus that infects the respiratory tract. The virus spreads through droplets from coughing and sneezing and on surfaces. Positive tests for RSV have been on the rise across the U.S., according to the Centers for Disease Control and Prevention. The rise in cases has come ahead of the typical winter peak for such illnesses, hospital officials said. 

For most people, RSV amounts to a cold, and nearly all children come in contact with the virus by the age of two, health authorities said. But it can be severe for some infants and older adults, especially for those that have pre-existing health conditions. 

Much like influenza, RSV cases were flattened during the first year of the Covid-19 pandemic. The respiratory virus that typically circulates in the fall and winter then rebounded in the summer of 2021.  

This summer, the virus continued to smolder at a lower level, instead of going away like it normally does, said Mark Kline, a pediatric infectious disease specialist at Children’s Hospital New Orleans. Then, it started heading upward again in recent weeks. Dr. Kline said the hospital was also seeing an early uptick in positive flu tests, as well as other common viruses. 

“We’re seeing the co-circulation of four or five viruses that are not unusual in the sense that they’re not rare,” he said, while noting that it is unusual to see them all circulating together at this time of year. 

“It’s just a viral petri dish out there right now,” he added. 

RSV is the most common cause of bronchiolitis, a lung infection, and pneumonia in children younger than 12 months in the U.S., according to the CDC. About 58,000 children younger than five years old are hospitalized due to RSV each year, leading to about 100 to 500 deaths annually, according to the CDC.

Most children and adults with RSV feel better after a week or two. But pediatricians may give high-risk children monoclonal antibody treatments to prevent them from getting sick or developing a severe infection.

There is no vaccine for RSV. Many companies, however, are racing to develop one. 

Children’s hospitals have reported that other respiratory viruses, such as the rhinovirus or enteroviruses, which cause common cold-like symptoms but can trigger more serious disease, have also fueled hospitalizations. 

In September, the CDC sent an alert to health providers about increases in pediatric hospitalizations, with severe respiratory illness in patients who tested positive for rhinovirus or enterovirus.  

Cases of respiratory illnesses like RSV fell during the beginning of the pandemic as people isolated and used masks, said Richard Malley, a senior physician in pediatrics at Boston Children’s Hospital. Children who would have typically become ill from a respiratory virus in 2020 or 2021 didn’t get the immunity protection that would come from an infection, he said.

Isolation and masking, which saved lives during the pandemic, also produced a sort of epidemiological experiment, Dr. Malley said. When society stopped isolating and fewer people wore masks, that allowed these viruses to start spreading again, likely leading to the current increases in cases, he said. 

The early surge in RSV cases has come amid a particularly severe season of enteroviruses, which has begun to trail off, said Larry Kociolek, the medical director of infection, prevention and control at Ann & Robert H. Lurie Children’s Hospital of Chicago. The increase in cases also occurred when many community hospitals have closed their pediatric beds, leaving pediatric hospitals strained to pick up the slack, he said. 

“All of those things are making it feel difficult and challenging for children’s hospitals across the country,” Dr. Kociolek said. 

Dr. Kociolek said the early onset of RSV cases means it may tail off before flu season gets in full swing, which could help hospitals with their capacity. But pediatricians are also preparing for the possibility that flu season will overlap with another rise in Covid-19 cases, which would offset the benefit of having an early RSV season, he said.

And flu season was light the past two winters, meaning most children under the age of two and half haven’t been exposed to it, Dr. Kociolek said.

“We are strongly encouraging parents, particularly with young children, to have their children immunized with influenza soon,” he said.