You might think that as COVID-19 becomes less of a threat, we would all be spending less time talking about viruses, testing and how to prevent the spread of germs.
But it seems that everywhere you turn these days, there are sick kids. Pediatricians are tending to a never-ending stream of patients, and children’s hospitals are reportedly filled to capacity.
In spite of low vaccination rates among children, COVID-19 isn’t the main culprit of the current glut of illness. Common respiratory viruses that doctors see peaking every year — RSV, rhinovirus, the flu — are hitting young populations earlier and harder than usual.
We asked pediatricians to address the current confluence of viruses and what parents need to know.
Why are infections spiking now?
The measures taken to control the COVID-19 pandemic — social distancing, masking, school closures — worked. Not only did they prevent children from contracting and transmitting COVID-19, they brought the number of cases of other respiratory viruses, such as the flu, to all-time lows.
A recent study published in the journal Chest found that pediatric intensive care unit admissions for bronchiolitis and pneumonia, potential complications of respiratory viruses, plummeted during the period of April to June 2020.
Now that masks are off and classrooms are full again, respiratory viruses are having a renaissance.
Parents often notice that when kids begin attending day care or preschool, there’s a period of frequent illness that eventually tapers down into a more manageable rhythm. As kids build up immunity to different viruses, they simply become sick less often. The pandemic disrupted this process.
“It’s kind of like everybody is starting off brand new in a preschool environment right now,” Dr. Tanya Altmann, a pediatrician in California who sees patients in her own practice and works with schools, told HuffPost.
During lockdown, she explained, “most kids were not exposed to common viruses that they usually would catch every year when they were young.”
Kids are now getting infected with these viruses — sometimes in succession, or even having more than one virus at the same time.
“Experts are calling this ‘immunity gap,’” Altmann continued.
Because kids haven’t been exposed to these viruses, “they haven’t built up immunity and it’s gonna take a year or two,” Altmann said, before things get back to the way they were in the years preceding the pandemic, when usually just those kids who were new to a group setting like school or day care caught viruses back to back.
There are additional possible explanations for the one-virus-after-another situation many families are facing.
Dr. Mona Amin, a pediatrician in Florida, said that “viruses mutate” and there might also be “a mutation shift making these viruses more virulent or contagious than in years past.”
Kids could be having worse symptoms than usual because of this viral mutation, and their symptoms may be worse because of the pandemic-created immunity gap as well.
Prior to the lockdown, “most kids were already exposed to RSV, either in utero or through mom’s breast milk, in the first two years of life,” Altmann said. “So when they caught it when they were older, they wouldn’t get as severely sick. Now, they have no primary antibody, so they are getting more severely sick.”
There’s also the expected seasonal surge in respiratory illness, which Amin says generally runs from October to April. But numbers right now are higher than normal.
“We are seeing increased viral spread than Octobers pre-pandemic,” said Amin.
At least one virus, respiratory syncytial virus, or RSV, made an earlier-than-usual debut this year, with infections beginning to climb in the spring and summer instead of waiting for fall.
Factors such as “weather, indoor activities, school back in session, viruses that thrive in the temperature change, immune systems still developing, and a post-pandemic world” have conspired to make this year particularly rough for kids and parents, Amin said.
Which viruses are kids getting and what symptoms are doctors seeing?
In addition to RSV, which usually causes only mild, cold-like symptoms but can lead to respiratory issues in young infants, the potpourri of current viruses in circulation includes rhinovirus (or common cold), flu, parainfluenza and COVID-19.
While most people won’t get very sick or need hospitalization when ill with a virus such as RSV, they are causing a strain on the health care system and other disruptions.
“Unfortunately, kids are getting sick every other week,” Altmann said. “They’re missing a lot of school.”
In addition to more hospitalizations, the surge of illness means that doctors are seeing more troublesome symptoms.
“I have gotten lots of calls about kids who are having persistent cough for two weeks,” Zee-Cheng said previously. “Kids are wheezing who have never wheezed before. They’re having these coughs that just last and last.”
While most of these illnesses cause mild symptoms in the majority of people, parents should be on the lookout for any signs that their child is having difficulty breathing. These might include the muscles of their abdomen working so hard that their rib cage shows, flaring of their nostrils as they breathe in, or, in infants, a grunting sound with each breath. If your child has any of these symptoms or other signs of trouble breathing, they should see a medical provider right away.
How has the pandemic changed the way we deal with viruses?
Another post-pandemic development has to do with testing. Previously, if you brought a sick kid into the doctor’s office, they would simply diagnose a respiratory virus and send the child home for treatment with fluids and rest — unless they were having trouble breathing, of course, in which case you likely headed for the hospital.
Doctors now have the ability to use in-office testing to find out precisely which virus — or even viruses — are causing your kid’s runny nose and cough.
“I have a BioFire rapid respiratory panel PCR machine,” Altmann said. “So I can actually identify most of the infections patients have.”
While it might not change the course of treatment to know which virus your child is infected with, Altmann says parents often like having this knowledge.
In addition, she said, it “helps the schools to know what’s going around.” With more information available, “we learn a lot about the viral patterns in our community,” she added.
In addition to precipitating the current surge of viral illnesses, and forever changing the way we deal with outbreaks, the pandemic has shown us which strategies are most effective in containing respiratory viruses.
Altmann spoke, for example, of advising a classroom teacher to rearrange the desks so that students weren’t facing each other in groups in order to slow the spread of a virus. In other situations, it might make sense to have kids mask for a few days to contain a virus, or to have kids who tested positive for a virus mask once they return to school.
Such measures “can really help keep kids in school and minimize the kids who bring it home to their families,” Altmann said.
At the end of the day — or, rather, at the end of this very long cold and flu season — it is building up kids’ immunity that is going to bring these common infections back down to their usual levels.
“It’s gonna take a year or two for all of us to get back to the usual winter cold and flu patterns,” Altmann said.
How can I keep my kids healthy?
As always, frequent hand-washing and disinfecting of high-touch surfaces — such as doorknobs — can slow the spread of infection.
It’s also important to keep your kids home from school when they have a fever or other significant symptoms.
“This is when they should be resting and when they are at peak contagiousness,” Amin said. “We all want to do our part to help reduce the spread.”
While there is not yet an RSV vaccine — although trials of a vaccine given to pregnant people show that it is effective in passing immunity along to babies — there are vaccines available for flu and COVID-19.
Vaccinating your children against these illnesses both reduces their risk of getting sick and slows the community spread, thereby offering protection to those who need it most, such as newborns too young for vaccination, older adults and people who are immunocompromised.