Parts of the United States are seeing a surge in respiratory syncytial virus (RSV), which causes a cold-like illness that is usually mild, but can lead to breathing difficulty for infants, older adults and people with certain medical conditions.

RSV cases dropped in 2020 at the start of the pandemic as communities put in place face mask policies and other measures to slow the spread of the coronavirus that causes COVID-19.

As these mitigation measures were lifted in the summer of 2021, RSV returned — in between the usual fall and winter seasons.

Now cases are rising again, with doctors concerned that a respiratory illness tri-demic — RSV, seasonal flu, and COVID-19 — will put additional stress on hospitals and medical offices.

With this in mind, we asked three medical experts for their perspectives on the current RSV surge and advice for parents of young children.

Dr. Daniel Ganjian is a pediatrician at Providence Saint John’s Health Center in Santa Monica, California.

Dr. Jonathan Maynard is a pediatrician at Providence Mission Heritage Medical Group in Orange County, California.

Dr. Juanita Mora is an allergist/immunologist and National Volunteer Medical Spokesperson for the American Lung Association in Chicago.

Here’s what they had to say.

Ganjian: During the pandemic many people were masking and doing a good job with hygiene, so most of them have not gotten RSV over the past few years.

Because of that, people’s antibody levels for RSV are now very low, so people are more prone to getting RSV — that includes adults, kids, and babies.

Generally, when these RSV surges happen, they are short-lived because many people get the virus during a short period and it goes away. So we’re hoping the current surge lasts only a few months.

Mora: Part of the surge is because we are coming out of the pandemic. This is the first fall and winter that we will have no COVID-19 restrictions in place in school settings, or even in public places like airports.

We’ve also had children doing a lot of virtual schooling at home over the last two years, so they didn’t get sick as often. Usually, most kids will have RSV by age two.

So now we have a whole population of younger children who have never seen RSV because they were at home much of the time and they were wearing masks when in school.

On top of that, many kids who have had RSV before are getting reinfected.

Ganjian: There’s no special medication for RSV. You treat it the same way as a common cold — nasal saline, suctioning the nose, vaporizer, acetaminophen or ibuprofen for any pain or fever, and plenty of TLC.

The symptoms usually worsen on days three to four, then they start dissipating. It takes about a week or sometimes two weeks for symptoms to completely go away.

Maynard: There is no proven treatment for the RSV virus itself. RSV care, therefore, focuses on the type and severity of symptoms.

In severe cases — especially those complicated by bronchiolitis, pneumonia, or apnea — patients may need to be hospitalized for respiratory support and treatment of dehydration.

Most children, however, are able to rest and recover at home without requiring medication.

Mora: Because we’re living in a tri-demic right now with COVID-19, RSV, and the flu — which often have similar symptoms initially — one quick thing you can do at home is a COVID-19 test of your child.

Then start giving medication to relieve their symptoms and provide supportive therapy — lots of fluids, ibuprofen if needed for fever, etc.

If the symptoms worsen, call your child’s pediatrician. They can do a nasal swab to test for COVID-19, flu and RSV, with an answer within minutes.

[NOTE: Do not use acetaminophen in a child under 12 weeks of age, or ibuprofen in a child less than 6 months old, unless recommended by your child’s doctor.]

Maynard: RSV often starts with nasal congestion and a runny nose. After a few days, people develop cough, fever and wheezing. For most patients, the symptoms are mild and resolve over a few weeks. For a small number of patients, the respiratory symptoms may become more severe and lead to difficulty breathing.

Parents should take their child to the emergency department if the child shows signs of difficulty breathing, which may include rapid breathing, flaring of the nostrils, the skin sinking between the ribs during breaths (intercostal retractions), wheezing and decreased activity or body tone.

Mora: RSV begins with mild cold-like symptoms — runny nose, sneezing, etc. — but once it hits the lungs, babies can start having trouble breathing.

So if there is any sign of respiratory distress — their chest wall is moving up and down or they start having a worsening cough — parents should definitely take the child to the emergency department.

The same with signs of dehydration. I tell parents to watch, especially in babies, the number of diapers they’re changing. If the number of diapers really starts to decrease, this might be a sign of dehydration. If so, seek medical care right away.

Ganjian: Kids generally do well with RSV. It’s the very young children and premature infants who are at higher risk for having more severe disease.

Also, older adults and adults with certain medical conditions have a higher risk of more severe illness with RSV. These conditions include heart disease, lung disease and immune deficiency.

Maynard: For young children (under 5 years old), and children with underlying health problems (lung and heart disease, immunosuppression, etc.), severe RSV infections can sometimes lead to significant difficulty breathing.

Along with breathing difficulty comes the risk of significant dehydration, as children are unable to drink adequately due to feeling short of breath. A small number of infants with severe RSV may even develop episodes of apnea, where they briefly stop breathing.

Mora: Children who are born prematurely — those born less than 32 weeks of gestational age — are at higher risk for complications from RSV because their lungs are not well developed.

Also at higher risk are children with congenital heart disease, problems with the lungs such as severe asthma, or a neuromuscular disorder that affects their breathing.

Ganjian: If your child has RSV or cold-like symptoms, don’t send your child to school without first seeing a doctor, especially if the child has had a fever in the last 24 hours or their cough is worsening. You can ask your child’s doctor how long to keep them out of school.

Mora: If a child is sick, we want parents to not send their child to school or daycare. I tell them, “keep the germs at home.”

Ganjian: To help keep your child healthy, you want to make sure their immune system is working optimally. That means making sure they get good sleep and good nutrition. Also, they should practice good hygiene, such as washing their hands before they eat.

If there is a baby at home with an older child who goes to school, have your older child shower and change their clothes when they come home from school. Then they can play with the baby.

Also, keeping a happy environment at home can support the immune system and help children fight off common viruses.

Maynard: RSV is highly contagious. It is mostly spread by direct contact with the respiratory secretions of an infected individual, or with an object, those secretions have contaminated.

It can also spread up to 6 feet away when an infected individual coughs or sneezes. Wearing masks, washing hands frequently, and cleaning common surfaces are very effective ways to prevent infection.

Mora: Helping children wash their hands frequently — or use hand sanitizer — is going to be important. Also, at home, especially in a multigenerational home, if a child is sick, have them wear a mask.

This is especially important if there is someone in the house who is immunocompromised, such as a grandparent, or an aunt or uncle who might be on chemotherapy or have diabetes, COPD or anything that puts them at high risk of complications.

Mora: Families will be gathering over the coming months for Halloween, Thanksgiving, and other holidays. To protect children and their family members, children who are eligible should get an updated COVID-19 booster and the influenza vaccine.

[NOTE: Children 6 months or older are eligible for the COVID-19 primary series; those 5 years and older are eligible for a COVID-19 bivalent booster. Children 6 months and older are eligible for a seasonal flu shot.]

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

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