RSV hospitalization rate for seniors is 10 times higher than usual for this point in the season

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CNN
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Respiratory virus season has started early in children this year and flooded children’s hospitals in many parts of the country, especially with the respiratory syncytial virus, known as RSV.

But adults can also get RSV. Although RSV doesn’t usually send as many adults to the hospitalit can be a serious and even fatal disease for older people and people with underlying health problems.

And with more children contracting RSV, the chances of adults being exposed increase as well. Some doctors say they are beginning to see an increase in adult patients.

This season, about 6 in 100,000 older adults have been hospitalized with RSV, according to data from the US Centers for Disease Control and Prevention. That’s significantly lower than the rate for children, but still unusually high. In the years before the Covid-19 pandemic, hospitalization rates for the elderly were about 10 times lower at this point in the season.

Dr. Ann Falsey, a professor of infectious diseases at the University of Rochester Medical Center, who has published research on adult RSV, he said that RSV increased a little in children during the summer and early fall of last year, but the usual proportional increase in RSV in older adults was not seen in the US at that time.

“I think older adults were more cautious about continuing public health measures like masks and social distancing last year because they were still concerned about covid,” Falsey said. “But this year, we’re starting to see older people end up in the hospital again with RSV, because everyone is shedding caution.”

Too often, RSV goes undetected in adults, he said. Many people, including doctors, overlook its impact on adults.

“They think it’s strictly a pediatric disease, but you know, if you don’t get tested, you never know what someone is really sick with,” Falsey said.

In the United States, tracking viruses like RSV it is not so complete as it is for Covid-19, so it’s hard to know exactly how many adults get sick with RSV. RSV case numbers come from self-reports that go to a few dozen laboratories that only represent about a tenth of the population, and then the reports are shared with the CDC.

According to the best estimates, there are between 10,000 and 15,000 adult deaths in the United States from RSV each year and about 150,000 RSV hospitalizations, Falsey said.

A 2015 study of older adults in industrialized countries said the disease burden of RSV is “substantial” and estimated that about 14.5% of the 1.5 million adults who contracted RSV were admitted to hospital. People 65 and older were more likely to be hospitalized than those 50 to 64.

“When we compare it to influenza A, it’s not far behind,” Falsey said, referring to one of the seasonal flu strains often associated with more serious illness.

RSV appears in adults the same way it does in children. It can resemble a common cold and include a runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. Symptoms usually last one to two weeks and go away with rest and fluids.

But in some adults, RSV can become dangerous because it can cause dehydration, difficulty breathing, and more serious illnesses, such as pneumonia and bronchiolitis, inflammation of the tiny airways in the lungs.

Adults who are most at risk for serious outcomes with RSV are those over the age of 65. The virus can spread quickly through a nursing home or long-term care facility, just like Covid-19 and the flu.

Adults with weakened immune systems should exercise caution in RSV season. This can include people undergoing cancer treatment, transplant patients, people with HIV, and those taking certain medications that suppress the immune system for conditions such as Crohn’s disease, lupus, or rheumatoid arthritis.

Adults with chronic heart or lung disease such as asthma, COPD, or heart failure are also more likely to need to go to the hospital if they contract RSV.

An infected person can transmit RSV through coughing or sneezing. If respiratory droplets land on a surface like a doorknob or desk and someone else touches them and then touches their face, they can get sick.

It is also spread because healthy adults often don’t know they have it. It usually doesn’t cause fatigue like the flu or covid, which is why many adults go to work or get on a plane or bus, attributing their symptoms to allergies. As they interact with others, it spreads further.

RSV can also be easily transmitted from children to adults.

If you’ve been coughing or have any other RSV-like symptoms and you’re in a high-risk category, you should see your doctor to get it checked out, says Dr. Daphne-Dominique Villanueva.

“We can’t test everyone right now, in an ideal world we would want to do that, but we want to focus on vulnerable people,” Villanueva said, an assistant professor at West Virginia University School of Medicine who has written studies on RSV.

Doctor’s offices have swab tests that can determine if an illness is flu, RSV, or Covid.

There are specific antivirals for flu and Covid-19 but not for RSV. The trick is to get tested early, even to rule out RSV; starting covid or flu antivirals right away can shorten the time you’re sick and prevent the virus from progressing to something more serious.

With RSV, the treatment is what is called supportive care: Drink plenty of fluids. Really rest. Stay at home so as not to spread it. Wear a mask around other people in your home.

If you start to gasp and become short of breath, Falsey said, those would be clear signs that you need to see a doctor or maybe even get to an emergency room quickly. At the hospital, they may give you supplemental oxygen if needed.

There is no protection from a vaccine for RSV, but that could change for next season. In the US, there are four RSV vaccines that may be about to be reviewed by the FDA, and more than a dozen are in testing. Some are designed to protect babies, and others are being tested in older adults.

“Since we have very limited ways to treat it effectively, you have to do everything you can to avoid getting it in the first place,” Villanueva said.

The protective measures for this busy RSV season will sound familiar: wash your hands often, sanitize surfaces, and wear a mask in crowded spaces.

“You might want to put off that visit for a week to see your grandkids, or you might want to wear a mask if you’re going somewhere crowded,” Falsey said. “Masks and hand washing work. I know people are over it, but if you’re frail or know you have underlying medical conditions, when we know RSV is rising, you need to do those things and be careful around children who are actively sick. Everything helps.”