‘SC is drowning in RSV,’ says division chief of pediatric critical care at MUSC Children’s Health

A common virus that just about everyone gets multiple times is taking a heavy toll on some babies this year, filling intensive care units with tiny patients struggling to breathe. Elizabeth Mack, M.D., division chief of Pediatric Critical Care at MUSC Children’s Health, put it this way: “South Carolina is drowning in RSV.”

RSV stands for respiratory syncytial virus. “You and I get it as a common cold. But babies with any viral illness are more likely to struggle with it because their airways are smaller. It's hard to clear the secretions. They’re obligate nose breathers, meaning they mainly breathe through their noses. So when their noses are stopped up, it causes problems with their breathing,” Mack said.

 

“We've seen it manifest in multiple ways. Sometimes they stop breathing; sometimes they have trouble breathing. They're pulling with their bellies to breathe harder, head bobbing, grunting. The unfortunate thing is that there is a vaccine against RSV, but it's only available to babies with high-risk conditions. Vaccinations begin in October, but the surge hit early.”

She said scientists are working on a vaccine that a woman would get while pregnant to protect the baby. But for now, most babies face the virus unprotected.

So why is RSV so bad this year? “There have been a lot of theories on this. We had a bit of a reprieve during COVID when people were masked and isolating. So it seems like RSV is back with a vengeance. We don't know if this is related to immunity not being primed, and now that people are back around one another, if our immune systems are reacting differently to a stimulus because we haven't seen these stimuli as much in a couple of years. We know that masking and distancing protected children from all respiratory viruses, but that protection is mostly gone now,” Mack said.

Those stimuli include not only RSV but other viruses. That’s important to keep in mind because when a baby gets one virus and then contracts another one such as RSV, it’s harder for the infant to fight off the infection. “One virus comes in and wipes out the immune system, wipes out the cilia, the like little hairs in the respiratory tract. That sort wears you down, strips you down to the base model,” Mack said.

She said babies often get RSV from someone in the household. “It's common that the older sibling goes to day care, went to the store, went to a party, came home, had a runny nose and then the infant got really sick.”

 

That’s exactly what happened recently to 7-week-old Liam Robertson of Mount Pleasant, South Carolina. Read his father’s first-person account of a harrowing time in that family’s life, including seeing Liam in intensive care on a ventilator.

Mack said most, though not all, of the children hospitalized with RSV, like Liam, are less than 4 months old. It’s a time when they’re transitioning from using their mother’s immune system to developing their own.

She had some advice for parents. “The things families can do to try to either prevent infection or prevent spread throughout the house include covering your coughs and sneezes with something other than your hands, whether that be a tissue or your sleeve. And washing your hands for at least 20 seconds before you're making contact with another person,” she said.

“Regardless of whether you’re symptomatic or have been around anybody who's sick, when you're talking about a newborn, it’s a good idea just to wash your hands before interacting with the baby. If somebody's sick, avoid close contact, avoid sharing utensils or food. Frequently touched surfaces should be cleaned if somebody in the household is sick,” Mack said.

“If possible, try to get the newborn in a safer situation, whether that’s with grandparents or if that's with the one healthy adult or whatever. I know it's not always feasible. But regardless of what's going on in the house, if somebody is sick with some sort of contagious illness, it’s always good to get a newborn out of harm's way if possible.”

She also encouraged anyone 6 months old and up to get a flu shot and get fully vaccinated against COVID – ASAP. “I'm very nervous because I'm hearing from colleagues around this state and in neighboring states as well as Lowcountry pediatricians that influenza is surging. I'm worried that if people don't get their flu vaccines, we are going to be in a world of hurt.”

A bad flu season could mean more children end up in intensive care, stressing an already burdened system. “In past seasons I've said it's okay to wait till later October, or maybe even November so that it would last through the whole season. But this season, we are recommending earlier vaccination against the flu.”