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RSV: What parents need to know about the surge of this airway infection · 20-Minute Health Talk

• 0:04
  We've gone through other types of infectious processes, but
• 0:08
  you know, to have so many children, particularly concentrated at a
• 0:13
  very young age to become so acutely, ill, almost at the
• 0:19
  same time; and I've been practicing for decades.
• 0:22
  It's been unprecedented.
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  Hello, and welcome to 20-Minute Health Talk
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  I'm Sandra Lindsay, today we speak with
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  Dr. Josh Rocker
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  and Margaret Duffy about the unprecedented surge of RSV cases
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  hitting hospitals across the U.S. as well as other winter viruses
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  Dr. Josh Rocker is the chief of pediatric emergency medicine at
• 0:55
  Cohen Children's Medical Center.
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  Dr. Duffy serves as the chief nursing officer
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  At Cohen Children's Medical Center.
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  Doctors Rocker and Duffy welcome.
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  Dr. Rocker: Thank you.
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  Dr. Duffy: Thank you for having us today
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  Host: In normal years RSV, sends thousands of children to the hospital over fall and winter
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  but for a second year, in a row cases of spiked early and leading to surges
• 1:27
  of the common respiratory virus across the u.s.
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  So, Peg typically RSV peaks in January and February.
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  Why are we seeing this increase in the number of cases and
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  hospitalizations now?
• 1:44
  Dr. Duff: Sandra, that's a great question, and we're not 100% sure what is causing
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  this sudden surge in RSV but most likely it is due to what happened
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  during covid.
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  So, as everyone recalls during covid
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  We all went into lockdown schools were closed.
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  Children were really pretty much sequestered at home, so many of those
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  younger children
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  school-age children have had the past two years where they really
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  have not had the exposure that children normally do during childhood,
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  to have the chance to get these viruses, and to develop the
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  immunity.
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  So as we've emerged from the covid pandemic, and now we're in an
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  endemic phase masks are coming off.
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  We're just so happy to have socialization again.
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  Going to see our loved ones, our family.
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  Taking trips.
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  Many of the transportation hubs are not requiring mask.
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  So basically with masks off we are seeing just a resurgence in it.
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  The other interesting feature to it is that we've seemed to have lost
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  some seasonality.
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  We were seeing respiratory illnesses in July that we would normally
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  see around the holidays.
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  We believe that that's what's causing this, along with that flu.
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  So, we, I'm, we're going to make on behalf of
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  Dr. Rocker and myself a shameless plug for that flu vaccine.
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  So flu is very much, you know, we see in other areas of the world, our
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  conversion from moving out of RSV to flu and we are seeing our
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  share, our fair share of flu illnesses as well.
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  So get your flu vaccine.
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  Host: I'm also going to make a shameless plug for the covid vaccine and the
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  covid boosters as well, Peg.
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  So thank you for that.
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  So, Dr. Rocker.
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  Can you explain
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  what our listeners should know about RSV.
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  Dr. Rocker: So RSV stands for respiratory syncytial virus, it is a virus
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  we commonly see every fall and winter. For children above the age of 2,
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  it generally causes a cold. Adults get it as well.
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  And it cold causes a cold, congestion runny nose, plus, or minus
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  fever.
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  But in children under the age of 2 and more specifically under the
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  age of 1, they get something called bronchiolitis.
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  And bronchiolitis is different than bronchitis.
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  Bronchitis is when you get mucus and the bronchi and that's when
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  you're coughing up, you know, loogies, you know, and green mucus, but
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  bronchiolitis is lower down, it's in the lungs.
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  And so what these children get is they get fever often, cough
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  congestion.
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  But then they get the wheezing.
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  They have difficulty breathing as well.
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  Not everyone, but it is frequent.
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  So bronchiolitis is
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  Different than just a regular upper respiratory tract infection.
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  It's something that involves the lower respiratory tract as well, and
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  these kids can get sick.
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  So it's very important for people to realize because there's a lot of,
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  you know, messaging in the news about RSV.
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  And then the hospital's, this is a completely different entity than
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  covid. RSV is extremely common.
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  Yes, is making kids sick but it
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  does not carry with it, the same
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  Mortality or anything close to covid.
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  Host: So those symptoms must be very scary for children and their parents
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  Dr. Rocker: 100%.
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  When someone is breathing hard
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  yes, that's very nerve-wracking to watch, and it's challenging for the
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  kids. And the way I describe it, is it looks like you're running a race,
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  but you're not running a race.
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  So you're pulling, you know, your lungs.
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  These are saying I need help getting air in, in the usual muscles
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  that work to get air in
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  It's usually just the diaphragm up and down, but that work isn't
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  sufficient because there is inflammation inside the lungs.
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  And so you have to recruit other muscles to help.
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  So if you're doing that, but there's no reason for you to be exerting
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  yourself
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  then that's because the lungs are having difficulty or a little bit to inflamed,
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  Host: How is RSV transmitted?
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  Dr. Rocker: So, I think we learned a lot during covid.
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  I think we all became, you know, virologist, and epidemiologist and
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  learned how things got transmitted.
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  We talk about airborne and, you know, tuberculosis, you know, measles
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  is Airborne and that's just in the air and it floats.
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  That is not RSV.
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  There's respiratory droplets, which kind of land on the ground.
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  And then there's contact transfer and RSV is mostly contact
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  transfer.
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  But a little
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  bit of respiratory droplet as well.
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  But it's basically it's on the countertop.
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  It's not a toy, it sounds something it's on the doorknob and you know,
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  children the way they interact with the world, they love to touch
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  things, they'll have to put things in their
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  mouth and so if you're in day care or if your older sibling, you know,
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  is in daycare and gets RSV, you know, and then comes home and they
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  sneezing and touching things.
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  That's how the child is going to get it as well.
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  Dr. Duffy: Sandra, that's a really good message to the folks who are listening today.
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  In terms of minimizing the potential for spread for RSV in the
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  respiratory viruses, hygiene practices are so important.
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  We do a lot of education with parents and caregivers around hand hygiene
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  What we all learned in kindergarten washing
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  your hands is so important.
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  So making sure when you children come home from school or they come
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  home from the playground or when they're out with their friends
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  making sure that they are washing their hands, not touching their face and
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  minimizing that.
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  And if that happens then doing this simple hand hygiene, we all get
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  concerned here at the hospital as we go into holiday season.
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  We're looking forward to spending our time, with our friends and
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  family, you know.
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  We there's so much burnout from covid that you really want to have
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  those warm family, gatherings, as we look forward to Thanksgiving, and
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  then the December holidays, but we really encourage families.
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  Particularly those, with the very young infants, under two months of
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  age to really think about who's being exposed to the very young and
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  the Very Old, the opposite ends of the spectrum, are those individuals
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  at risk.
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  So as much as we want to be together, I think the message is to try to
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  be smart and to protect particularly those, those young infants.
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  Host: It also sounds like it would be beneficial to just have a routine of
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  wiping down or surfaces as well.
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  Dr. Rocker: Yeah, I think that definitely makes sense.
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  And one thing about the hand hygiene that we talked about, we say
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  washing hands, but the most important because I think a lot of times
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  people put the soap in the palm of their hand, rub their palms
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  together, and then wash it off.
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  But it's the fingers that come to our noses, come to our mouths, come
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  to our eyes.
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  So, it's actually washing fingers that are the most important part
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  of the hands.
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  Host: What are some supportive
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  kind of therapies that you're using?
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  Dr. Rocker: That's a term, that's used a lot.
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  We don't have any treatments
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  but we give you supportive care, and I just want to clarify
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  what that means.
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  So treatments, stop the virus, kill the virus, we don't have that.
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  But supportive care is, if your oxygen is low, I'll give you oxygen.
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  If you're dehydrated I'll give you fluids if your lungs are working so hard
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  I could put you on machines that make breathing easier for you.
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  So we support you
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  nd your body until the virus goes away and you recover.
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  So if there's really poor feeding, difficulty breathing, we definitely
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  want to see those children, but if it's fever and otherwise they seem
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  to be doing well, that's certainly something
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  That we could follow with your pediatrician, but there's
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  not necessarily the urgency to come to the emergency department,
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  unless you're, you know, below, a certain age, if you're below 2 months
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  and you have a fever, you do, once you in the emergency department,
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  Host: So, how do you make the diagnosis?
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  So the diagnosis of RSV specifically RSV is a respiratory viral swab
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  that we do and then it will tell us if it's RSV.
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  However, I don't want the audience to think that RSV is the only virus
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  that causes bronchiolitis.
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  Bronchiolitis can be caused by a bunch of other viruses, but right
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  now, the large majority of the children that we're seeing with chronic
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  bronchiolitis, are, in fact, RSV
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  Host: So, who is most at risk for severe RSV?
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  Dr. Rocker: So, great question, those who are most at risk, as we
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  mentioned, where those, under the age of 1 specifically, even
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  younger and then premature babies as well are at higher risk.
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  We are seeing some older kids who may have complex medical conditions
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  who are a little bit more fragile when they get
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  RSV, it may be more challenging for them, but it's really the younger
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  kids that were most concerned about.
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  Host: As an adult, should I be concerned about RSV, generally?
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  Dr. Rocker: No, but as an adult who has children or has children who has
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  children, that's something that you should be a little bit thoughtful of
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  And I mean, I just want to stress one thing.
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  You know, we're busy.
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  We have never seen higher numbers in our emergency department ever.
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  And I'm saying, you know, by 50% more than extremely busy times.
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  So in regards to the public health message to the adult, it's be
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  thoughtful about the children because we're in a crisis right now.
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  Host: So when did we really start to see RSV hit this year?
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  Dr. Rocker: I would say
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  four weeks ago is trickling in and then three weeks, it really
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  started taking off. December, is kind of, when traditionally flu comes
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  in a little bit more with a Vengeance.
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  We're expecting even higher numbers then.
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  So RSV tends to be a little bit of a hump, not a big spike.
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  So we anticipate RSV to still be around well into December and Jenny,
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  And we know it's going to be overlapping with flu at that point as well
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  Host: So Dr. Rocker, do you think the high number of infections you're seeing will
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  be a one-time event or a new normal? Is the pattern of the virus
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  changing?
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  Dr. Rocker: We're not certain.
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  We know as Peg mentioned last year was different than this year, this
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  year is a little bit closer to normal, but definitely abnormal and I
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  think we suspect that we will Trend back to the old ways just because
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  the logic with
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  Covid, is that we weren't socializing?
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  And now we are socializing. Covid didn't change viruses.
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  So I suspect strongly suspect that next year.
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  Barring any other, you know, social bizarre phenomenon, that will
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  probably be back on par.
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  Host: Peg and Dr. Rocker
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  Have you seen anything like this in your practice before?
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  Dr. Duffy: No, not at all.
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  You know, we've gone through H1N1, we've gone through, you know, other
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  types of infectious processes.
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  But, you know, to have so many children, particularly concentrated at
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  the very young to become.
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  So, acutely, ill and almost, you know, almost the same time and, you
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  know, sometimes we describe it as a tsunami and it comes in waves, you
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  know, we might have maybe 12 hours where the volume is a little,
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  bit less, which actually we say you know we take a breath and we say
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  well that you know 12-hour volumes
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  hat's not so bad.
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  That would have been a busy day
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  2 years ago, right?
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  So so everything is relative but to be honest now this is something
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  I've been practicing for decades, it's been
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  unprecedented.
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  Dr. Rocker: Yeah, I mean I remember when we set up flu pods in the 2018-2019 flu
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  season and flu that was really much more an outpatient.
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  burden where we had so many patients coming in who are
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  concerned.
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  And, you know, they generally were fine and they're saying with H1N1,
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  The Atrium of the Children's Hospital basically became you know, a
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  testing center and Urgi-center, but it didn't impact the, the
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  admissions nearly as much as this is right now
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  To Peg's point
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  I have never seen us borrow space from the adult side and we just
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  Really needed it.
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  When we were
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  received it
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  So it's a different entity than we've seen in the past.
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  Host: Can you talk to us a little bit about your strategies to manage the
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  volume?
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  Dr. Duffy: So last year, we did quite a bit of planning predicting almost what
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  you can't predict, but seeing that we had lost some seasonality as a
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  leadership team.
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  We came together and said how can we if this comes and in a wave that
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  that may be unexpected, how can we be ready for it?
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  So we had hired up.
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  We looked at all of our alternative spaces.
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  We looked at our surge plans and said, how can we become more flexible
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  and Nimble?
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  So what we've ended up doing is having a lot of satellite spaces.
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  We borrowed a unit from our LIJ Medical Center friends.
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  They've been very gracious we've repurposed areas here within Cohen's
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  for the Emergency Department.
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  We've had to step up, we've been doing this for months now so that we
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  are positioning ourselves.
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  Selves to provide that quality care that we are known for and
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  but it's been challenging.
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  It's been very challenging and as we see the severity of
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  illness go up it is a challenging concern
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  Host: Dr. Rocker, what role does
• 16:18
  covid and influenza play in this RSV surge?
• 16:23
  Dr. Rocker: Covid hasn't left us.It is a smoldering virus that is there.
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  We still have patients who are admitted with covid.
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  It is certainly not overwhelming our numbers but it's a presence and
• 16:38
  influenza currently is on the rise.
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  We're definitely seeing it in some patients.
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  I expected to be a much more significant thing in the weeks to come
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  Host: Dr. Rocker, what can parents do to keep their children out of the hospital to
• 16:56
  prevent their kids from getting RSV?
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  Dr. Rocker: So with kids going to school, it's hard to prevent RSV, you know,
• 17:07
  transmitting in the community and you know, we're happy that kids are
• 17:11
  in school and we're happy that kids are without masks and we're happy
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  that they're developing normally in an appropriate environment.
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  And it's not just kids, it's specifically the young kids, right?
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  The ones that are being hospitalized are the ones that are you know,
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  No, the newborns the, you know, under one year of age, so be more
• 17:33
  cautious with those kids and, you know, for those siblings, you know,
• 17:39
  in a household who have a child who is, you know, less than one year
• 17:42
  of age, they may have a common cold.
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  They may come in with, you know, a runny nose congestion.
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  Maybe that's where you should do a little distance thing in the house,
• 17:50
  you know, wash the counters, a little bit more.
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  Host: I couldn't end this podcast without asking how are you and the team
• 17:58
  coping with the search?
• 18:03
  Dr. Duffy: So, one thing that we do.
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  Well, here is really support each other.
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  We have an incredible support system on each unit.
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  They really are a family here and I'm really proud.
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  We've had people who've come here for short stints and they decide to
• 18:19
  work here, because the team is just really incredible.
• 18:24
  We have holistic nurses, who help support our team members on the
• 18:28
  front lines through
• 18:30
  Reiki sessions, they go to the units, we have a system called tTeam
• 18:34
  Lavender, where we've got specially trained individuals who will go to
• 18:38
  the units to help support, particularly if there's a really
• 18:42
  challenging case.
• 18:43
  And ethical issue, a death of a child to really support that team
• 18:47
  through that event, whether it's an emergency department, or on the
• 18:50
  inpatient units. Our chaplains
• 18:52
  here are just really incredible.
• 18:54
  So there's lots of communication among our team both at the senior
• 18:59
  level,
• 19:00
  Well, as our throughout our leadership level down to, you know, down
• 19:04
  to our Frontline team members and throughout all of our disciplines.
• 19:10
  Dr. Rocker: Yeah.
• 19:10
  To just reiterate what Peg is saying
• 19:13
  I think the heart in this institution is big and it's big because
• 19:19
  we're caring for vulnerable children.
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  But it's big because people just like working with whom they work
• 19:25
  with.
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  And so I just completely agree with what Peg is saying.
• 19:29
  So there's a lot of camaraderie after shifts.
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  There's a lot of, you know, like oh my gosh, you know, feelings and
• 19:37
  there's lots of text messages and, you know, you're sharing of stories
• 19:41
  and that's what gets you through the day, is the relationship is the
• 19:44
  camaraderie, and knowing that your team has your back.
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  And I think, you know, our team feels that way.
• 19:50
  Host: And I felt that camaraderie and teamwork and you know, it was so
• 19:56
  palpable when I visited and toured some of the
• 20:00
  The units with Peg
• 20:01
  Absolutely.
• 20:04
  Drs. Rocker and Duffy.
• 20:06
  Thanks so much for joining us on 20-Minute Health Talk
• 20:10
  IAnd to you the listener
• 20:13
  thanks for tuning in.
• 20:14
  I'm Sandra Lindsay
• 20:15
  Have a great day and be safe.
• 20:24
  Get more expert Insight from the leading voices in healthcare today.
• 20:30
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