RSV Resurges as COVID Pandemic Precautions Recede

An early season surge of RSV and other respiratory illnesses requiring children to be hospitalized at historically high rates has been attributed, in part, to the withdrawal of precautions against COVID-19 which had reduced exposure to, as well as immune recognition of other respiratory viruses.

The circumstance is described in an analysis in JAMA as an "immunity debt," incurred during the period of protective measures such as masking and social distancing which had protected many children.

"But this year, as in-person gatherings and travel increased and kids went back to school and daycare without masks, the virus has ripped through a large pediatric population with little to no immunity," the analysis recounts.

In a separate assessment of this pattern across the globe, Thomas Williams, MB BChir, MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK, and colleagues assert that the timing of such a "delayed" peak could be anticipated.

"For countries that have experienced an entire year without RSV or influenza, mathematical modeling suggests the possibility of a hard rebound marked by increased morbidity and mortality from one or both viruses in the winter of 2021/22," Williams and colleagues wrote in an article published last July.

Although possibly foreseeable, the magnitude and severity of the surge has quickly challenged the capacity of children's hospitals and pediatric offices in the US.

On November 14, a letter to President Biden and Xavier Becerra, Secretary of the Department of Health and Human Services, sent jointly from the executive officers of the Children's Hospital Association and the American Academy of Pediatrics, called for declarations of both a national emergency and a public health emergency.

"The pediatric health care system is doing all it can to meet these overwhelming needs across the continuum of care and taking regional approaches to meet the growing demands. We need emergency funding support and flexibilities along the same lines of what was provided to respond to COVID surges," wrote Mark Wietecha, CEO, Children's Hospital Association, and Mark Del Monte, JD, CEO/executive vice president, American Academy of Pediatrics (AAP).

Declaring both types of emergencies would, according to Wietecha and Del Monte, allow waiver of certain requirements of the Medicare, Medicaid, or Children's Health Insurance Program (CHIP), and of the Emergency Medical Treatment and Labor Act, which could facilitate sharing of resources. Among the anticipated measures would be increased transferring of patients and creating off-site triage to manage capacity challenges; and licensure reciprocity to support cross state care and telehealth.

In their letter, Wietecha and Del Monte relate that more than three-quarters of pediatric hospital beds are full, and that many states are reporting that 90 percent of their pediatric beds are occupied. They point to ongoing attempts to care for this population in community care centers and at adult hospitals, which have limited or no capacity to care for children.

In a press release corresponding to the joint letter, Wietecha warned, "Our system is stretched to its limit and without immediate attention the crisis will only worsen."

In a CDC briefing on November 4, José Romero, MD, Assistant Secretary for Preparedness and Response, commented that vaccination is the best defense in preventing influenza and COVID-19. While vaccines appear to be on the near horizon for RSV, non-pharmaceutical measures remain important for reducing exposure to, and transmission of these respiratory viruses.

"People should also practice everyday preventive measures such as cough hygiene, or etiquette that is covering your coughs and sneezes, staying away from individuals who are ill, and frequent hand washing or using alcohol gels," Romero encouraged. "People may also choose to wear a well-fitting mask as an added precaution."