You’ve probably had respiratory syncytial virus (RSV) at some point in your life. Just a few years ago, RSV was nothing much to worry about: a common virus that nearly all children are exposed to before the age of two, RSV presents as a mild cold in healthy people. Over the past few months, however, RSV has surged, and pediatric care units are at or over capacity in the United States. Cases in both children and adults are nearly three times what they would be in a normal season. This spread is worrisome, since the virus can be serious and even deadly for infants and the elderly. What has caused what The Atlantic has called “the worst pediatric-care crisis in decades”?
One reason is that children and adults have been less exposed to viruses over the past three years of mask-wearing and social distancing. Scientific American reports that “most kids encounter RSV some time in their first year and a half of life and develop some immunity as they recover…thanks to the social distancing and masking, a whole birth cohort of kids had never been exposed to RSV before.” As of early November, at least 75% of pediatric hospital beds in the United States are full. As we head into the winter, this has the potential to get worse, especially with COVID and the flu.
COVID cases have largely leveled off, but according to the CDC, the US is seeing the highest flu hospitalization rates in a decade for this time of year. People ages 65 and older have been hit the hardest, followed by young children. Massachusetts has not seen a large spike in influenza cases, but neighbor Connecticut and nearby New Jersey are experiencing high activity levels. With RSV cases on top of the flu and COVID, the US faces a “tripledemic” in the winter Healthcare professionals are considering what can be done.
Though there is no FDA-approved vaccine for RSV at the moment, there probably will be soon. Several pharmaceutical companies, such as Pfizer and GSK, have already begun RSV vaccine trials. Pfizer recently announced that their maternal RSV vaccine, given during pregnancy, was 82% effective at preventing severe RSV in babies through three months of age. Another Pfizer vaccine tested in older adults was 86% effective, and GSK’s trial vaccine was 83% effective in adults 60 and older. In an interview with Scientific American, virologist Barney Graham said he expects to see at least one RSV vaccine approved by the end of 2023.
There is more good news, which is that most RSV cases are mild and resolve within a few weeks. Nonetheless, if you are the parent of an infant or you have elderly relatives, you need to exercise caution. We all need to follow the usual public health measures this fall and winter. Washing your hands, staying home or avoiding contact with at-risk populations if you are ill, and vaccinating against COVID and the flu will be crucial for slowing the spread of illness and lowering its severity.
There is another contributing factor to the “pediatric-care crisis” that requires our attention. This is the shortage of healthcare workers that has resulted in longer wait times and the difficulty getting immediate access to care patients have had across the United States. In Massachusetts, hospitals have struggled to fill an estimated 19,000 job openings. According to a WBUR report, the pandemic “increased stress and burnout among health care workers, and many have left their jobs, retired early, or reduced their hours.” The staff that remain are overworked as a result. A cycle has emerged of a stressed healthcare system pushing healthcare workers to leave, which further stresses the healthcare system.
How well can US hospitals and healthcare facilities handle another crisis? A worst-case-scenario winter could see hospitals once again pushed to the breaking point. Alternatively, we could see a winter like 2021-2022, which was not as severe with regard to COVID and the flu as had been predicted. Even in this more positive scenario, the healthcare crisis will continue its long, slow progress. Consulting firm Mercer forecasts a shortage of more than 400,000 home health aides and 29,400 nurse practitioners, as well as shortages in the number of physicians and healthcare educators, by 2025.
The global market economy has linked us inextricably with the rest of the world. A consequence of globalization is an increased likelihood of pandemics, and we will no doubt see more COVID-like viruses and health crises in the future. We must be vigilant. We must also find a way to address to the healthcare crisis, so that once-mild illnesses like RSV or new viruses as yet undiscovered do not overwhelm us. This will require a degree of cooperation currently lacking in our own government or in international relations – which makes individual responsibility to follow public health measures all the more important.
