What you need to know about RSV, the flu and virus myths
For the third winter in a row, we are facing the very real threat of our emergency departments and hospitals becoming overwhelmed. This year, however, things look a bit different, as the main virus behind this threat is not COVID-19 but rather RSV and the flu.
The first salvo was fired by the rapid increase in cases of respiratory syncytial virus (RSV) and other viral respiratory infections in children. On Monday, Southern California’s Orange County declared a state of emergency due to record numbers of pediatric hospitalizations.
Cases of influenza led by the Flu A (H3N2) strain have also increased faster than in previous years – and a full two months earlier than usual – particularly in the south and southeast states. (Fortunately, our quadrivalent flu vaccines this year do include this strain, and early data from Chile show an approximately 50% vaccine effectiveness against hospitalization.)
What you need to know this flu season
STD rates are surging.Are common myths to blame?
One popular explanation for the current rapid rate and high incidence of RSV and other viral respiratory infections is that children are paying an “immunity debt.” The theory is that three years of public health measures like social distancing, masking and school closures, enacted to protect them from COVID-19, significantly reduced their exposure to other common infections.
But this term is a bit misleading in that it assigns blame to public health measures that were established based on the knowledge of the virus at the time. And the “debt” implies that children’s immune systems are now weakened due to this lack of timely exposure.
In fact, what we are seeing is simply that children’s’ immune systems are naïve, or immature.
Why is RSV surging right now?
Infants born in 2020 or after did not experience their first season of RSV on a typical timeline. So now there are many children under 3 years of age all experiencing RSV and other viral infections for the first time at the same time. The extraordinary absence of RSV during the previous winters led to a high cohort of young children without natural immunity who are now all susceptible to infection as they returned to school and started re-socializing after public health measures were lifted.
The pandemic certainly interfered with and disrupted the natural timeline of exposure we had been used to. It will likely take years before it can correct, but we have to also consider the possibility of a new normal.
Another potential game-changer: Pfizer just announced that its bivalent RSV vaccine candidate showed 82% efficacy against severe lower respiratory illness in infants through the first 90 days of life. When likely approved by the end of this year, it will be the first RSV vaccine.
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The confusion over virus symptoms
As RSV, flu and other viruses surge, some people claim you can self-diagnose which virus you have based on your symptoms.
You can’t.
COVID, influenza, RSV and other respiratory viral infections all trigger similar symptoms, particularly in adults.
The best way to figure out which virus you have is to test. I recommend waiting 24 hours into symptoms before doing a home rapid antigen test to rule out COVID-19.
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Michael Daignault, MD, is a board-certified ER doctor in Los Angeles. He studied Global Health at Georgetown University and has a Medical Degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps Volunteer. Find him on Instagram @dr.daignault and Twitter @MichaelDaignau3
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