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While spring has officially begun, concerns about respiratory viruses are lingering longer than usual, with cases of respiratory syncytial virus (RSV) cropping up later than expected and a new COVID-19 variant spreading across much of the country.
The Centers for Disease Control and Prevention (CDC) said in a recent update that RSV had started later than expected throughout most of the U.S.
“This unusual timing means higher levels of RSV activity may continue into April in many regions. Emergency department visits and hospitalizations for RSV are highest among infants and children less than 4 years old,” the agency stated.
For most people, RSV cases will cause mild flu-like illness, but for young children and older adults, the disease can cause severe illness, leading to hospitalization that could involve being placed on a ventilator.
“Unlike some other viruses, you’re actually pretty contagious throughout your entire time with RSV. And so, if your kid is coughing and they’ve had RSV and they go to daycare, all of those kids are exposed. And so it is definitely one of those illnesses we worry about,” said Sarah Nosal, a physician and president of the American Academy of Family Physicians.
There currently are no treatments specifically indicated for RSV, though preventive treatments have been approved in recent years.
RSV vaccines are available to older adults and pregnant women, with administration to expectant mothers believed to confer some protection to their children before they are born. An RSV monoclonal antibody is also available for infants and young children.
Nosal noted this past respiratory viral season was also unique in how the flu behaved.
“Flu sort of had two spikes this year in that we had an early flu A,” she said. “We had what we predicted, and then had a late flu B as well, where we had lots of patients. And I saw those patients in the last month or so who were still getting this tail end of influenza B.”
The strain that circulated later in the season was dubbed a “super flu” in the media. However, physicians emphasized that it was just another strain of the influenza virus, one that presented with somewhat more severe symptoms and appeared to evade immune protection more effectively.
As states deal with a late RSV season, more are also detecting cases of the so-called “cicada” variant of COVID-19, with 25 now reporting the strain. According to the CDC, COVID-19 activity remains low, but some aspects of this strain are of concern.
“This ‘cicada’ variant has had more mutations in the spike protein, which makes it a bit more different. It’s a more distant cousin, and therefore it’s able to evade some of the protection that we’ve had from prior infections and from prior vaccinations. So, it’s finding a place out there and being able to spread,” said William Schaffner, professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine.
“Fortunately, it’s not more severe,” he added. “It’s likely to be a variant that is included the next time the covid vaccine is updated.”
Nosal added that the extra mutations observed in the cicada variant, while likely giving it more of an ability to evade the immune system, also indicate it’s ultimately less able to cause infection.
“The actual mutations don’t match as well to like human cellular morphology. It doesn’t kind of match and infect ourselves as easily,” she said.
Schaffner lamented that this past season was affected by the mass layoffs at the CDC carried out by the Department of Government Efficiency.
A study published this year found that among the nearly 40 CDC databases that were no longer being updated, 87 percent were vaccine-related. Among the remaining stagnant databases, four out of five pertained to respiratory diseases.
While respiratory viruses from the winter continue to circulate, springtime allergies are also beginning to hit people, which could play a role in how individuals are affected by lingering viruses.
“There are research studies that show just being exposed to pollen and other allergens, even if you personally don’t get allergy symptoms, increases your inflammation in your mucosal membranes and makes you more vulnerable to viral illnesses,” Nosal said.
She noted many people are prone to dismissing respiratory virus symptoms for allergies during this time of year and advised that they still test themselves if they’re feeling unwell.
Due to the late RSV season, many state and local health departments have extended their RSV seasons and the immunization window for children, at least until the end of April. Schaffner advised that parents consider these options despite it being past the typical respiratory viral season.
“RSV continues to be the leading cause of hospitalization in young infants, so being able to prevent that is very important,” Schaffner said. “And since the RSV season is extending, the recommendations have been to pediatricians and parents to still consider even though it’s kind of late in the season.”
Schaffner and Nosal said planning for each respiratory viral season is essential to better outcomes for people.
“For my chronically ill patients, I’m going to see them in three months. So I’m going to start seeing them again as we start to think about starting vaccination for the fall,” Nosal said.