An Old Challenger Emerges: The Return of RSV Cases

It’s November and we’re in the thick of cold and flu season. We have been battling COVID over the last 2+ years, and we are now seeing a rise of viruses like influenza and respiratory syncytial virus (RSV). These viruses had seemingly milder seasons during previous COVID surges due to a number of behavioral changes, like mask wearing, social distancing, and more care to hand washing and sanitizing. Now with vaccines, communities are masking less and children are back in schools and daycares more regularly, which has given an opportunity for illnesses that were center stage during past winter months to surge.

How can you prevent RSV or reduce the risk of spreading RSV?

You can avoid RSV in many of the same ways you would prevent catching the flu or COVID:

• Hand washing/using hand sanitizer.

• Mask wearing is still quite protective. N95 or surgical masks are good options (rather than cloth masks).
  

• Covering your cough and sneezes by coughing/sneezing into your elbow or tissue.
  

• Avoid going to school or work when you have cold & flu symptoms like fever, cough, and body aches.
  

• Keeping children home from school if they are feeling ill or with symptoms.

How can Carbon Health help properly diagnose what virus a patient may have?

Test. Tests are often provided after clinical evaluation and deemed appropriate. This is a good opportunity to make use of Carbon Health’s multiplex cepheid machines, where available, to differentiate from COVID and flu, and confirm RSV. This testing is most important for high-risk patients:

• Infants younger than 6 months, premature infants, children younger than two with chronic lung disease or heart disease, immunosuppression, or neuromuscular disorders. 
  
  - It is important to remember that infants and young children with RSV infection may have runny nose and decreased appetite as the only symptoms initially, and cough usually develops one to three days later. Soon after the cough develops, sneezing, fever, and wheezing may occur. 
  
  - For very young infants, irritability, decreased activity, and/or breathing difficulty may be the only symptoms of infection.

• Older adults, especially those 65 years and older and adults with chronic lung or heart disease, weakened immune system, COPD, or severe asthma.

• Patients with respiratory complaints who share a home with the above high risk patient populations.

Recommendations for those who test positive for RSV?

The recommendation for managing mild cases of RSV is supportive care, with over-the-counter cough remedies and medications like Children’s Tylenol or Children’s Motrin, as well as humidifiers, hydration, and rest. 

RSV cases in patients who might be immunocompromised or experiencing more severe symptoms, like shortness of breath or difficulty breathing, should be seen in clinic or with their pediatrician. Some severe cases may need to be directed to the emergency room.

Outside of cases growing, let’s look at RSV demand via Google Trends data.

As referenced above, COVID threw-off seasonal RSV progression in 2020 due to so many families and people being isolated from each other. With that said, as families started getting back together and some schools started opening up last year (2021), RSV “interest” started coming back as indicated by Google users searching for RSV-related terms.

This year (2022) we’re seeing searches sky-rocket. To be sure, some of the large increase in searches is because many news outlets started reporting on cases of RSV increasing; but regardless, if search volume related to a clinical issue is up it is a good indication that the need or desire for testing is present. 

Children that are emerging from an era of lockdown are now being exposed in ways their immune systems might not have been challenged with in the past. Because of this, we are seeing cases of RSV earlier and will also see a rise in cases from recent years.

To compare how RSV Google search interest compares to Influenza (the flu) and the common cold, we pulled the Google trends chart below to show the growing interest relative to each other.

The above chart shows that while flu and the common cold have been gradually rising through October into early November, RSV begins to shoot up at a steeper rate around October 20th, with gradual interest increases going into November. Stunningly, RSV is now on par with the flu and the common cold, in terms of search demand/interest among U.S. browsers.