Around Virginia, respiratory illnesses surge among children

VCU Emergency hospital entrance in Richmond, Va. Parker Michels-Boyce for The Virginia Mercury

Hospitals statewide are seeing an uptick in respiratory illnesses, especially among young children. Some pediatric units are full or close to full weeks before the typical season when flu and other respiratory viruses surge.

“The thing that is surprising to all of us is the early onslaught and ferocity of this year’s respiratory season,” said Dr. Shari Barkin, physician-in-chief for the Children’s Hospital of Richmond at Virginia Commonwealth University and chair of the Department of Pediatrics for VCU School of Medicine.

In regions as far apart as Richmond, Northern Virginia, Hampton Roads, and Southwest Virginia, doctors and hospital officials say flu, flu-like illnesses, and a common respiratory syncytial virus (RSV) are rising among children.

Barkin said that flu and RSV cases typically see a significant rise in December and January. But this year, “instead, from September to October, we saw a fourfold jump in RSV, and we’re also seeing kids that are getting much sicker than in the past with RSV,” with flu also appearing in higher than usual numbers.

Surges in respiratory illnesses can be seen nationwide this autumn, as the ever-mutating influenza virus appears poised to be particularly severe and communities face what researchers call an “immunity gap” — a lag in acquired immunity to viruses circulating in the population due to two and a half years of heightened isolation during the COVID-19 pandemic.

“As a population right now, we are a couple of years behind having any type of influenza immunity,” said Lisa Sollot, respiratory disease coordinator at the Virginia Department of Health. “Our immune systems haven’t seen that virus now in a couple of years.”

In an update sent to Virginia clinicians Oct. 21, State Health Commissioner Dr. Colin Greene reported that emergency department and urgent care visits by people diagnosed with RSV had quadrupled since early September and were continuing to increase rapidly. Emergency and urgent care visits were also higher compared to the past five years. 

ED and urgent care visits that include RSV in the discharge diagnosis. (Virginia Department of Health)

“We typically have seen RSV seasonally in years past,” said Seth Brown, chief medical officer for Ballad Health Niswonger Children’s Network, a regional health system that covers Southwest Virginia and east Tennessee. “However, I’ve never seen it this early in my career, number one. Number two, I’ve never seen quite the severity in terms of children requiring respiratory support and even ventilator support.”

Children “are in the (intensive care unit) for days, multiple days, much longer than what we would anticipate and much longer than we have seen historically,” he said.

Some young patients are also coming in suffering from multiple viruses — not just RSV, but also rhinovirus, croup, and similar ailments said Dr. Samuel Deel, a pediatrician with Ballad Health Medical Associates.

“When they have two or three different viruses, it’s an added effect,” he said.

Pressure on hospitals

While most children who contract flu, RSV, or another respiratory virus will be able to recover at home without incident, rising case numbers are already putting pressure on many hospitals.

Niswonger Children’s Hospital’s pediatric ICU has been full for several weeks, prompting Ballad to expand the unit into other areas of the hospital. The Children’s Hospital of Richmond has been operating at greater than 95% capacity for several weeks and has, on occasion, been full. Inova Fairfax’s children’s hospital in Northern Virginia told The Washington Post earlier this month that it was operating at capacity. And Children’s Hospital of the King’s Daughters, which operates throughout Hampton Roads and as far north as the Middle Peninsula, is “seeing an increase in visits related to respiratory illnesses, including the flu and RSV, at our pediatric practices, urgent care centers, emergency department, and our main hospital,” said Dr. Laura Sass, the medical director of infection prevention and control.

“We are very busy, but we have been able to handle the volume, and we’re continuing to monitor the trajectory of the surge,” she said.

Whether the surges are occurring uniformly around Virginia or are hitting some areas particularly hard isn’t yet clear. Julian Walker, vice president of communications for the Virginia Hospital and Healthcare Association, said the organization is gathering data from its 25 member health systems covering 110 hospitals in Virginia.

“We certainly are aware that several of our members in Northern Virginia and Richmond and Charlottesville have publicly expressed that they’ve seen an influx of pediatric patients with respiratory problems,” he said. “It is our hope that in the coming days, we will have statewide data that has been validated that will give us a clearer picture of the extent of this current public health situation.”

Illnesses may also be impacting certain groups harder than others: Greene’s Oct. 21 clinician letter noted that the U.S. Centers for Disease Control and Prevention had “consistently observed” racial and ethnic disparities in influenza-associated hospitalizations. Over the past 13 years, the CDC found that hospitalization rates for Black, American Indian, Alaska Native, and Hispanic adults were, on average, 1.2 to 1.8 times higher than those for white adults.

Getting data on RSV, which is a common and routine illness for most children, may prove especially challenging. While doctors in Virginia are required to report cases of flu and COVID-19 to the health department, no such requirement exists for RSV, and not all clinics carry tests for it. Adding the virus to the list of reportable illnesses would require legislation, said Sollot, with the state health department.

‘Do not kiss my baby’

Doctors offered several explanations for why respiratory illnesses are hitting communities, and especially children, so hard this year.

Flu season, all noted, does tend to be unpredictable.

“The flu mutates faster than our immune systems can keep up with it,” said Sollot.

Flu vaccination in Virginia has also been lower for younger age groups this year than in previous years, according to the Virginia Department of Health. Fewer than 15% of 6-month- to 4-year-olds have gotten a flu vaccine this year, compared to just under 20% in 2019. 

Virginia Immunization Information System data show lower flu vaccination, especially among younger people, this year compared to the prior three years. (Virginia Department of Health)

Long periods of isolation since the COVID-19 pandemic emerged in Virginia in March 2020 also mean that many young children have not built up immunity to many viruses. Many have never been exposed directly to illnesses like flu or RSV, which declined precipitously during the pandemic due to social distancing, widespread masking, and more vigilant handwashing. Last year, Barkin said cases of common respiratory illnesses like RSV dropped 98% due to masking and social distancing.

Furthermore, said Deel, because many adults also haven’t been exposed to the most recent strains of respiratory viruses, mothers may not have immunity to pass on to infants.

Babies “rely on antibodies passed from moms through the breastmilk or the placenta,” he said. “And moms haven’t been exposed to RSV.”

Those immunity gaps are now colliding with declines in preventative measures like masking in crowded areas, extra handwashing, and staying out of school or work by people who are sick.

Medical professionals say those steps are needed to help combat rising respiratory cases and protect particularly vulnerable members of the population, including very young children, the elderly, and those suffering from conditions such as cancer, asthma, and black lung.

“I think everybody needs a big old sign that says: ‘Do not kiss my baby,’” said Deel.

Both doctors and health officials also say up-to-date vaccinations for flu and COVID are critical, particularly because hospitals are seeing patients infected with multiple viruses.

“Your other vaccinations are very important here,” said Brown, noting that a patient can contract COVID, flu, and RSV. While there’s no vaccination for RSV, “if I had all three of those infections, I’d love to be protected from two,” he added.

“It’s everybody’s responsibility to keep our kids well,” said Barkin. “Anything we can do right now to reduce the burden on kids, their families, and hospitals, we should do.”