Season 5 | Episode 3

Title: RSV Myths and Misconceptions

Opening Audio Hospitals are seeing an unprecedented surge in a respiratory illness among children. This is really frightening. RSV is a common cold virus that can be associated with severe disease in young children and older adults. And the CDC says it's already hitting peak levels in some areas.

Joe McIntyre, Host: Welcome to the fifth season of the Merck Manuals Medical Myths podcast. On this show, we set the record straight on today's most talked about medical topics and questions. I'm your host Joe McIntyre. On this episode, we welcome Dr. Brenda Tesini of the University of Rochester Medical Center. Dr. Tesini’s clinical interests include all aspects of infectious diseases and children with a particular focus on prevention and treatment. Today we will diagnose the myths and misconceptions surrounding RSV. Dr. Tesini, thank you for joining us.

Brenda L. Tesini, M.D.: Thanks for having me. I'm really excited.

Host: Great. First, can you tell our listeners what RSV stands for and why we're hearing so much about it right now?

Brenda L. Tesini, M.D.: It stands for respiratory syncytial virus. So, you understand why we call it by its initials, RSV, even those of us in the medical field, and that the name relates to how it looks and behaves in the lab. But we're hearing a lot about it now, in the context of having RSV in our in our communities. At the same time, we also have influenza that causes flu, and the virus that causes COVID. And so, seeing all of those at the same time, understandably, caused a lot of interest to know what's going on and how that impacts our children and our healthcare systems.

Host: What are some of the symptoms of RSV? And how exactly does it spread?

Dr. Tesini: RSV, in most of us, would cause one of our common colds, and we probably wouldn't be able to really pull it out from any of our other colds. And everyone gets RSV. Pretty much everyone gets it in the first couple of years of life, and we will continue to get it throughout life. Where it really gets pulled out as maybe causing something a little more unique or a little more concerning is most notably in young infants. In their first year of life, particularly babies that are less than six months of age, it can cause an infection that gets deeper into their low, little airways that go right to the lungs. And some people may have heard the term bronchiolitis and that is almost like pneumonia. It's infection and inflammation and irritation of those little airways. That's what RSV is probably most known for is causing that in young infants usually less than two years of age. And in those babies, it can cause wheezing, really fast breathing, hard time breathing, and look much more like pneumonia than just a cold.

Host: Is it like a traditional cold where we typically get them in the colder months or is RSV kind of happening and children, infants are susceptible to it all throughout the year?

Dr. Tesini: Before COVID, we used to have what we call “RSV season” that your pediatricians or other child health care providers would know it is RSV season, it is RSV time. In most of the US, that would be in the fall and the winter, usually would happen a little bit before we think of flu season. But all of the changes we did to prevent the spread of COVID was actually very effective at preventing the spread of RSV during that time. And it's kind of turning the seasons around for us. I think that's also a lot of what we're hearing now about RSV is that it's popping up in the summer, in times that we wouldn't have thought that people need to worry about. So, it probably will end up going back to that seasonality again, but it's really turned around a little bit these last couple of years.

Host: You mentioned that it's not a new virus. But is it because we were so effective at curtailing a lot of viruses during COVID prevention that now that it's increased there's so much more conversation around it?

Dr. Tesini: Exactly. So, there's a lot of conversation about, “Huh, you know, we've known about this virus since the 1950s.” And it always behaved the same way every year and so this is no different for us and it really is quite common in pediatrics. You know in a typical RSV season, it could be the main reason kids are in the hospital. It's something we all who care for children really know about and worry about. So, seeing it behave differently has us all alarmed, and we're seeing a lot more of it this past year. People probably have been reading about that and hearing about that, and that could be because a lot of kids didn't get it during those couple of years of COVID. Now they're a little bit older, so we're seeing it in slightly older kids coming in for care who normally it would be a cold for them and they'd stay at home and we'd never hear about it. But now we're having the babies get it, who would typically get it every year and need to come for care, and some older kids too. That's increasing the number of cases we're seeing and how it's impacting our pediatrician's offices, our emergency rooms and our hospitals.

Host: Let's say we have a sick child at home, and we're trying to determine whether they have RSV, COVID-19, or something else. Are the symptoms of RSV and COVID similar? Or how different are they? Is there a way to tell whether your child likely has RSV or is maybe infected with COVID-19?

Dr. Tesini: There's a lot of overlap. Even before we get into these symptoms, if they've been around someone who recently got diagnosed with COVID, or flu, or RSV, or someone in the house has had it and got tested, or it’s going around at their daycare or classroom, that's a big clue that we often use already. That is knowing if they were in contact with someone who had one of those infections. For older kids and adults, it could be hard to tease out because all of these viruses can cause a cold kind of illness. And older kids and adults with healthy immune systems, RSV would be really unlikely to cause the fever, flu-like, “I feel really sick” that a lot of people do with COVID and flu. So, I would say for most adults and kids, RSV would be more mild or less likely to have that really severe presentation. Then in the young babies, RSV is probably more likely to have that wheezing picture, that really fast breathing, tugging to breathe. But again, that's only a minority of babies who have that. But it would be, if you're seeing that more severe picture that more likely is RSV. Then in older adults, I think all three of these RSV, COVID, the virus that causes COVID, and flu could show up the same way as a cold or certainly as more concerning, like a pneumonia kind of picture.

Host: Let's talk about some of the myths and misconceptions about RSV a little bit, you mentioned that it's primarily fairly dangerous or severe for those babies, who are six months and under. Is that only the types of people who are super susceptible to RSV and having severe cases of it, or does it expand beyond that?

Dr. Tesini: No, it does expand beyond that. So, we really think about the extremes of age. As we've talked a lot about and people are probably more familiar with are those young babies in the first six months, and certainly babies who were born prematurely, or babies who were born with certain heart or lung conditions, even up through the first two years of life. They’re at high risk of having that more severe form of RSV. But another group that we're just starting to really educate people about and understand more are older adults. So, the other extreme of age, and it's not even that extreme, even adults over 65 and certainly also those who have underlying heart conditions or lung disease and respiratory conditions. The majority of deaths from RSV are actually in that population and not the babies. It can be certainly just as severe as a case of the flu for people in those groups.

Host: For any group, is RSV something where, similar to the common cold, you should just let it run its course, or when should they go and see their primary care, or for an infant when should they go see their doctor for their child?

Dr. Tesini: For most otherwise healthy kids and adults, do the things you do for your common cold. And for anyone, but particularly for the young babies or the older adults, so people that we think of as being high risk for getting a severe form of it, you really want to pay close attention to how they're breathing.
For adults, are they getting winded really easily? Are they having a hard time moving around and still taking care of themselves? And for the infants, parents can watch for fast breathing, you get to know your baby pretty well and what's normal and not. So fast breathing, pulling up their chest, their chest moving differently, and seeing the ribs move differently, their nose flaring open or making noises as they're breathing. Certainly, if there's blue or purplish discoloration in or around their mouth, and also, if they're just having a hard time or just seems so tired. They're not interested in drinking as much, and you're worried that they could be dehydrated. Those are all reasons that you'd want to call your doctor, or at least talk it through with them, or take them in to be seen.

Host: Are there any risks or long-term effects of contracting RSV for either young babies or older adults that can have lasting effects once that virus is out of your body?

Dr. Tesini: Yeah, we don't really think about it as causing particular damage that's ongoing. There are studies that show an association with babies who had really severe RSV also tend to be more likely to be kids who have asthma or other breathing problems. But, we don't know if that's the chicken or the egg. It's just an association. And again, everyone gets RSV. So, there's nothing in particular to watch out for. But I think the biggest concern would be for people who already have lung disease, heart disease, and breathing problems that can definitely be associated with exacerbations or trigger worsening of asthma or chronic lung disease in older adults, and so it can be harder to bounce back from that infection. But that can be true for all of the respiratory viruses.

Host: Is there a vaccine that someone could take to protect themselves against RSV?*

Dr. Tesini: Really exciting work going on right now. So, research is underway for both vaccines and treatments to both prevent and treat RSV, and really focusing on those populations, older adults and how to protect young babies through that first year or two of life.*

Host: What are some of the best tips to prevent an RSV infection if there are any?

Dr. Tesini: The best thing is to try and avoid getting it in the first place. And so RSV, respiratory viruses are spread through some version of getting contact with the virus that someone has coughed or breathed out, or with the case of RSV and babies, smeared on you with their gooey, gooey noses and wet kisses. So, with RSV, again, that is a really common way that it gets spread around households and daycares and schools, it's just in these gunky, runny noses that seem to never stop running. Directly touching that and not washing your hands before touching your own eyes, nose or mouth is a common way to spread it. To prevent it is really practicing good hand hygiene, washing your hands with the hand sanitizer or soap and water before touching your face and as often as possible. For parents with babies in that high-risk category or older adults who are also at high risk, try to avoid crowded places if you can when you know that RSV is going around in your community. A big public health message is for people to stay home when they're sick, and to avoid going to those places where they know these at-risk young babies or older adults would be. And the classic covering your cough, but for RSV, really, really good hand hygiene and avoid that up-close contact with anyone who might be sick.

Host: This is maybe separate from RSV, but do you think people are more likely to stay home when they're sick now as opposed to three years ago? Have you seen people more likely to say, “Hey, I'm feeling a little under the weather, let me stay home for a little bit,” as opposed to what you saw back in 2020 and before?

Dr. Tesini: I really think so. I see that working in a hospital, a lot of people don't want to place anyone they work with at risk, but also have this sense of like, “Oh, it's just a cold and I’m needed here.” I see that changing a lot in our culture overall. And I think what's really important is for social gatherings too, like “Guys, I'm not feeling so well, I probably shouldn't get together. I don't think that's a good idea. I don't think that's safe.” And then people wearing masks, too, in that in-between situation and just being more aware. I have seen a big change and hoping that will stay.

Host: Switching gears back to RSV quickly, can you give our listeners some strategies to treat RSV assuming they don't need serious medical care such as going to the hospital or anything like that, are there any strategies to treat it? For adults or babies?

Dr. Tesini: One of the biggest things you can do is make sure that you stay hydrated. That's really going to make everything worse, and a common reason for people to need to come in and seek care is for getting dehydrated. So, it's keeping up with your liquids and using medications that you would use for other colds or flu-like illnesses to just keep yourself comfortable during the illness. For most people, it'll be less than a week, generally around five days or so that you'd expect to feel sick from it.

Host: Finally, Dr. Tesini, where should our listeners go to learn more about the symptoms, diagnosis, prevention, treatment, anything else related to RSV? Where would you send them?

Dr. Tesini: We have great patient and family centered resources at the Merck Manuals online. The American Academy of Pediatrics also has high-quality resources for patients and families, and that's through HealthyChildren.org.

Host: Wonderful. Well, Dr. Tesini, thank you so much for joining us on this podcast. Certainly, it was a great conversation busting some of the myths around RSV. As we close out, I'll let you leave our listeners with our final word as we always do.

Dr. Tesini: Medical knowledge is power. Pass it on. Thank you so much. 

*Interview was recorded before FDA approved a vaccine for expectant mothers in August 2023.