What to know as respiratory virus strains children's hospitals, including at Oishei in Buffalo

The threat of Covid-19 remains low, but Oishei Children’s Hospital – like many of its kind across the country – has spent the last few weeks grappling with a record number of visits and admissions for a similar condition caused by the Respiratory Syncytial Virus, or RSV.

“We are seeing an unprecedented surge of patients coming in with RSV,” said Dr. Stephen Turkovich, chief medical officer at the Buffalo hospital. “Right now, about one in five patients presenting to the emergency room is testing positive.”

Infection with the virus causes mild, cold-like symptoms in children and most adults, but can cause serious illness, particularly with infants and those 65 and older or with a compromised immune system.

It is the most common cause of bronchiolitis and pneumonia in children younger than 1. Almost all children get RSV by age 2. It is almost never fatal.

Children ranging from a few weeks old to age 3 tend to be those most hospitalized, though this still includes only a small fraction of that age group.

Like flu season, the season for RSV traditionally ran from October through February in the U.S. before 2020, when Covid-related lockdowns, mask-wearing and other precautions taken by most people during the first year of the pandemic made RSV much more rare and those patterns less consequential.

In December 2019, Oishei Children’s admitted 181 children with RSV.

About 200 children were admitted last year during September and October, a number far earlier and higher than in previous years, Turkovich said.

As of Friday, 340 children had been admitted this October alone.

“You can see the dramatic increase,” he said, “and that's obviously not even a full month's worth of data.”

The virus is also prolonging wait times in the Emergency Department.

“We’re averaging about 165 patients or so a day,” Turkovich said Friday, “and about 20% of them are RSV positive. We’re seeing some uptick in the flu, which is unusual, as well. Before the pandemic, we often didn't see kids admitted with the flu until late November or December. So far this month, we've had two admitted with the flu and had 30 or 40 kid in the ED that have tested positive.

“Yesterday at Oishei, we had 230 inpatients in the hospital. That obviously includes everybody, pregnant moms, babies, but that is the highest census that I've seen since we moved (to the new hospital) five years ago.”

The onslaught has clogged the Oishei Children’s Emergency Department and forced staff at the 185-bed hospital to set up five overflow areas, including for its 20-bed pediatric intensive care unit, which has been at or over capacity every day for the last two weeks, Turkovich said.

“We've been in touch with Rochester, Syracuse, Albany, Pittsburgh and Cleveland,” he said, “and the stories are all the same. They are at or above capacity. They have difficulty accepting any transfers from outside of their region and are just trying to keep afloat.”

Covid-19, influenza and RSV present themselves with similar symptoms: cough, congestion, fever, malaise and, for babies, difficulty with feedings.

Providers at Oishei and elsewhere can use one nasal swab to test for those three and some other respiratory viruses. Results come within an hour.

About 70% of those who tested positive this month at the Buffalo children’s hospital had RSV. Roughly 20% had a rhinovirus that can cause the common cold. Covid, influenza and other viruses accounted for the rest, Turkovich said.

He advised loved ones to call a pediatrician if a child develops symptoms and visit an urgent care center or hospital emergency room if they are pronounced. Medications can often lessen the time and intensity of RSV when started early.

Signs a higher level of care is needed include dehydration that can produce vomiting or a dramatic decrease in wet diapers, labored breathing, excessive sleepiness, difficulty to arouse, or blue lips or fingers.

Oishei and other children’s hospitals have treatments that reduce symptoms for Covid-19, the flu and RSV and boost oxygen levels. Deep suctioning of mucus is often used with the sickest child patients and ventilators are sometimes needed.

Several young patients have tested positive for both Covid and RSV at Oishei Children’s, Turkovich said, “but RSV in and of itself is the main culprit for kids landing in the ICU and needing respiratory support.”

The number of positive Covid test results reported in Erie County fell during the first two weeks of this month as RSV cases climbed.

That could change as colder weather pushes more people indoors, Turkovich said. Australia, the harbinger of flu season in the Northern Hemisphere, just experienced a severe season that started earlier than normal during its winter while Buffalo experienced a glorious summer.

“Unfortunately, there's no vaccine for RSV just yet,” Turkovich said, “but if you can get vaccinated for Covid in the flu, you can obviously protect yourself from those.”

RSV is passed through droplets, which also makes hand-washing important, he said.

“If you've got younger kids at home, especially babies, you want to be a little bit more conscious of where you're taking them,” Turkovich said. “It may not be a good idea to take them into large crowds, large areas. You also want to be conscious about who's coming over to visit them. Even if somebody has the sniffles, it may not be a good time."

“If you have cold symptoms or go out in public," he said, "it would be great to mask up so that you're not transmitting whatever cold virus you have to others and continuing the spread of the virus."