Respiratory illnesses hitting earlier and stronger
“Flu and, in particular RSV, are dramatically affecting children and overwhelming our pediatric hospital resources,” says Dr. David Wilcox of Bemidji Sanford Health.
This year’s respiratory season started earlier this year and more severe cases of illness are being seen regionally and throughout the state, said Dr. David Wilcox from Sanford Health in Bemidji.
“Flu and, in particular RSV, are dramatically affecting children and overwhelming our pediatric hospital resources,” he said. “But just because we’re seeing more of other respiratory illnesses this fall doesn’t mean COVID is gone. Once we start to travel more, gather for the holidays, spend more time indoors and put larger groups of people together, that’s a recipe for any infectious disease to be very successful.”
Wilcox said being vaccinated for flu and COVID is especially important now in light of the number of RSV and flu cases in the community.
“With the strain that’s on the healthcare system now, for those who feel the vaccination issue won’t affect them, if you look at the state’s emergency room waiting times, they’re going up because of the amount of hospital beds being taken up by people with preventable respiratory illness,” he said. “When you need attention for your heart attack or your car accident, the resources that are normally there are getting used up by those with preventable illnesses.”
Advice for holiday gatherings
Wilcox said taking precautions to protect yourself and others from respiratory illnesses can help make gatherings safer.
“As we celebrate the holidays, the best supportive measure is not getting sick,” Wilcox said. “[Practice] good hand washing and following the usual infection prevention measures. Stay home if you’re sick and get vaccinated for the things you can get vaccinated for. Less than 15 percent of Minnesotans are appropriately vaccinated for COVID, which means getting the bivalent booster.”
He said most home tests for COVID are antigen tests, which may show a negative result even when someone has been exposed to COVID.
“Typically, once you’ve been exposed, there are one or two days where you’ll have no symptoms and a negative test,” he said. “Then on day 3 or 4, you might start shedding some of the virus that’s measurable and start developing symptoms. Most people get symptoms by day 5 or 6, and that’s when the tests become reliably positive. If you’re symptom free, the home tests are not very good at telling if you have COVID.”
That means if you’re visiting people who are in vulnerable health, you could be exposing them without knowing it.
“Wearing a mask to protect anyone who is vulnerable would be a good idea,” he said. “It’s great for people to get together, but every time you add more complexity, the more times you get exposed to more people in a different environment that isn’t your usual network of people, the more at risk you are to run across someone who is sick. Exposure takes 15 minutes unprotected with someone who has active symptoms. You don’t know any of those things when you get on an airplane.”
RSV cases surging
Wilcox said pediatric units in the region have been stressed by young patients needing care for RSV.
“We manage uncomplicated RSV in children here in Bemidji, but if they need a higher level of care, they would have to be transferred to a facility that may not have room for them,” he said. “The pediatric ICUs are overflowing in Fargo, Sioux Falls and most of our Twin Cities hospitals. The Minnesota Hospital Association works collaboratively to figure out where patients can go. Everybody is stressed. I’d say the pediatric units are more stressed now than they were with COVID.”
While some pediatric RSV patients need hospitalization, Wilcox said less severe cases can be treated at home.
“Good nasal suction for infants is a very good symptom reliever,” he said. “Treat this like the common cold, unless they begin to struggle to breathe. Children at most risk are under one year old. For little children who are struggling to breathe, their nostrils start to flare with each breath. They breathe much faster than normal. Their rib cage sucks in. They’re working hard to breathe, so their upper abdomen and between their ribs suck in when they take a deep breath. When they’re very severe they start to grunt as they breathe. They’re in respiratory trouble and they should go to the emergency room.”
RSV doesn’t just impact children.
“We’ve had hospitalizations for RSV for older patients as well,” he said. “I think the difference this year is we probably know a little bit more about RSV in the elderly. Part of that is because our go-to test is now the quad test. We test all at once for Influenza A, Influenza B, RSV and COVID with just one swab.”
Wilcox said RSV is usually due to community transmission.
“RSV was unusual this year in that there have been two peaks,” he said. “Typically, we see RSV in mid to late winter. January to February is when we typically see an RSV surge. We saw a little surge this summer and now we’re already seeing a surge this late fall.”
Influenza hitting early
“This year, the influenza season is a full month ahead of schedule,” Wilcox said. “Our influenza cases started climbing the first week in October, and that doesn’t usually occur until mid November.”
Schools in the Twin Cities metro are already seeing increased absences due to influenza. “Generally, Bemidji has been a week or two behind in surges,” Wilcox said. “That's how it was with COVID. We’d hear about it really ramping up in the Twin Cities area, and then two to three weeks later would see impacts in our region.”
This year’s flu vaccine appears to be a good match for the strains circulating.
“It’s early in the season, but in the lab the match (between the vaccine and the strains currently circulating) seems to be good,” he said. “It’s not too late to get vaccinated. As far as hospitalizations, it tends to the elderly and people who have a chronic illness or underlying lung disease.”
For those with influenza, he said treatment with Tamiflu may help.