As COVID-19, influenza and Respiratory Syncytial Virus (RSV) all have similar symptoms, it is necessary to be tested to tell the difference between them.

Shelly Mahowald is a family medicine nurse practitioner at Sanford Health in Park Rapids with 32 years of experience.

“I saw my first respiratory illness in a 2-year-old last week in a family with COVID,” she said. “And in Park Rapids, some preschools and daycare centers are seeing some RSV.”

COVID rates concerning

The Oct. 14 community briefing from CHI St. Joseph’s Health Community Health in Park Rapids showed a positivity rate of 23.2 percent from Oct. 7 to 13. There have been 186 cases reported in the county so far this month, and there were 478 cases reported in September. Hubbard County has seen 2,814 cases since the pandemic began and 44 deaths.

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According to information from Dr. David Wilcox, chief medical officer at Sanford in Bemidji and family medicine physician with over 30 years of experience, the portion of COVID-19 cases for ages birth to 18 has exceeded the two previous local surges.

In the October through November 2020 surge, when children were masked and distance learning, they comprised 14 percent of all COVID-19 cases.

Most schools in the region returned to classes this fall unmasked, and the current, ongoing surge started in September. Children currently make up over 30 percent of all local cases during this surge.

Minnesota is divided into eight Emergency Medical Service regions. The Department of Health found that the EMS region in Northwest Minnesota has the highest rate of cases among kids in the state.

COVID-19 hospitalizations, ICU care and death are mostly impacting the unvaccinated. At Sanford Health, 93 percent of all hospitalizations for COVID-19 are among unvaccinated and 97 percent of all patients needing ICU care or a ventilator have not received a vaccine.

According to Wilcox, “Vaccines are the path forward for anyone who is eligible to receive them to dramatically reduce hospitalizations and deaths.”

On Oct.15, the first child, aged 8 months, was admitted to the Sanford Bemidji Medical Center for COVID-19. On the same day, two pregnant women were admitted to the hospital and one newborn in relation to COVID-19. Sanford Health locations in North and South Dakota have also seen cases of pediatric patients with COVID-19 being admitted to their hospitals.

“With the current amount of circulating virus, COVID-19 is more greatly impacting the health of our local children and young families than previously,” explained Wilcox. “We will do everything we can locally to provide care. However, hospitals across the state and country are full, with adults suffering from COVID-19 and other ailments. There are even fewer resources, dedicated hospital beds and staff available to care for hospitalized pediatric patients.”

Mahowald said while she has seen positive cases of COVID-19 among children 10-14 years old in the Park Rapids community, she has not seen anyone needing to be admitted for hospital care here.

“Their cases have been manageable and they are getting comfort care at home,” she said. “Tylenol, Advil, cough care. Parents are doing a good job treating them for their symptoms.”

She said a large study of the Pfizer and Moderna vaccines showed a significant percentage of breastfed babies of vaccinated moms had elevated antibodies against COVID.

Mahowald said quarantining for COVID-19 should be done for 10 days from the onset of symptoms.

“They also need to be fever-free for 24 hours without any fever-reducing medication,” she said. “Sometimes it’s hard when parents need to get back to work, but it’s important.”

Mahowald said wearing masks can help prevent the spread to children too young to be vaccinated. Flu vaccines are recommended for children six months and older.

RSV warning signs

According to the Centers for Disease Control and Prevention (CDC), RSV is a respiratory virus that mostly manifests as a mild illness with cold-like symptoms in adults, but that can cause pneumonia and bronchiolitis in very young children. It can be life-threatening in infants, and most cases occur in late fall to early spring.

Last year, when more people were wearing masks and social distancing, RSV and other respiratory cases were down. With many states no longer having mask mandates, doctors are starting to see a resurgence of the virus nationwide.

Mahowald said RSV symptoms usually start showing up four to six days after exposure.

“In older kids and adults, RSV usually causes mild symptoms,” she said. “A low-grade fever, runny nose, sneezing, headache and a dry cough. Then after a couple days, it can settle into the lower respiratory tract. That’s where they can end up with pneumonia or bronchiolitis, swelling of the small airway passages. There may be a severe cough, a croupy wheezy high pitched sound when exhaling. Infants are most severely affected by RSV.”

Symptoms of severe RSV in young children include struggling to breathe, taking shallow frequent breaths, a high fever, coughing, not wanting to eat and being tired and irritable.

“If you take their shirt off, you can see the retraction of their chest muscles, and you can see the skin pull inward with each breath,” she said. “Their nose may be flaring when they breathe and their nails or around the lips may be blue. These are very sick infants and need immediate attention. You need to get those kids into the doctor.

“It’s essentially the same picture, whether it’s COVID-19, RSV or just a common viral issue or the flu. These kids can all look the same at the start, but the littlest can get worse fast. When they get into a care provider we can do a swab test.”

When necessary, doctors refer children to a higher level of care. “We consult with pediatric teams at Sanford Fargo when managing kids who are really sick, getting guidance from them along with Dr. Shane Nygard at the Sanford Park Rapids Clinic, who has many years of experience providing care,” she said.

Children may have a cough that lingers. “In most RSV infections, most symptoms last a week, but some may linger for weeks.” she said. “Encourage them to drink fluids, eat and manage their low-grade fever.”



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Home care tips

Mahowald said, in most cases, children are able to recover from respiratory illnesses at home with supportive care. Keeping them hydrated is very important. Pedialyte, half-strength Gatorade or half-strength Powerade are the best choices, and nothing with caffeine.

If those options aren’t available, a homemade drink from the World Health Organization can be made with 5 cups of clear water, 1/2 teaspoon of salt and 6 level measuring teaspoons of sugar. Mix the salt and sugar in a warm cup of water to dissolve, then add 4 cups of cold water.

Keep nasal passages clear with a bulb syringe, use cool mist machines to add moisture to the air, encourage fluid intake in small frequent amounts and use non-aspirin fever-reducers cuch as acetaminophen.

Isolate ill family members from others in the household as much as possible and sanitize surfaces and toys often, using products designed to kill viruses. It is recommended that anyone diagnosed with illness wear a mask and social distance.