LOS ANGELES, CA — California enters its second full holiday season of the pandemic, another respiratory virus is slamming the Golden State.
Tests in the state for respiratory syncytial virus came back positive in roughly 10 percent of cases over the last week. In some parts of the state, such as Redding, tests for the virus came back with a whopping 40 percent positivity rate, ABC7 KRCR reported.
Because the virus tends to be most acute in infants and younger children, some of the same hospitals slammed with adult cases of the coronavirus are struggling to make room for pediatric cases of RSV.
It’s a major concern for health officials in counties with low COVID-19 vaccination rates in children and adults. Health officials remained on edge about the prospect of a “twindemic” of flu or COVID-19 outbreaks. But it’s RSV and COVID-19 that kept pediatricians and emergency rooms busy this week. Hospitals in the Central Valley were already overwhelmed. It’s a dire situation that doesn’t bode well for the winter, when COVID-19, flu and RSV cases can be expected to peak.
Some places might be “doing all right, but that may not last. Once this thing kicks off, it goes exponential,” Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, told the Los Angeles Times.
Dr. Rais Vohra, the Fresno County interim health officer, was blunt.
“We don’t have enough hospitals to serve the population and the needs,” he told the Times.Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla, told the Los Angeles Times.
When it comes to RSV, both infants and older people are most susceptible to severe bouts of RSV leading to hospitalization. There is currently no vaccine to prevent RSV or antiviral drug to treat it.
RSV symptoms often mirror coronavirus symptoms, and the virus typically overlaps with flu season. But this year, it began spreading throughout the summer and remained unusually high for November.
Meanwhile, influenza hasn’t really spread widely in California yet, according to the state health department’s weekly tabulation of confirmed cases. In California hospitals, the flu was tied to just 0.1 percent of hospitalizations, according to California’s health department. About 0.5 percent of laboratory tests were coming back positive for flu statewide.
California recorded its first flu death in Los Angeles County this month. But the flu doesn’t appear to be circulating at high levels across the state. The victim was an unvaccinated middle-aged patient who had underlying health conditions.
“Although most people recover from influenza without complications, this death is a reminder that influenza can be a serious illness,” according to a statement from the Los Angeles County Department of Public Health. “Pneumonia is the most common complication of the flu. Flu can also aggravate underlying health conditions like heart disease or asthma. Annually, thousands of people nationwide are hospitalized or die from influenza-associated illness.”
As with influenza, the spread of RSV was low last year, meaning most toddlers had no exposure to it and don’t possess the antibodies to combat infection. Hospitals across the state reported an increase in pediatric hospitalizations with RSV.
“RSV manifests similarly to COVID-19, so while parents might think of COVID-19 first, it is important for them to know that RSV is also circulating now,” said Dr. Priya Soni, a pediatric infectious disease specialist at Cedars-Sinai Medical Center. “In addition to the common fever and cough symptoms, there are some differentiating symptoms. For example, we know that COVID-19 often presents with unique symptoms, such as loss of taste and smell, fatigue and muscle aches. This is not so common with RSV. There is a reliable test for RSV, an antigen-based test as well as a PCR test. When parents bring their sick child to the pediatrician for care, they should consider an RSV and a COVID-19 test. Unfortunately, although it’s rare, co-infection is a possibility.”
Fever and an intense cough can be signs of RSV in babies and toddlers.
“Significant coughing, significant runny nose, significant wheezing, and rattling of the chest,” pediatric pulmonologist Dr. Jerry Lysinger told KTVQ . “It’s safe to say it kind of gets worse for three to four days and stays the same for three to four days and then it goes away for three or four days.”
The virus’s head start during cold and flu season and its seeming severity may be a result of the pandemic. It may also be a harbinger of a severe cold and flu season that could slam the Golden State over the winter; it’s too soon to tell.
Over the last 18 months, the pandemic has repeatedly disrupted typical flu and cold season patterns.
Last year, as public health officials braced for a “twindemic” of COVID-19 and flu hospitalizations, the flu season was the mildest in California’s recorded history. But not all the same factors that suppressed influenza last winter were likely to be at play this year, since schools and businesses have reopened.
In California, flu season is typically October through May, and flu activity usually begins to increase in late November or December, according to the California Department of Public Health. The 2020-21 influenza season was unusually mild, but health officials expected the flu to make a comeback this winter.
“This low flu activity was likely due to the widespread implementation of COVID-19 preventive measures like masks, physical distancing and staying home,” Centers for Disease Control and Prevention Director Rochelle Walensky told reporters. “Because of so little disease last year, population immunity is likely lower, putting us all at risk of increased disease this year.”
The state’s health department urged Californians to get vaccinated for both flu and COVID-19. Appointments for both vaccines can be made through https://myturn.ca.gov/.
The same phenomenon may be behind the severity and spread of RSV.
There has been a big head start on the traditional RSV season, said Dr. George Rutherford, a professor of epidemiology at University of California, San Francisco.
“That is a big concern,” Rutherford added. “In the Northern Hemisphere, it started in late May, and it may be peaking around now. These are pretty high levels, and this is after very little, if any, last winter.
“The more RSV circulating, the more cases there will be,” he added. “This is one of the benefits/problems caused by COVID. You basically have a year’s worth of kids who haven’t been exposed. We are now seeing this population a little bit older, 6 to 24 months old, who are susceptible to being hospitalized.”
Parents of premature babies or infants with lung problems should be particularly careful while RSV is circulating at high rates because such babies are vulnerable to severe RSV infections.
At this point, it’s difficult to predict if the upcoming flu season will have the same trajectory as RSV, according to Rutherford.
“I’d say the Southern Hemisphere flu season was mild this year,” Rutherford said. That would usually portend a mild flu season in the Northern Hemisphere as well. “However, we are only one mutation away from a worldwide pandemic,” he added. “The flu is very touchy.”
As with RSV, the overall population didn’t have much influenza exposure last year, so people would have built up less natural immunity to it.
But thanks to the pandemic, people have made good hygiene more routine with thorough hand-washing, mask-wearing and staying home when sick. Just as these habits helped slow the spread of the coronavirus, they can slow the spread of influenza and RSV.
Winter surges in the coronavirus, influenza and RSV remained a major concern for health care providers because they could combine to overwhelm hospitals.
“The same specialists who would care for COVID patients are among those who would be caring for flu patients as well,” Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told The Washington Post. “We don’t want those individuals to be so overworked they cannot appropriately care for you, regardless of what brought you into the hospital.”