RSV surge sending children to emergency rooms in Inland Empire

By David Downey | Contributing Writer

The Inland Empire is seeing one of its worst surges in years of a virus that is sickening large numbers of children and sending many to the hospital.

Concerns about respiratory syncytial virus, which is hammering the region and nation harder and earlier in the season than usual, prompted San Bernardino County’s health officer on Friday, Nov. 4, to issue a health advisory urging people to take measures to prevent its spread.

“San Bernardino County is seeing high rates of respiratory illness severely impacting capacity in our pediatric hospitals with respiratory syncytial virus (RSV) being a contributing factor,” County Health Officer Dr. Michael Sequeira said in a news release.

On Thursday, Nov. 3, Riverside County’s public health officer, Dr. Geoffrey Leung, urged parents to take precautions as well.

However, Dr. Jennifer Chevinsky, deputy public health officer, said Riverside County did not intend to declare an RSV health emergency like one the Orange County health officer proclaimed Tuesday, Nov. 1.

San Bernardino County also had no plans to proclaim RSV a public health emergency, Department of Public Health spokesperson Francis Delapaz wrote in an email.

In Los Angeles County, the county Board of Supervisors directed health officials to work with schools to inform parents about the risks and preventive measures they can take.

Such measures include some of the same practices Southern Californians are familiar with from the coronavirus pandemic, such as wearing a mask, washing hands often, avoiding close contact with people and frequently cleaning such surfaces as doorknobs and mobile devices.

RSV has been around a long time and tends to spread during the fall and winter, coinciding with the flu-and-cold season. Generally, the virus causes mild cold-like symptoms such as runny nose and fever.

But it can lead to serious illness in babies, very young children, older adults and anyone with weakened immune systems, health officials said.

“While RSV is a common respiratory virus, it can make young children quite ill,” Leung said in a news release.

RSV is the most common cause of bronchiolitis, an inflammation of the small airways in the lungs, and of pneumonia, an infection in the lungs, in children younger than 1 year old in the U.S., the release states.

Dr. Emily Wong, a pediatric hospitalist at Loma Linda University Children’s Hospital and director of the hospital’s acute care pediatric unit, said RSV can trigger serious illness in older children afflicted with asthma.

“RSV is notorious for causing asthma flares, often leading to hospitalization,” Wong said Thursday.

Complications from RSV and other viruses are prompting many parents to rush children to emergency rooms.

An example is Pomona Valley Hospital Medical Center.

The Pomona hospital’s emergency department has seen a surge of children with a variety of respiratory viruses, spokesperson Amber Brenneisen said. In a majority of cases, children had RSV infections, she wrote. Some were diagnosed with flu and other viruses.

“Due to the severity of symptoms seen in the ED, we have been continuously admitting patients to our pediatric unit for multi-day stays with typical treatment consisting of supplemental oxygen, IV fluids, breathing treatments and pain management,” Brenneisen wrote.

The unit is averaging 12 patients per day, most of them 2 years old or younger, she said.

Arrowhead Regional Medical Center in Colton, which is run by San Bernardino County, also is reporting a surge in respiratory infections and hospitalizations among children, said Dr. Webster Wong, the pediatrics department chair.

Many are coming through the emergency-room doors.

Dr. Ben Archambeau, who works in Arrowhead’s emergency department, said one troubling trend is the age range.

“We are seeing 2-, 3-, 4-, 5-, 6- and 7-year-olds that are having more severe disease,” Archambeau said.

Even young adults, he said, have been getting very ill from RSV.

“That’s really unusual,” he said.

Arrowhead is sending the most seriously sick kids to other hospitals, among them Loma Linda University Children’s Hospital and Riverside University Health System Medical Center in Moreno Valley, Archambeau said.

Loma Linda’s Dr. Emily Wong said the children’s hospital has been struggling to keep pace.

“We’ve been close to, if not at, capacity for the last few weeks,” she said, referring to the hospital’s emergency room, inpatient beds and pediatric intensive care unit.

Wong said the 364-bed Loma Linda University Children’s Hospital is treating more children for RSV than it has at any time over the past four years — including the typical mid-winter peaks.

The “most remarkable thing” about the current wave is the timing, Wong added.

“It’s not that we haven’t felt this busy before,” she said. “But it feels like we are in January or February, and it is only November. And we know it is only going to get more busy for us.”

Wong said the children’s hospital was less busy during the heart of the coronavirus pandemic than was its overwhelmed sister hospital that treats adults. Now there are many sick pediatric patients, she said, and “the chatter amongst us is, ‘Is this our COVID moment?’”

It’s not just RSV driving the wave. Many kids are coming down with other viruses or influenza.

Some are testing positive for two viruses at the same time, and even three, Wong said.

“That is often why they end up sicker,” she said.

Chevinsky, Riverside County’s deputy public health officer, said precise numbers of cases are unavailable because agencies aren’t required to report RSV infections.

“In general we are seeing levels of RSV that are higher than we would typically find at this time of year,” Chevinsky said, adding: “We haven’t seen those cases plateau or fall down yet.”

The reason for the surge, Arrowhead’s Archambeau said, is likely partly “the lack of interaction and exposure that kids have had for the last few years because of COVID restrictions and masking.”

Normally, children get exposed to RSV and build up immunity to the virus during the first couple years of their lives, health officials said. However, young children born right before or during the pandemic spent little time in day care centers or other public places where they would be exposed to the virus and didn’t build up immunity.

Now that pandemic restrictions have been cast aside, large numbers of children are being exposed and becoming sick with RSV for the first time, officials said.

People with RSV generally show symptoms such as runny nose, fever, coughing, sneezing and decreased appetite within a few days, officials said.

Wong, of the Loma Linda hospital, suggested parents talk to a pediatrician to find out what steps they should take, based on their children’s symptoms.

The time to take a child to an emergency room, Wong said, is when a child is laboring to breathe or taking breaths very fast. Having difficulty breathing also can impede a child’s ability to drink and eat, and cause dehydration, she said.

In such cases, a child may need additional oxygen and fluids at a hospital.

“It can be difficult to keep your children safe from the transmission of viruses, especially with school and the holiday season in full swing,” said Dr. Muzna Atif, pediatric hospitalist and medical director for inpatient pediatrics at Pomona Valley Hospital Medical Center.

“If your child does become sick and starts showing any of the more serious signs of RSV, such as labored breathing, wheezing or decreased appetite, it’s time to take them to the emergency department,” Atif said.

PREVENTING RSV

If a parent has cold-like symptoms, they may want to:

• Wear a mask when doing anything over a baby, when droplets could easily get into the baby’s mouth or nose
• Cover coughs and sneezes with a tissue or upper shirt sleeve, not one’s hands
• Wash hands often with soap and water for at least 20 seconds
• Avoid close contact with other people, such as kissing, shaking hands and sharing cups or eating utensils
• Clean frequently touched surfaces such as doorknobs and mobile devices
• Get a monoclonal antibody medication called Palivizumab that is available for infants and young children who are at high risk for severe disease.

Source: Riverside University Health System – Public Health