Why is the US Experiencing a Surge in RSV Infections Out of Season?

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Discussion Overview

The discussion centers on the recent surge in respiratory syncytial virus (RSV) infections in the United States, which is occurring outside the typical winter months. Participants explore potential causes for this anomaly, including the impact of COVID-19 mitigation measures on immunity and the current state of healthcare facilities in relation to RSV and other respiratory illnesses.

Discussion Character

  • Exploratory
  • Technical explanation
  • Debate/contested
  • Experimental/applied

Main Points Raised

  • Some participants suggest that the increase in RSV cases is linked to an "immunity gap" resulting from COVID-19 precautions, which reduced exposure to RSV and flu, particularly in children.
  • One participant notes that RSV is currently affecting schools significantly, with reports of entire classes being out due to the virus.
  • There is mention of new RSV vaccines that appear promising but are not yet available, with a historical context provided regarding past vaccine development challenges.
  • Healthcare professionals report that hospitals are facing challenges due to concurrent cases of COVID-19, RSV, and flu, with some regions experiencing high hospital occupancy rates.
  • Participants reference CDC data indicating a notable number of RSV cases since October 1, although some data points, such as hospital occupancy rates, remain unverified.

Areas of Agreement / Disagreement

Participants express a range of viewpoints regarding the causes of the RSV surge and its implications for public health. There is no consensus on the primary factors contributing to the increase or the effectiveness of current healthcare responses.

Contextual Notes

The discussion highlights limitations in data verification regarding hospital occupancy and the specific impact of RSV compared to other respiratory illnesses. There are also unresolved questions about the long-term implications of the immunity gap and the effectiveness of new vaccines.

Who May Find This Useful

This discussion may be of interest to healthcare professionals, educators, parents of young children, and individuals following public health trends related to respiratory illnesses.

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TL;DR
Respiratory Syncytial Virus RSV is reported at rates 60% higher than last year because of an "immunity" gap. Something similar happened to the 1918 H1N1 influenza pandemic with greatly increased mortality
RSV background: https://www.cdc.gov/rsv/index.html
"immunity gap": https://www.cnn.com/2022/10/26/health/rsv-immunity-gap/index.html

RSV -respiratory syncytial virus - commonly occurs in small children, sometimes in older adults. It is a lower respiratory disease with some mortality.

The US is seeing a 60% increase in RSV for this year - and in the "wrong" months. In the past RSV was seen in winter months. A spike began this year in late August and is roaring along now (10/26/2022), very much an atypical occurrence.

The reason is probably an "immunity" gap caused by our response to Covid. Mask use, social distancing, and other increased hygiene behaviors to control Covid had a secondary effect - large reductions in RSV and flu infections. So, the immune systems of small children did not "see" RSV. Lots of children are now becoming sick since they were not exposed earlier and have not developed antibodies.

One of the reasons the H1N1 1918 flu pandemic was very severe, ~50 million deaths, was probably due to a generational immunity gap with disproportionate mortality in the 18-40 year old population. In addition to the "usual" mortality in small children and older adults.

See: https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html
 
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My wife (primary teacher) says it's going strong through the schools. One class in her school was almost entirely out for a few days due to RSV.
 
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U.S. hospitals overwhelmed by Covid, RSV and flu​

https://www.nbcnews.com/nightly-new...overwhelmed-by-covid-rsv-and-flu-156572229552

A number of healthcare folks we know have told us that RSV is affecting children and elderly. There is some flu around, and positive Covid cases have increased slightly. Locally, our county had no Covid-related deaths for 18 days from 8 Nov through 24 Nov. In the last 11 days, there were 7 deaths related to SARS-Cov-2 infections.

I don't know of any combined infections, but some friends have had kids with RSV.

CDC reports about 4500 since October 1 this year. Hospital beds are at 79% occupied (I haven't independently verified).

Some counties/regions have a high level of hospital occupancy.
https://www.covidcaremap.org/maps/us-healthcare-system-capacity/#3.5/38/-96
 

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