Resurgence of childhood viruses could strain ICUs: experts

RSV is the most common reason young children in the first year of life get admitted to hospital.

Ottawa Citizen 4 minute read July 26, 2021

CHEO chief of staff Dr. Lindy Samson says most of the children who have attended the Brewer assessment centre for testing did not have COVID-19, but they did have viruses — the kind that are common in children, but that almost disappeared during earlier stages of the pandemic. Rhonda McIntosh / CHEO

After all but disappearing during the pandemic, childhood viruses are making a comeback and pediatric health officials are bracing for what is expected to be a severe year ahead.

Authors of a commentary in the Canadian Medical Association Journal warn that the anticipated resurgence of RSV, a common and sometimes serious childhood virus, “could stretch resources in pediatric intensive care units across Canada.”

That off-season resurgence, which could begin this summer, would come as pediatric hospitals are already coping with a growing mental health crisis among children and youth as well as patients whose treatments and therapies were delayed during the pandemic. Officials are also watching for a possible fourth wave of COVID-19.

Cases of RSV rose sharply in Australia and parts of the United States as pandemic restrictions were loosened.

In Ottawa, there are already signs of what is likely to come.

In the past week, there has been a spike in the number of children showing up at the Brewer assessment centre to get tested for COVID-19, said Dr. Lindy Samson, chief of staff and chief medical officer at CHEO. The vast majority of those children don’t have COVID-19. But they do have viruses — the kind that are common in children, but that almost disappeared during earlier stages of the pandemic. Last week, Brewer was seeing up to 250 children a day.

Ottawa is not yet seeing cases of RSV (respiratory syncytial virus), a common virus that affects the lower respiratory tract and can cause severe illness and death in some cases. But health officials should be prepared, warn the authors of the commentary published in the CMAJ last Monday.

Canada should anticipate a resurgence of the respiratory virus “as COVID-19 physical distancing measures are relaxed.” And that will put vulnerable children at risk, the authors wrote.

“The off-season resurgence in seasonal respiratory viruses now potentially poses a threat to vulnerable infants,” wrote Dr. Pascal Lavoie of the B.C. Children’s Hospital Research Institute and coauthors.

RSV is the most common reason young children in the first year of life get admitted to hospital — often with bronchiolitis, Samson said. Premature infants or those with immune deficiencies are particularly vulnerable to severe outcomes from RSV infections.

Babies from Canada’s Arctic regions, including Nunavut, have the highest rates of RSV in the world, leading to calls for preventative treatment for all infants there. There is no vaccine against RSV, but there is preventative therapy that is administered monthly to the most vulnerable infants during the peak of viral season, usually beginning in late fall. Many infants from Nunavut who become severely ill are flown to CHEO for treatment, often on ventilators.

For most children and adults who have antibodies, the virus causes mild cold-like symptoms.

Between November and January is usually the busiest time for RSV at CHEO, and more than 200 young children can end up in hospital each year.

But this has not been a typical year.

In 2019-2020, CHEO recorded 455 positive tests for RSV. During the fall and winter of 2020-2021, when mobility was limited and public health restrictions were in place, there were just six positive RSV tests and no hospitalizations, Samson said.

Canada-wide, there were only 239 positive cases of RSV between Aug. 29, 2020, and May 8, 2021, compared with 18,860 during a similar period the previous year (between Aug. 25, 2019, and May 2, 2020), according to the CMAJ commentary.

“The virus seemed to disappear.”

Samson is concerned that the resurgence this year will create a “double cohort” of vulnerable children because very few have been exposed to it since the pandemic began.

“We have two whole birth cohorts that wouldn’t have been infected.”

In a resurgence of RSV in Australia, the median age of children infected was 18.4 months, compared to between 7.3 and 12.4 months in previous years.

“This could suggest that infants who were not exposed to RSV in their first year did not develop sufficient immunity, such that they remained susceptible into their second year,” the authors of the CMAJ commentary wrote.

In addition, the authors wrote that infants could become sicker if they are infected this summer because they weren’t exposed to boosted antibodies in utero. They suggest that preventative treatment to the highest-risk infants be given in the summer if cases increase to levels normally seen in the fall.

CHEO’s Samson said a big message from the rise of RSV in other parts of the world is that people must continue to meticulously wash their hands, not go to work sick, even if they don’t have COVID-19, and follow other measures aimed at preventing spread of infections.


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