RSV Overwhelming US Healthcare 

Respiratory syncytial virus (RSV) infection is a common respiratory illness (1). In adults and older children, the virus typically manifests as a short-term “cold” with flu-like symptoms such as cough, low-grade fever, and sore throat. In infants and elderly adults, however, RSV is more likely to progress to bronchiolitis or pneumonia (2). The infection can spread to the lower respiratory tract and lungs, triggering wheezing, difficulty breathing, cyanotic skin, and severe fever (1). Due to infants’ immature respiratory systems and smaller airways, symptoms are exacerbated (2), making RSV a leading cause of hospitalization in infants (3). Communicated through airborne droplets and contaminated surfaces, the virus is highly contagious, with approximately one to seven people becoming infected for every one person already infected (4). Typically, the virus exhibits a seasonal cycle, causing more infections in the winter and spring (4). However, this winter has seen a surge of RSV that is overwhelming the healthcare system. 

During the winter of 2022 and 2023, RSV infections skyrocketed past predicted trends. In previous years, roughly 58,000 to 80,000 children younger than 5 years old and 60,000 to 120,000 adults older than 65 were hospitalized with this illness (5-7), but experts predict even higher totals this season (8). According to the CDC’s RSV surveillance network, previous years have exhibited hospitalization rates between 12 and 30 per 100,000 people — in the 2022-2023 season, however, the rate has exceeded 43.4 hospitalizations per 100,000 (8). In addition to affecting more people, the RSV season started several months earlier than expected (9). High rates of RSV combined with COVID-19 and influenza have caused some to name the 2022-2023 season a “tripledemic,” which has overwhlemed the U.S. healthcare system (10). Experts believe that the unprecedented increase in RSV hospitalizations occurred due to the sudden exposure of infants and young children to the virus as a result of loosened COVID-19 restrictions (11). Most children suffer from RSV infection and thereby develop partial immunity by the time they are two years old (12), but the lack of exposure to the virus in recent years has prevented many children from acquiring immunity (11). 

The high volume of patients admitted to the hospital with one of the three illnesses is overwhelming healthcare systems across the country, especially intensive care units (ICUs) and emergency departments. While rises in influenza and COVID-19 cases were expected, the sudden influx of infants and children with RSV have caused hospitals to struggle, resulting in RSV being called “the pediatrician’s COVID-19” (13). Hospitals have been adding beds to the ICUs, placing adult care physicians in pediatric wards, postponing non-emergent cases, and moving older children to the neonatal intensive care unit (13, 14). Specialty hospitals, including adult hospitals and pediatric cancer centers, have also begun to accept pediatric RSV patients (13). As RSV cases are soaring at 300% higher than average years in some areas (11), most hospitals are operating with at least 70% capacity (15). In addition to a labor shortage caused by a loss of healthcare professionals during the COVID-19 pandemic (11), there is also a supply shortage — palivizumab, the preventative drug prescribed to infants with high susceptibility to RSV, is expensive and produced in lower quantities than is currently needed, contributing to hospital overcrowding (16).  

To combat the overflow of RSV patients that is overwhelming U.S. healthcare, hospital officials are prioritizing equipment and labor distribution in pediatric wards and recommending that parents take their sick children to see their primary provider before going to the emergency room (17). Additionally, they are urging people to return to preventative protocols that they utilized during COVID-19 waves — washing hands, social distancing, wearing masks — to prevent transmission and reduce hospitalizations (11, 18). Unlike COVID-19, however, RSV can be transmitted via surfaces, so experts recommend sanitizing surfaces (18). As in previous years, the amount of RSV cases may begin to subside in the spring, but the labor and supply shortages across the country may exacerbate the so-called tripledemic and be too much for our current healthcare system to handle. 

References 

1: Drysdale, S., Green, C. and Sande, C. 2016. Best practice in the prevention and management of pediatric respiratory syncytial virus infection. Therapeutic Advances in Infection 3(2):63-71. DOI: 10.1177/2049936116630243.  

2: Pickles, R. and DeVincenzo, J. 2015. Respiratory syncytial virus (RSV) and its propensity for causing bronchiolitis. Journal of Pathology 235(2):266-276. DOI: 10.1002/path.4462. 

3: Krilov, L. and Anderson, E. 2020. Respiratory syncytial virus hospitalizations in US preterm infants after the 2014 change in immunoprophylaxis guidance by the American Academy of Pediatrics. Journal of Perinatology 40(2020):1135-1144. DOI: 10.1038/s41372-020-0689-y. 

4: Weber, A., Weber, M. and Milligan, P. 2001. Modeling epidemics caused by respiratory syncytial virus (RSV). Mathematical Biosciences 172(2):95-113. DOI: 10.1016/s0025-5564(01)00066-9. 

5: Rha, B., Curns, A., Lively, J., Campbell, A., Englund, J., Boom, J., Azimi, P., Weinberg, G., Staat, M., Selvarangan, R., Halasa, N., McNeal, M., Klein, E., Harrison, C., Williams, J., Szilagyi, P., Singer, M., Sahni, L., Figueroa-Downing, D., McDaniel, D., Prill, M., Whitaker, B., Stewart, L., Schuster, J., Pahud, B., Weddle, G., Avadhanula, V., Munoz, F., Piedra, P., Payne, D., Langley, G. and Gerber, S. 2020. Respiratory syncytial virus-associated hospitalizations among young children: 2015-2016. Pediatrics 146(1):e20193611. DOI: 10.1542/peds.2019-3611. 

6: McLaughlin, J., Khan, F., Schmitt, H., Agosti, Y., Jodar, L., Simoes, E. and Swerdlow, D. 2022. Respiratory syncytial virus-associated hospitalization rates among US infants: a systematic review and meta-analysis. Journal of Infectious Diseases 225(6):1100-1111. DOI: 10.1093/infdis/jiaa752. 

7: McLaughlin, J., Khan, F., Begier, E., Swerdlow, D., Jodar, L. and Falsey, A. 2022. Rates of medically attended RSV among US adults: a systematic review and meta-analysis. Open Forum in Infectious Diseases 9(7):ofac300. DOI: 10.1093/ofid/ofac300.  

8: Centers for Disease Control and Prevention. 2023. RSV-NET interactive dashboard. Dataset. URL: https://www.cdc.gov/rsv/research/rsv-net/dashboard.html.  

9: Bendix, A. 2022. “Surge in cases of RSV, a virus that can severely sicken infants, is filling hospital beds.” NBC News. URL: https://www.nbcnews.com/health/health-news/surge-rsv-virus-fills-hospitals-can-severely-sicken-babies-rcna52082.  

10: Walker, A. 2022. “Just how bad is the ‘tripledemic’?” New York Times. URL: https://www.nytimes.com/interactive/2022/12/16/us/covid-flu-rsv-tripledemic-data.html.  

11:  Austin, D. 2022. “Why RSV cases are ‘exploding’ right now and what parents can do about it.” USA Today. URL: https://www.today.com/health/cold-flu/rsv-cases-2022-rcna54132.  

12: Centers for Disease Control and Prevention. 2022. “Respiratory syncytial virus infection (RSV): Infants & young children.” URL: https://www.cdc.gov/rsv/high-risk/infants-young-children.html. 

13: Baumgaertner, E. 2022. “‘This is our March 2020’: children’s hospitals are overwhelmed by RSV.” New York Times. URL: https://www.nytimes.com/2022/11/01/science/rsv-children-hospitals.html.  

14: Morse, S, 2022. “RSV surge is overwhelming some hospitals and pediatric care capacity.” Healthcare Finance News. URL: https://www.healthcarefinancenews.com/news/rsv-surge-overwhelming-some-hospitals-and-pediatric-care-capacity. 

15: Paquette, E. 2022. “A cold virus is creating crises for pediatric hospitals.” The Hill. URL: https://thehill.com/opinion/healthcare/3708205-a-cold-virus-is-creating-crises-for-pediatric-hospitals/&sa=D&source=docs&ust=1673826569610209&usg=AOvVaw1Ep–KuTu_4Y-_vXQJs_ip.  

16: Reis, J. and Shaman, J. 2016. Retrospective parameter estimation and forecast of respiratory syncytial virus in the United States. PLOS Computational Biology 12(10): e1005133. DOI: 10.1371/journal.pcbi.1005133. 

17: Bruise, C. 2022. “Cribs shortage amid RSV spikes cause US hospitals to reach critical levels.” Nurse. URL: https://nurse.org/articles/crib-shortages-pediatric-hospitals/.  

18: Romo, V. 2022. “RSV is surging. Here’s what to watch for and answers about treatment options.” NPR. URL: https://www.npr.org/2022/11/02/1133040571/rsv-questions-answers-treatment-options.