RSV is a nasty virus but hope is on the way
Imagine two parents, in their twenties, hovering over their four-month-old baby whose noisy breathing woke them up at 3 a.m.
It is minus 30 C outside, winter's icy grip has been intense in the previous seven days. The baby, who a few hours earlier seemed to be fighting cold symptoms, now appears to be fighting for his life, gasping for air. An ambulance transports the infant to the nearest hospital and, by sunrise, the baby is in the intensive care unit.
A few days later, the situation has passed, but the parents are traumatized by this dramatic shift of events. A few months later, the baby's doctor diagnoses asthma in the toddler, now just over one year old. The doctor tells the parents that the nasty virus which hospitalized their baby is the most probable cause of the asthma. The family takes the prescribed inhalers with them wherever they travel for the next five years and occasionally, usually at night, rush to the ER to step up the asthma treatment.
What if the above story could have been prevented? How much money would have been saved?
Could the taxes paid by the province where this family lives have been used for other purposes? Ignoring the cost of hospitalizations, what was the cost of the asthma treatment, ER visits and parents having to take time off work to care for their first and only child who also misses a lot of school days due to “being chesty”?
The virus that caused the baby to end up in ICU goes by the name of RSV. This virus has been around for many decades and its seasonal appearance every year varies. Some years, the virus infects us early in the fall, before winter's grim, grey arctic air relentlessly hovers over the northern latitudes. In other years, it arrives later.
RSV usually infects the very young. It is the most common cause of acute lower respiratory tract illnesses in the young and it is the leading cause of death in infants under six months (NEJM April 20, 2023). If a baby is infected by RSV, the risk of apnea (stopping to breathe) is significantly higher.
Of all the RSV infections in children under age two, approximately one to two per cent end up in the hospital. They stay there for as long as three to seven days and, fortunately, the majority of babies do not end up in ICU.
When an RSV season is particularly intense, the bed shortages in children's hospitals often make front-page news and then the predictable blame game goes into overdrive. Why was such a crisis not seen in advance? Should taxes go up? Why was the health-care budget reduced? Can doctors and RNS, stressed out by long hours and bruised mentally by COVID-19, cope with an avalanche of RSV admissions?
Why the yearly RSV season varies so much remains a mystery. It is no mystery that prevention is better than a cure.
The good news is that RSV can be prevented, or at least its impact reduced, by giving an
RSV vaccine during pregnancy between 32 and 37 weeks gestation. If, for whatever reason, that is not possible, then there is a new prevention product that recently became available for children under age two.
This product is known as a monoclonal antibody and one injection provides protection against RSV which lasts throughout the RSV season.
Because RSV is a global problem, this intervention
(using monoclonal antibodies for children under age two) has been studied in various countries. Many studies involved two to three countries banding together, especially in Europe. I am unsure why the researchers decided to name the trials “Melody” and “Harmonie.” I can only speculate that the good news of how successful the product is was music to many ears.
Given the success in preventing RSV and reducing hospitalizations significantly, various immunization advisory bodies came up with their recommendations. In a number of European countries, governments have already decided to proceed with the vaccination of children under two. In these countries where medical care is funded by taxpayers, the cost of the vaccine is covered.
The U.S. has decided to cover infants comprehensively, but as expected, availability hinges on the private health plan du jour.
In Canada, the situation is very Canadian. Despite data from other parts of the planet, Canadian bureaucrats believe they must do their own analysis first. NACI, a body of vaccine experts, must weigh in and Health Canada also has to pontificate before anything unfolds. After that, it is up to individual provincial governments to make a choice.
That choice is simple: Taxes can be used to pay for hospitalizations, ER encounters and doctors visits or taxes may be used to pay for a vaccine that works well.