Pediatrician to parents: Take virus infections ‘very seriously’
COVID infection rates are soaring yet again, and kids under 12 aren’t eligible for the vaccine. What does that look like on the front lines? And what is RSV, the other flu-like virus that’s driving a surge in hospitalizations?
Christina Propst is a pediatrician at a private practice in Houston, as well as a member of the American Academy of Pediatrics’ Council on Children and Disasters, and of the Texas Pediatric Society Committee on Infectious Diseases and Immunizations. This week, she weighed in about what’s on her mind.
Q: With COVID rates rising, pediatricians and general practitioners are back on the healthcare frontlines. What are you seeing?
A: We’re seeing, unfortunately, a convergence, a perfect storm of COVID plus a truly unprecedented rate of infection with RSV — respiratory syncytial virus.
RSV is a common virus, normally a wintertime virus, and it tends to run in tandem with flu season. This winter, for whatever reason, we had very mild flu and RSV seasons — most likely because people were masking, and many people were vaccinated against influenza. But this summer we have seen a truly vicious resurgence of RSV.
It’s at an unprecedented level. The Texas Department of State Health Services normally stops tracking RSV data for the state in mid- to late June. If you go to their website and look at previous years, the graphs literally cut off. There’s an end date. This year, it goes straight through today and will continue to go into the fall.
We’ve had a huge surge in hospitalizations of babies and toddlers in particular with RSV infections — RSV pneumonia, with respiratory distress and respiratory failure — requiring intensive care stays.
And now we’re also starting to see an uptick — absolutely an uptick — in COVID-19 infections in children.
Q: Is COVID somehow linked to RSV?
A: We don’t really know yet. RSV has been around far longer than SARS-CoV-2 in terms of viral etiology. It’s seasonal. We see it every year. There’s an RSV season, just as there’s a flu season.
I’d say that RSV is slightly less well known to the general public than influenza or the flu. But it is very well known among pediatricians and among families who have children with cardiopulmonary disorders or parents of children with premature infants or premature children. There are very specific criteria that premature babies have to meet to be able to qualify to get vaccinated against RSV, and premature babies do get a monthly injection with a vaccine during RSV season. But there is not a
vaccination for RSV that is given widely and widely available.
So RSV certainly predates COVID-19 tremendously, and is not necessarily causally related to COVID-19. But why it is raging here in the summer right now no doubt has something to do with COVID-19. But what that is, is unclear.
Some biologists think that viral crowding or viral competition could have suppressed RSV this winter. Therefore it was basically lying in wait or lying dormant, and has now come back with a vengeance. I don’t know if that is the complete explanation.
My skepticism is based on the fact that we’re not seeing flu right now — we’re not seeing Influenza A or Influenza B. Yes, we try to immunize very widely against influenza. But the immunity from last fall’s influenza vaccines by now certainly would have waned considerably. So it is unclear to me why we’re seeing this huge uptick in one specific virus, RSV, as opposed to influenza A or B.
Q: Let’s talk now about COVID. What are you seeing in your pediatric practice?
A: In the past week, I’ve seen a tremendous uptick. I was on call this weekend, and we had far more positive test results for COVID-19 among our patient population than I had an any other call weekend of this entire pandemic.
It’s a combination of the delta variant and of the virus seeking the vulnerable. Ages 11 and under are not eligible to be vaccinated, and unfortunately, a fair number 18 and under are not vaccinated. So in that way, again, it’s a perfect storm.
There’s a coalescence of vectors. Children are coming back to town. They’ve been traveling all over the place. In many cases, babies or infants have been on flights, and obviously, they’re unmasked, since children under 2 cannot be expected to wear a mask. Plus, preseason sports is starting to get underway, school is about to start.
That, plus a truly virulent variant circulating very widely right now, and children being vulnerable.
Q: You said that in your practice, you’ve seen the most patients test positive this past weekend out of the entire pandemic. How many would that be?
A: Boy, it’s hard for me to actually remember all the lab results and pages. But I would say this weekend alone, I probably dealt with 15 to 20 who either were COVID-positive or recovering from COVID and developed complications. And there’s certainly a higher number for whom there’s a COVID suspicion, and I directed them to get testing. That was just from this weekend.
In the past two months, I have hospitalized more babies — particularly babies under 3 years of age — than I had in the prior three years. It’s been unbelievable, the amount of morbidity right now — from RSV, particularly RSV, but also COVID, and now a combination of the two.
I know that there have been children hospitalized who were positive for both viruses. I cannot imagine how horrible they must feel. What it puts their family through it is just horrendous.
Q: I assume that you’re strongly advising families to vaccinate the kids who are eligible to be vaccinated?
A: Yes, absolutely.
Q: Are they generally following your advice and vaccinating?
A: They are. I am blessed with a very educated, science-trusting, science-believing, caring and responsible patient population. The families in our practice are wonderful and are very receptive.
Of course they have questions, and I don’t blame them. I expect that. There is hesitancy even in our practice, so it’s important to take the time and speak with those parents and those families.
I try not to overwhelm them with the data. But I try to share some of the more basic data, particularly current data on children and hospitalizations and COVID-19, as well as some of the potential complications from even a “mild to moderate” COVID-19 infection such as MIS-C or PASC (long-haul COVID).
I discuss with them my concerns for their child in particular if their child has complications or has certain pre-existing conditions that put them at high risk. I certainly have kids who have complex congenital heart disease, who have moderate to severe asthma, or who have elevated body mass indices. There’s a sizable at-risk pediatric population.
Q: What advice do you give the parents of kids 11 and under who can’t be vaccinated?
A: The advice I’ve given them is, No. 1, to rewind and go back to their peak time of concern — to go back to the period of time when there was a lot of uncertainty about COVID. Rewind to that mentality.
I want them masking. I want them distancing. This doesn’t mean they can’t be outside. This doesn’t mean they can’t see their friends and they can’t interact. They can go for a bike ride, etc. There’s plenty that children can and need to do. But we have to be very careful right now.
Masking is a huge and easy component in preventing the spread of COVID-19 and mitigating infection among the vulnerable. The American Academy of Pediatrics issued a statement quite unequivocally based on the data that children two years and up should be masking indoors in school this coming school year, and the CDC just made a similar recommendation.
So I recommend to my families, if they can, be in a school that follows the science, that urges or even requires masking for children 2 and up. I certainly have patients who are seriously considering homeschooling again. Unfortunately, of course, that’s not an option for everybody. That takes time and resources, and some kids really cannot tolerate that. And some parents can’t: I wouldn’t be able to tolerate that with my kids. So it’s tough.
But parents need to take this very seriously right now.
Q: You keep up with a lot of other medical professionals. What are you hearing from them?
A: I was just seeking care for someone who is in a hospital system elsewhere in Texas and is seeking an ICU bed here in the Texas Medical Center. But there are no ICU beds at the hospital in the Medical Center that this patient was hoping to be transferred to — the hospital where she has in the past gotten all of her care. None.
The hospital is full, so they cannot transfer her. Her doctor has put in the request, but she’s on hold. She’s waiting. She’s on standby. That’s where we are right now.
And it’s July. It’s not flu season yet. There aren’t as many people on the roads, getting into car wrecks, as there will be when school starts and everyone comes back to work.
This is a dire situation right now, and the predictions for the Texas Medical Center really are frightening.
I don’t want to yell fire in a crowded theater. But I smell smoke. This is a tremendous problem. This is not January. This is July. This should not be happening now. There should not be this many sick kids right now.
If the children’s hospitals are at or near capacity, which they are right now in the Texas Medical Center, that means that the adult hospitals, which now are also either full or nearly full, have no pop-off valve.
In previous surges we were able to use the children’s hospitals to treat adults. But the previous surges did not include RSV infection that is just a tsunami driving child hospitalizations right now.
This is a critical moment. It really is. I don’t know where these patients are going to go.
Q: Given the number of COVID infections that we’re seeing, we expect hospitalizations to keep rising. Are doctors and nurses bracing for this?
A: Doctors and nurses have been bracing for this for months — certainly among my colleagues and peers. RSV started surging in May, got much worse in June, then got significantly worse in July. That was a huge red flag, and many of us tried to raise that red flag loud and clear. We saw this coming: An RSV surge in June and July does not bode well for a health care infrastructure that already been challenged, that has major weaknesses and that frankly needs some overhauling. It is very concerning.
Q: What should Houstonians be thinking about now? How should people be living their daily lives?
A: Just as Houstonians came together after Hurricane Harvey, I would hope that they’ll really come together now for the greater good — that they’ll think of their neighbors, their friends, their friends’ children, their teachers, their doctors, nurses, firemen and police. That’s really the only way we are going to get through this.
People need to get vaccinated. People who are eligible to get vaccinated need to get vaccinated.
People over the age of 2 who don’t have specific developmental or medical conditions need to wear a mask, whether they’re vaccinated or not, especially indoors.
People need to look around and think of others.
I hear people saying, “I just want things to get back to normal. I want my kids to have a normal school year.” I certainly do as well. But then they’re doing things that are directly contradictory or counterproductive to that goal. That degree of cognitive dissonance is very frustrating for many of us in health care.