Marin physicians report early spike in dangerous respiratory virus

Respiratory syncytial virus, a seasonal menace that can pose serious risk to infants and the elderly, has arrived much earlier than normal in Marin.

“This is a very early RSV season,” Dr. Matt Willis, the county’s public health officer, said Wednesday. “Our pediatricians have not seen this number of cases this early, ever.”

Willis said the virus is showing up at all five of the sites where the county collects wastewater samples.

Dr. Nelson Branco of Tamalpais Pediatrics, which has offices in Larkspur and Novato, said the practice has had “a huge increase in the number of sick babies and children.”

“We’re seeing the volume of illness that we would typically expect in January or February, but at a really early point in the season,” he said.

Dr. David Hoffman, medical director of MarinHealth Medical Center’s hospitalist program, said he is also seeing evidence of a local surge in RSV cases.

“We have had to admit multiple patients for RSV,” Hoffman said.

Hoffman said in at least one case the medical center had to transfer a young patient to a pediatric intensive care unit in the University of California, San Francisco system. UCSF Benioff Children’s Hospitals has such units in San Francisco and Oakland. California Pacific Medical Center also operates a pediatric intensive care unit in San Francisco. None of Marin’s three hospitals has a pediatric intensive care unit.

“What we’re hearing is that the intensive care units in those hospitals are in some cases full,” Willis said.

Hoffman said MarinHealth Medical Center is trying to take some of the pressure off the hospitals with pediatric intensive care units by caring for as many of local RSV patients as it can safely manage.

He said the biggest challenge has been finding enough nurses.

“We’ve really been having to work hard to accommodate the kids with RSV that we’ve needed to admit,” Hoffman said. “To my knowledge, we have not had to transfer any kids due to a lack of nurses.”

Branco said the early surge of cases has put an added strain on pediatricians who are typically busy this time of year doing sports physicals and other examinations related to the beginning of the school year.

“We’re also seeing a lot more behavioral health and mental health visits in the aftermath of the pandemic,” Branco said. “Our advice nurses on a recent Monday got double the number of calls that we typically get on a Monday at this time of year. So it’s added stress to an already busy schedule.”

Willis said most people will experience RSV as a common cold. Symptoms include a runny nose, coughing, sneezing, decreased appetite and fever, according to the federal Centers for Disease Control and Prevention.

For children who are less than 6 months old and adults age 80 and older, RSV poses greater risks. It can develop into lung infections such as pneumonia and bronchiolitis, and it can be life-threatening. Willis said the airways of infants are so small that mucus generated by RSV can block the passage of oxygen.

“We’re recommending that the parents of small babies refrain from taking them out in crowded indoor public spaces for at least three months,” Willis said, “and if they do have visitors to make sure grandparents and other visitors wash their hands before holding the child.”

Unlike COVID-19, which spreads mainly through droplets in the air, RSV is transmitted through the air and through physical contact, and can live on surfaces for hours.

“So hand washing and wiping down surfaces is an important way to protect against infection,” Willis said.

There is no vaccine for RSV, but that might change soon. Willis said that in just the last few weeks promising results have been released from early clinical trials on a new vaccine, but it is designed for adults.

Hoffman said there is one antibody medication on the market that reduces the chance of contracting RSV. The drug, Synagis, requires monthly injections and is prescribed for children who are at increased risk if they contract RSV, such as significantly premature children and children with cardiac defects. There is no treatment for people who have contracted the virus.

Willis said the early spike in RSV cases is likely due to precautions such as mask wearing and sheltering taken to stop the spread of COVID-19. In addition to suppressing the spread of the coronavirus, the precautions reduced the number of people contracting other respiratory viruses such as RSV and influenza. Now that these safeguards have been removed, there is a larger group of children who have never been exposed to the viruses.

“RSV is making up for lost time,” Willis said.

Branco said, “It’s important to note that it’s not that RSV is becoming more severe or has changed in any way.”

Branco said several of his young patients have also tested positive for influenza.

“It is very early to be seeing influenza,” he said, “and we’re still seeing kids testing positive for COVID.”

Hoffman advises parents to make sure their children are vaccinated for COVID-19, influenza, pertussis and pneumococcus.

Willis had one bit good news. He said a new surge of COVID-19 cases, feared by some last month due to a spike of cases in Europe, has so far failed to materialize. Willis said the surge of cases and hospitalizations in Europe have subsided and the number of cases in Marin has decreased further over recent weeks despite the emergence of new variants.

However, he said, there are no guarantees the respite will continue.

“The wild card here,” he said, “is that the holidays have just begun.”