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In a normal year, cold season in Utah and the rest of the United States would be ending right about now. But nobody needs to be reminded that this is not a normal year.
Colds are spreading, and it’s thought to be the indirect result of the COVID-19 pandemic. And, while RSV — Respiratory Syncytial Virus, which causes colds — is an annoyance for most of us, it’s potentially serious for newborns, young children and older people.
Utah experienced a typical cold and flu season in the fall and winter of 2019-2020, right up until March 2020 when COVID-19 protocols went into place and everything else just disappeared.
“Flu went away. RSV went away,” said Per Gesteland, a pediatrician at University of Utah Health and Intermountain Primary Children’s Hospital and an associate professor of pediatrics at the U. medical school. “And then we didn’t see much at all for the entire respiratory season this last year.”
It’s impossible to say for sure, but it appears that masks and social distancing helped stop colds and the flu in their tracks.
“Well, that’s the best explanation,” said Andrew Pavia, chief of the division of pediatric infectious diseases at the University of Utah. “It’s often hard to prove things with viruses because there are many things going on, but it’s very likely that babies were not exposed to a lot of other people. There was less travel. … But probably the major thing that stopped it was mask use and physical distancing.”
Until mid-April of this year, when cases of RSV began to reappear and the coughing, sneezing, congestion and headaches returned.
The biggest danger is that, as is the case in any cold season, older kids and adults can catch it and bring it home to newborn babies or family members with compromised immune systems or heart and lung disease.
“What can be a mild cold for one person can be a significant infection for somebody who’s at risk,” Gesteland said.
Looking Down Under
Doctors in Utah and around the country are concerned about what’s been happening in Australia, which has seen a rise in RSV in that nation’s summer months, the opposite of what normally happens.
“Australia can be a helpful bellwether to know what’s coming for us, because they have their season before we do,” Gesteland said. “Right after they lifted COVID restrictions, they had a fairly sizable summertime RSV outbreak, which is a pretty unusual thing.”
There were spikes in several Australian cities, “but even there, it does not appear to have been consistent across the continent,” said Pavia. “And in the United States, we’re seeing confusing local increases in RSV, but with no clear pattern at all yet. … So far, everyone is scratching their heads and watching very carefully to see if we might repeat the Australian experience. We are not seeing that yet and we just don’t know.”
The normal cold and flu seasons come when temperatures drop, humidity rises and people are indoors together, which is not the case in Utah right now.
“So we have some of those things going for us to not have a big RSV outbreak this summer,” he said.
But those factors may not matter if people congregate in large groups and kids go back to diving into the ball pit at a local pizza place.
Gesteland noted that trying to predict what will happen with RSV “especially in these really unusual times, is fraught with peril. But what I will say is, yeah, we didn’t have RSV for an entire season. That virus hasn’t gone away. And we have a lot of susceptibility to it.”
So if people do gather in large groups, “it’s probably still going to be able to spread. Just how big and bad it’ll get — we don’t actually know, because we’ve never really looked at RSV outbreaks in the summer. But the Australian story should make us a little bit cautious that it’s possible that this could pick up and cause a significant amount of disease this summer.”
How bad is it?
Keeping track of RSV outbreaks is difficult at best — the Utah Department of Health doesn’t track it, the Centers for Disease Control and Prevention has limited information.
Fewer than a dozen cases were reported in Utah this past winter. Intermountain Healthcare does track RSV on its Germ Watch website, and has recorded almost 70 cases in the past six weeks, peaking at 30 in last week of May.
(That’s not everyone who has a cold, obviously, it’s just the patients who test positive for RSV.)
That’s not a lot — there are 300-500 cases a week during a typical Utah winter — but “it’s very unusual to see that much in summer,” Pavia said. “We suspected we might be on the verge of having things take off.”
But then the numbers dropped back to 10 and 15 in the past two weeks.
“It hasn’t exploded, but it’s out there and smoldering around,” Gesteland said. Intermountain has hospitalized a number of young kids and even some a bit older with a virus not normally seen in the heat of summer.
“These are pretty low numbers and not showing any sort of big surge,” Pavia said, “but something is going on with RSV that bears careful watching.”
All the more so because RSV is a “moderately predictable” virus, unlike the flu.
“In Utah, it comes pretty predictably around the first week of December,” Pavia said. “Some years are bad and some years are worse, but it’s pretty predictable that it will show up, last eight to 12 weeks and start going away. So this is a very unusual situation for the world to be looking at RSV without the ability to predict when it’s going to show up.”
Twice as many susceptible babies
Whether cold season returns to Utah early this year or not, when it does arrive doctors expect it to be harder than usual on the state’s youngest residents. Every year, new babies are susceptible to RSV. And because there was virtually no RSV spread in the past year, babies who would normally have been exposed weren’t.
“If they don’t get exposed to it for an entire season,” Gesteland said, “you just build up the size of that pool of kids that are going to be susceptible.”
So, theoretically, there could be twice as many susceptible and twice as many hospitalizations as in a normal year.
Most people get RSV when they’re babies and “start to develop some immunity that makes it less severe,” Pavis said. “And then you get it over and over again, and you develop more immunity. Well, now we have a group of kids who have no immunity to it and may get sicker than we’d expect 1-year-olds and 2-year-olds to get.”
Gesterland agreed that’s a possibility.
“We don’t know,” he said. “But normally, if you’ve had it before, it’s not as bad. So older kids and adults just get a nasty head cold and sometimes a chest cold, but normally don’t get all that sick from it.”
While immunity to RSV fades over time — that’s why you keep catching colds year after year — the fact that most people haven’t been exposed to it in the past year won’t necessarily make their next cold worse than their last one.
“We just don’t see hospitalizations due to RSV in people older than 5 who have a functioning immune system until they start to get quite aged,” Pavia said, adding that those ages 75 or older were at some risk.
Others who are at risk include those who have had organ transplants, or patients who are on medications that suppress the immune system or some types of cancer therapies.
Don’t let your guard down
The medical advice when it comes to colds hasn’t changed — wash your hands, sneeze into your elbow and keep away from other people if you’re feeling ill.
Gesteland advised parents of newborns and young children to be on the lookout for any signs of breathing troubles or dehydration. “And check in with your pediatrician if you’re concerned about those things.
“It would be a real shame to go through a whole COVID pandemic only to get really sick from RSV at the tail end when we let our guard up a little bit.”