ER doctor concerned by rise in dangerous respiratory virus in N.S. children

A top doctor at Nova Scotia's children's hospital is concerned about the jump in the number of young children she's seeing infected with a potentially dangerous virus.

"I'd say that it's probably taking up at least 20 per cent of the patients I see on a shift," said Dr. Katrina Hurley, chief physician at the IWK's emergency department.

Hurley said there were no confirmed cases of respiratory syncytial virus, or RSV, in Nova Scotia last year because COVID-19 precautions work to prevent other viruses.

"That means any child under the age of two right now has essentially not been exposed to RSV," she said.

RSV is a highly contagious respiratory virus that is particularly dangerous to babies. It's most common in the winter months and can lead to bronchiolitis, a potentially serious lung infection.

"The infants [with] the highest risk of severe disease are under six weeks of age. But I would say, overall, anyone three months old or younger would be in a higher risk category," said Hurley. 

"Most parents would easily pick up signs compatible with bronchiolitis. So if your child is struggling to breathe, this would raise a red flag and an alarm to probably 99.9 per cent of parents."

Most children with symptoms of influenza-like illness that are admitted to hospital are swabbed and tested for RSV. Between Nov. 21 and Nov. 27, Nova Scotia reported 19 positive RSV cases, for a total of 46 cases so far this year.

'Never heard anything like that in my life'

A few weeks ago, Andrea Thompson's 8½-month-old, Whitley, started developing symptoms. 

"I have dealt with RSV and pneumonia and bronchitis — but this was completely different," she said.

"I had even gone as far as recording the way she was breathing because I ended up calling 811 because I had never heard anything like that in my life."

RSV symptoms may include runny nose, decreased appetite, coughing, sneezing, fever and wheezing, according to the U.S. Centers for Disease Control. In very young infants the only symptoms may be irritability, decreased activity and breathing difficulties. 

Thompson said she had a frustrating experience going back and forth from the Colchester East Hants emergency room to the IWK emergency room in Halifax as Whitley went through a cycle of getting better and then getting worse over the following days after her RSV-positive test.

Thompson said it was her daughter's dermatologist who eventually informed her that a medication Whitley used to treat a vascular birthmark might have added to her respiratory symptoms.

"I should have actually taken her off her medication while she had it but none of the physicians that we met with had known any different," she said.

Thompson's two-year-old daughter, Georgina, also caught RSV, but her symptoms were more mild than her little sister's.

IWK ER visits up 28%

Hurley said the volume of all patients coming through the IWK emergency room is up about 28 per cent over the same period in 2019 — Sept. 1 to Nov. 15.

"And if that trend continues and we rise 28 per cent over what is normal in winter, we'll be in a pickle," she said.

Hurley said she thinks part of that increase is to do with the number of RSV cases she's seeing, and it's partly to do with decreased availability at walk-in clinics due to COVID-19.

On the other hand, said Hurley, "You don't want to tell people to stay away because if they stay away, you run the risk of somebody who really should come, not coming."

RSV long-haulers

According to the CDC, RSV accounts for fewer than 500 deaths per year in children five years old and younger in the U.S., though complications after the disease may linger for years.

Jennifer MacLeod gets emotional remembering what she went through with her then 10-day-old daughter, Lauren, in 2008.

"It's been 13 years, but you just put yourself in that moment again," she said.

"Her oxygen saturation was 72 per cent when we went in … which is dangerously low, and they were actually slapping her back for a spinal tap to check for meningitis when a nurse came tearing down the hall and she said, 'Wait. We got the results of the mucus swab and it's RSV.'"

Lauren spent 11 days in hospital but returned half a dozen times over the course of the next year or so. 

"That first 24 hours is utterly terrifying because they tell you … had you waited, this wouldn't be the same outcome."

MacLeod said her daughter is a happy and active 13-year-old, but that she still suffers some lingering effects from RSV.

"So we all know now in a COVID world the term 'long haulers.' And that would apply to some RSV kids," she said.

Lauren had damage to her larynx from coughing and was given a prescription for an at-home nebulizing machine, which she still uses to this day.

"This is RSV season," said MacLeod. "It starts as early as October goes through March. Those were our torture months."

The same precautions for preventing COVID-19 are effective at preventing RSV: washing hands, using sanitizer and masks, and staying home if you're sick.

"I think that we need to consider whether or not it's worth taking babies out to mingle when we know that there is possibly a high degree of virus circulating in the community," said Hurley.

Both Thompson and MacLeod have the same advice for parents to prevent their little ones from getting sick during RSV season.

"Right now — even even with COVID, even without COVID — people shouldn't be kissing babies.... RSV is a serious illness. It kills. It kills babies. They can't do anything to protect themselves," said Thompson.

"It's the hardest thing in the world because you're basically begging parents to say to their family, the best way to love my new baby is from over there," said MacLeod.

There is no specific treatment for RSV, said Hurley. Hospitals can provide intravenous fluids, mucus suction and oxygen if need be but there is no magic pill that will cure the virus.