Minnesota seeing early RSV season, severity unclear

A surprise early start to the winter respiratory virus season is clogging pediatric hospitals in Minnesota with sick and wheezing children.

The uptick is mostly from RSV and influenza, and a little COVID-19.

"Our emergency departments are seeing volumes that we have never seen before and the hospital capacity situation is worse than it has ever been overall during COVID," said Dr. John Hick, medical director for emergency preparedness at HCMC in Minneapolis.

Children occupied 141 of Minnesota's 144 pediatric intensive care beds on Tuesday and 417 of 437 general pediatric beds, according to the latest state figures. The filled beds belatedly match trends in the southern U.S.

RSV stands for respiratory syncytial virus, a cause of the common cold that can lead to serious breathing problems and other complications in infants and toddlers. Cases normally increase in the cold Minnesota winter, but they surged unexpectedly in summer 2021 and have surprised doctors again in fall 2022.

"Post-COVID, the seasonality of pediatric viral illnesses no longer applies," said Dr. Rob Sicoli, medical director for emergency medicine at Children's Minnesota.

More than 40% of RSV rapid tests were positive in the last week of October, and the rate remained unusually high at 25% in the first week of November, according to weekly tracking by the Minnesota Department of Health. RSV also caused about 190 hospitalizations in the seven-county Twin Cities area in the last week of October and 175 in the first week of November. Most admissions involved infants or toddlers, but one in five involved people five and older, including some adults.

David Henke, 36, expected his infant daughter would get sick after she was taken to child care for the first time in September, but he didn't expect RSV at this point in the year. His daughter needed clinical care from the surprising infection but no hospitalization, suffering mostly congestion, coughing and fever.

Both parents then got sick from RSV in October, and Henke — a spokesperson for the M Health Fairview health system — had a rare complication that was likely a result of the infection. An overreaction by his immune system resulted in Guillain-Barre syndrome, which caused nerve damage primarily in his hands.

"I wasn't able to button a shirt, I wasn't able to turn a key in a lock — all of those basic things you take for granted," said Henke, who was hospitalized for a week and is slowly regaining his mobility through occupational therapy.

Whether an early RSV season also means a more severe RSV season is unclear based on ER trends so far, Sicoli said. "There are definitely some of these kids that are presenting for care who are very ill — significant respiratory distress, oxygen required, things of that nature. And some are less ill. We've seen the usual broad spectrum."

RSV has combined with other infections to fill up the emergency rooms in Children's pediatric hospitals in Minneapolis and St. Paul, and cause backups and delays in their waiting rooms, Sicoli said. A triage process still ensures that children with severe respiratory distress or other urgent needs get seen quickly, he added.

Severe cases have consumed intensive care beds in general pediatric hospitals, prompting transfers of children with RSV to Gillette Children's' Specialty Healthcare. The St. Paul hospital traditionally treats children with complex disorders and disabilities rather than common infections.

The RSV season might have peaked already at the end of October, according to the latest state data, but doctors believe it will linger and combine with influenza to pressure hospitals.

"It's really feeling like quite a busy time and we haven't hit Thanksgiving," said Dr. Madeleine Gagnon, a complex care pediatrician at Gillette. "I'm sort of guarded on what the rest of this respiratory season will look like."

The 182 flu-related hospitalizations among all ages in Minnesota so far put the state well ahead of the typical start of the flu season — which usually surges over the holidays when family and group gatherings increase viral transmission.

Children have been early targets, with the per capita rate of flu-related hospitalizations being higher in children four and younger right now than in senior citizens, according to state influenza data. Usually the median age of flu-related hospitalizations is around 50 to 70 in Minnesota, but so far this year it is 30.

The state also reported 97 flu-like outbreaks in schools in the first week of November. Outbreaks are reported when schools have 5% of students absent or three children are missing from the same elementary school classroom with flu-like illness.

Doctors urged people to still seek medical care for children with severe symptoms, but that home care of milder symptoms could avoid some unnecessary trips and long waits in emergency rooms.

Consistent suctioning of nasal secretions will help children breathe, eat and sleep better during illness. No specific antiviral treatments against RSV are available for children, though several antibody treatments and vaccines are undergoing clinical trials.

Disrupted breathing, dehydration, irritability and lethargy are all reasons to consider medical care, Gagnon said. "We don't want parents to be alarmist and overact and have elevated anxiety … but we would rather see you and provide reassurance and supportive care like IV fluids or oxygen versus seeing you too far in the course" of illness when more life-sustaining measures might be needed.

Doctors urged people to reduce their risks by getting vaccinated against influenza as well as COVID-19, which has maintained a steady presence in Minnesota even if the infectious disease hasn't surged like it did over the last two falls.

The latest state update showed 480 COVID-19 hospitalizations in Minnesota among all age groups on Tuesday, an increase from the average of 444 this fall but a decline from a recent peak of 525 on Oct. 25.

Risks at this stage of the pandemic remain highest among the elderly. Out of 417 Minnesotans with COVID-19 who were newly admitted to hospitals in the week ending Nov. 5, only 12 were younger than 18.

The connection between COVID-19 and the early start of RSV and flu seasons remains unclear. The dominant coronavirus might have altered the timing of other respiratory viruses. Efforts to avoid infections during the pandemic might have left people more susceptible now, allowing respiratory viruses to spread more quickly.