A Brief Overview of Respiratory Viruses as We Enter the Winter Season

November 2022

It’s that wonderful time of year again for the flu, the common cold, respiratory syncytial virus — and don’t forget my personal favorite: COVID-19. Loaded sarcasm aside, it is important to have a basic understanding of the symptoms of each of these respiratory viruses, as many of the [symptoms] are overlapping, making it sometimes challenging to tell them apart.

I spoke with Dr. Jane Buroker with Witham Pediatrics of Anson about the specific symptoms, how quickly they present themselves and which symptoms should be monitored more closely to prevent hospitalization, specifically in children. However, the elderly and people with underlying health conditions should also be aware and cautious of their exposure to these respiratory viruses. And of course, as our publication is not an expert in health and/or medicine, any questions or concerns should be discussed with your medical providers.

Symptoms and Treatments of RSV

Dr. Buroker gave a brief overview of RSV and identified the most vulnerable population.

“RSV is a virus that has always been around,” Dr. Buroker explained. “It typically causes infections, usually, in the fall and wintertime. That’s when we normally would see the peak of infections. It tends to be a [respiratory] virus of infants and toddlers. I would say [RSV] is most concerning if the child has any underlying medical conditions. RSV can be an especially serious infection in children less than 2 years [of age] and even more so in infants less than 6 months of age.

According to Dr. Buroker, most kids get an RSV infection by age 2, and the most common symptoms of RSV include runny nose, cough and fever.

“The symptoms of RSV have a more gradual onset than influenza [flu], so its symptoms tend to ‘peak’ at day three, four and five,” Dr. Buroker shared. “That’s also when [younger kids] or infants can get into trouble [with RSV]. For a lot of kids, it will be a mild illness and similar to the common cold. Those kids don’t end up in the pediatrician’s office, and they don’t end up in an urgent care [facility] or ER. Their symptoms are managed at home. But for some kids, RSV creates more of this ‘RSV bronchiolitis,’ and that’s when the virus causes more inflammation of the lungs and more mucus in the lungs. That will give these kids and infants a raspier kind of productive and harsh cough. Again, those respiratory symptoms are what tend to peak on days three, four and five of the illness.”

Dr. Buroker added, “If the child has enough inflammation in their lungs or enough respiratory distress, that’s when they can get into trouble. There is no specific [outpatient] treatment for RSV other than supportive care at home. If it’s an infant, parents and/or guardians will do a lot of bulb suction to get rid of the nasal congestion and used nasal saline and drops to thin the mucus and then suck it out using bulb suction and similar devices because the child is working harder to breathe. Feeding can also be a challenge for them, so we typically recommend smaller and more frequent feedings, especially if they’re infants. Also, having a humidifier in their room can be helpful as can taking the babies into a bathroom and allowing them to breathe in warm steam from the shower so that it is easier for them to breathe.”

Currently, there is no available vaccine or specific antiviral medication for RSV outpatients, and Dr. Buroker confirmed that steroids and antibiotics don’t help. She added, “Sometimes, I tell the family that a time machine is all that can help. We need to get to days six and seven. We’d be fine if we just jumped over the next few days.”

Dr. Buroker mentioned that there are specific respiratory supports for children who are hospitalized and that the primary reasons for hospitalization are because the children have too much inflammation in their lungs and are not able to stay oxygenated purely on room air.

“These kids need oxygenation support, and sometimes they will actually go into respiratory failure and will need additional support — ventilation — to help them breathe as their lungs are recovering,” Dr. Buroker said. “Kids can also get dehydrated because they are working so hard to breathe and they aren’t taking in the liquids they need, so kids [who have been hospitalized] will receive IV fluids.”

The State of Cold, Flu and COVID-19 in Our Community

Dr. Buroker stated, “The common cold isn’t typically a concern, although some kids can get a secondary infection like bacterial pneumonia or a bacterial ear infection. Currently, COVID-19 has seemed to be milder for both children and adults over the last several months. Rarely, it can cause serious respiratory infections in children, and luckily, I haven’t seen a lot of that recently in my Boone County patient base.”

Acknowledging that there are many variables at play with COVID-19, Dr. Buroker emphasized that as we go into the holiday season, we should still be mindful of visiting with relatives and friends who are older or have health impairments that put them at a higher risk for more serious COVID-19 infections.

“It is still very reasonable and appropriate to do a home COVID-19 test or an in-office COVID-19 test [at your doctor’s office] prior to family gatherings if you’re concerned that you have symptoms or have been exposed to COVID,” Dr. Buroker encouraged. “This will minimize transmission to someone in your family or friends group who could still get very sick with COVID, even though the [infection] numbers are down and the disease seems to be milder at this point.”

If you suspect you may have COVID-19 or have tested positive at home, it is recommended you contact your health care provider for questions and concerns.

When asked if Indiana is seeing more cases of influenza than in previous seasons, Dr. Buroker said, “When you look at the CDC’s map of influenza activity, we’re seeing it [influenza] a little earlier than we have in other years. Classically, influenza does cause rapid onset of symptoms that almost always include fever, chills, body and muscle aches and then respiratory symptoms such as coughing, sore throat, stuffy nose, that kind of stuff. Symptoms of influenza tend to happen pretty quickly as opposed to RSV or the common cold, where those symptoms build up over the course of a couple of days.”

Dr. Buroker added, “Some people are more symptomatic with influenza, and it will hit them harder. We’re definitely seeing what is referred to as this ‘immunity gap,’ most likely a result from all the precautions we took during the pandemic and people’s immunity may have waned and [they] may be more symptomatic. I’ve definitely had school-aged kids miss a week of school because they were having a fever every day and couldn’t go back to school.”

Prevention and Precautions

Dr. Buroker advises her patients to get their flu and COVID-19 vaccines and to eat well, get plenty of sleep, consider wearing a mask indoors during “respiratory season,” wash their hands, cover their coughs and stay home when they’re sick.

“I always tell my families to trust their instincts,” Dr. Buroker suggested. “If you’re worried about your child, call your doctor. Your child should be seen for these respiratory illnesses if they’re having signs of respiratory distress or increased work of breathing, meaning they’re breathing really fast, grunting and/or having retractions where they’re doing a lot of belly breathing — and if they’re very lethargic or very irritable. Also, if they’re having signs of dehydration. We want kids to urinate at least three times in 24 hours or once about every 8 hours. You don’t necessarily need to go to the ER every time your child has a cough, so, in our practice, we want families to call us because we can either give you supportive care over the phone or direct [you] to the ER if necessary.”

Witham Pediatrics of Anson

Jane Buroker, M.D.

Janice Kunkel, M.D.

6085 Heartland Drive

Suite 208

Zionsville, IN 46077

Phone: (317) 768-2222

Writer:

Janelle Morrison

Photography:

Courtesy of Witham Health Services