The symptoms of Respiratory Syncytial Virus

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A surge in respiratory syncytial virus (RSV) cases among infants in Germany has left intensive care doctors shocked and hospitals stretched to breaking point. The German Interdisciplinary Association for Intensive Care and Emergency Medicine have said that the marriage of the seasonal surge in RSV cases with a shortage of nurses was causing a “catastrophic situation” in many healthcare facilities. In fact, a recent survey by the association revealed that there were fewer than 100 free intensive beds available for paediatric patients across the country — leaving doctors to make difficult decisions as to which children get one. In some cases, kids with RSV and other serious conditions are being transferred to hospitals elsewhere in Germany that presently have spare capacity.

RSV — which is also known as human orthopneumovirus — is a common, contagious RNA virus that infects the respiratory tract. Its primary name is derived from the fact that it causes infected cells to fuse together to form larger bodies called “syncytia”.

The virus is the single most common cause of respiratory hospitalisation in infants, and reinfection can occur later in life across all age groups. Its impact, however, varies.

In older children and adults it typically only causes a cough or cold. It is typically more severe, however, when it manifests in young children — often causing bronchiolitis — as well as the elderly and the immunocompromised, among whom it can trigger pneumonia.

Symptoms of RSV typically manifest within around four–six days after infection and usually include coughing, decreased appetite, fever, a runny nose, sneezing and wheezing.

In young infants, who nearly always experience at least one RSV infection prior to their second birthday, symptoms can often be limited to breathing difficulties, decreased activity and irritability.

Most RSV infections resolve themselves within a week or two. Parents of infected infants can help relieve the symptoms by administering over-the-counter fever reducers pain relievers such as acetaminophen or ibuprofen. It should be noted that aspirin is not suitable for children. Administration of fluids is also recommended to avoid dehydration.

Hospitalisation of patients with RSV can become necessary in the cases that they are having difficulty breathing, or if severe hydration sets in. Fortunately, hospital stays with RSV typically only last a few days.

In the most severe cases, patients may need to be administered intravenous fluids, given additional oxygen, or be intubated — a process in which a breathing tube is inserted down to the airway to facilitate mechanical ventilation.

Here in the UK, RSV case numbers are also on the up this winter following it having “almost disappeared” during the COVID-19 pandemic when lockdown measures had the side-effect of helping to keep the older virus at bay.

Paediatric infectious disease specialist Professor Marieke Emonts of the Great North Children’s Hospital in Newcastle upon Tyne said that RSV has returned since the UK has opened up once again — with a worrying winter likely lying ahead as the number of cases that are resulting in hospitalisation being is on the rise.

She told ChronicleLive: “RSV is going back into the community and spreading rapidly. It’s like influenza — if you have had a bad flu season, the next year tens to be better as more have been exposed. This year we’ve already seen the number of RSV cases go massively up.

“For most children it’s not too bad, but some can become really really sick, They might need oxygen and help with their breathing, some will even need to be put on a ventilator.”

Fortunately, however, the impact of this year’s seasonal surge does not yet appear to have reached close to the crisis situation being experienced over in Germany.

Professor Sebastian Brenner is the head of the paediatric intensive care unit at the University Hospital Dresden. He told n-tv: “If the forecasts are right, then things will get significantly more acute in the coming days and week.”

There are already precedents for this, he noted: “We see this in France, for example, and in Switzerland. If that happens, then there will be bottlenecks when it comes to treatment.”

Others are warning that German doctors are already finding themselves unable to provide the urgent care required to all the children that need it.

For example, the head of paediatric intensive care at the Hannover Medical School, Dr Michael Sasse, told the Associated Press that the situation “is so precarious that we genuinely have to say children are dying because we can’t treat them anymore.”

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On Thursday, Germany’s Health Minister, Karl Lauterbach, announced that the government would be easing various regulations to make it easier for hospital administrators to transfer nurses to paediatric units to compensate for staffing shortfalls.

In addition, the German authorities have committed to providing an additional €600million (£515million) to paediatric hospitals over the coming two years in an attempt to get ahead of future seasonal surges.

Last month, meanwhile, the European Union’s executive commission authorised the use of the world’s first one-dose drug for infants against RSV — nirsevimab, which is sold under the brand name Beyfortus by AstraZeneca and Sanofi.

European Foundation for the Care of Newborn Infants (EFCNI) chair and co-founder Silke Mader said: “Respiratory syncytial virus represents a health threat among infants, and each year we see the impact it can have on families, healthcare providers and the healthcare system. “

She added: “At EFCNI, we are excited about the opportunity to expand prevention efforts to all infants, as we believe this can help ease the current emotional, physical and financial burdens of RSV.”

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