Jerry Evans: The situation is that RSV which is a virus that we usually see every year but we haven't seen in two and a half years is now flaring up pretty extensively in the state of Michigan. The spik is pretty high right now, we're seeing a lot of cases of RSV. RSV is called Respiratory Syncytial Virus, that's the official name of it, but we call it RSV it’s a virus that causes respiratory infection. It can affect anybody but primarily the danger is in kids. So the smallest of the children or the very elderly with a lot of medical problems. The bottom line is that RSV is hitting our children really hard right now. We're seeing a lot of kids coming into the emergency departments with respiratory complaints. Most kids do very well with it. But our pediatric hospitals in the state of Michigan are full and they're full of RSV cases, and a number of other things, but RSV primarily and what that's doing is it's causing a backup into other hospitals. So for the most part, non-pediatric hospitals, if you need to admit a patient, will transfer those patients to the pediatric hospitals. So here in West Michigan that means we send them to DeVos Children's Hospital. But DeVos is now at or near capacity and so what they're doing is saying, you know, that one doesn't sound too bad let’s hold him there for a while and see how they do, which is the appropriate thing to do because they need to take the worst of the worst, right? They need to take the kids that are in real trouble that may need a ventilator, those kind of things. So what that's forcing are smaller hospitals to do is to hold patients for much longer time. But most hospitals don't admit kids anymore for respiratory problems. So we're holding kids for longer periods than we normally do. And that's an unusual situation right now. And it's a serious situation because of the number of kids still going up, that are getting RSV. So the spike is not ending it still on the rise. So we're hopeful that this will slow down, but we just don't know when.
Patrick Center: So, if you're a parent, what are the symptoms? And when do you know that you need to act and that you do need to have medical attention?
JE: That's a great question. So initially, it starts out as basically a cold: runny nose, cough, congestion. And in many kids, it stays that way. It's just a bad cold. But in some kids, it gets to a point where they start having trouble breathing. And this is true, especially in the youngest children. So less than one year of age, especially
if they're struggling to breathe, if it looks like they're working hard to breathe. Something called retractions, which is if you look at their chest, the skin between the ribs will suck in when they're breathing in rather than expanding, they’re working hard to breathe. Or their stomach, when they breathe in, that will suck in instead of expand out. Again that's called retraction and that’s a significant sign that they're working harder to breathe than they should. Also the respiratory rate is higher than normal in these kids and they have a noisy breathing. The retractions and the respiratory rate are the 2 biggest signs that you're starting to get in trouble and you need to come in. The fever can go up and down. The fever we don't worry too much about. You can treat the fever with Tylenol, but with the retractions and the respiratory rate. And if you have a pulse oximeter, which is what a lot of people have now because they checked oxygen levels with kids or for adults. If the pulse oxygen is below 90%, that's a problem, too. So those are the things that we look at, respiratory rate, breathing. And then the other issue becomes feeding. So kids who are working hard to breathe can't feed well.
So they’ll get dehydrated, too. And that's a real issue. So watching how many diapers their wedding and they would in a normal number of diapers or is that decreasing? If they are they taking in a lot less food than usual, then that's a problem.
PC: So it sounds as though there are different age groups impacted differently. So when you get into that age group, beyond 1 and 2 years of age, how should parents treat that?
JE: It's similar in that kids, even 2, 3, 4, 5, can get into trouble with RSV, but that's not the norm. Most kids with that age group, they do a little bit better because they can breathe a little stronger, their little stronger there, little more endurance. And some of them have been exposed to RSV before so they don't get quite sick. So with these kids, the older kids, again, it's a matter of watching how hard they're working when they breathe. What's the respiratory rate? Are they working really hard and having to breathe really fast compared to their normal and again, looking for those retractions as well and wheezing. If their wheezing a really bad, then bring them in. RSV can be tough on kids with asthma. So if you have a history of asthma that can make it that much worse. So these are the kids that we worry about and that we check them out. They come into the emergency department. We'll check your temperature, we’ll check the respiratory rate, we’ll listen to their lungs. We don't normally do chest x-rays on these kids because the pneumonia is not really a big issue with this. it's called bronchiolitis, which is the inflammation of the larger airways in the lungs. And so that's where we will listen to them, we’ll look at their oxygen level. We'll check for hydration status. See what they look like. It's not a lot of tests that you can do for these kids. Except for the RSV nasal swab. You can do that. That's primarily what we would do is check them for RSV. Check oxygen level, check how they're doing and hydration status. Suctioning is one of the biggest things that you can do, especially for little infants is just suction their nose. Keeping nasal passages clear, and by doing that, that helps greatly with their ability to breathe. And so if you can do that at home, that's great. And they do better. That's fine. If they're still struggling to breathe, bring them in and we’ll check them out further. A lot of these kids can be maintained at home. But there are some that get sick enough to need to be in the hospital. It's highly contagious. I mean, this is RSV has been around for many, many years and we see a spike every year except for the last 2. So this is nothing new. It's just that this spike seems to be a little higher than the previous spikes. And we're dealing with COVID and influenza at the same time. So influenza is now hitting Michigan now, too. It’s just starting. So if we get an RSV and influenza spike, both, that's going to overwhelm the children's hospital even more. So that's where we're struggling. So for RSV, basically keeping kids hydrated, suctioning the nose, given Tylenol for the fever and watch them carefully. Most of them will do just fine if they get into trouble, bring them in. We'll take a look at them, we’ll evaluate them and make a decision as to whether they need to be hospitalized or not. And we'll go from there.
PC: Essentially, it's washing hands, right? It's all those age old preventative measures. And then when your kid is sick, don't send them to school.
JE: Exactly. And, you know, one of the things that the hand sanitizers and wash your hands of it is critical. But if your kids are sick, don't take him out. And if your kids are little, for example, if you have a newborn or, you know, 3 month-old somewhere in that range, be real careful about where you take them because RSV is everywhere. So you just got to be careful and watch out and make sure that you're watching them closely. Most kids will be fine even at that age group, but occasionally get really sick and they need to come in. So the other thing is influenza coming up, that's a little bit different than RSV. Still a respiratory virus that does affect adults as well as kids. The flu shot does help, significantly helps that. There's no immunization for RSV, but the flu shot does really make a difference for a lot of people. I will say that influenza, that can cause or lead to more pneumonia than an RSV. So influenza is a little more serious in that sense. But we see or we used to influenza every year, again not for the last 2 years. So it's going to be interesting to see what happens if we get a double spike with those 2.
PC: Doctor, Jerry Evans, medical director Region, 6 healthcare coalition. As always, we thank you for your time.
JE: Thank you.
