- So you made it through COVID.

You're ready to take off your mask and breathe easy for just a few.

But then, why is everyone I know getting sick right now?

- Great question, Sheena!

Like what is going on?

I mean, look at the bags under these eyes right now.

The hospitals are mayhem.

As a pediatrician, I can tell you from what the data says and from what I'm seeing, this is the worst respiratory virus season in recent memory.

- What the heck is going on?

How much do you actually need to worry and how can you stay safe and healthy?

Let's dive in.

(light music) - In a typical year, most people get sick in the winter, but this year doctors notice a surge of respiratory infections that started over the summer.

And since then things have only gotten worse.

- To see how bad it is, let's take a look at this chart.

These lines show how many patients are showing up to the doctors with flu-like symptoms, fever and cough.

That top line shows the cold and flu season that we're in right now.

The other colored lines are the past few years.

So you can see we are way, way higher right now.

- In case you're wondering, these numbers were not very high during COVID because sick people went to testing centers or took COVID tests at home, and if they did have to go to an emergency department they had symptoms like shortness of breath, which basically put them in a different category altogether.

So this is basically comparing the level of non-COVID respiratory infections.

Now, right now we have about four to five outbreaks happening at once in about every part of the country.

- This started back in June, and it kind of ramped up through the summer months, and then in September and October, it really just exploded.

- I've been in practice 28 years.

The surge is like we haven't seen in a long time.

All units are at full capacity and it's gotten to the point where playrooms, doctor rooms, call rooms, and units that were not for pediatric care are being turned into pediatric units so that we can create beds, basically, we can create rooms to take care of the patients.

- The biggest driver of the surge is a virus called RSV.

It's not that famous, but it is serious and it's been around for decades.

In fact, virtually all children will be infected with RSV by the time they're two years old.

It's usually mild, but for some, such as young babies and those with underlying heart or lung disease, it can be serious.

In fact, for infants younger than six months, about one to 2% will wind up hospitalized.

- And because this is such a common infection, that adds up.

Even in a typical year, RSV kills a few hundred American infants as well as 14,000 American adults and many more around the the world.

So here's what I'm seeing.

My last RSV patient was a COPD patient who was 45 years old, otherwise healthy and was completely miserable, crying at how much in pain he was and the cough and the sore throat and the achiness.

So just because it shows up as a common cold does not mean that it cannot affect your entire body and all your organs.

- My colleagues and I, what we're mostly seeing in the emergency department or in cases that are transferred from other hospitals are kids who are really struggling to breathe, to move air because of viruses, because of the inflammation, because of all the mucus, all the congestion.

Little babies are most susceptible, because their bronchials are tiny, they're narrow and easily clogged.

It's all a matter of size.

It's basic physics.

- This can happen to older children, too.

This is Sonny.

He's three years old from Austin, Texas and when he got sick, he ended up in the hospital.

- And we were just like, ah, well I guess it's just another cold.

And not only that, we were getting pretty much told by our pediatrician's office that, you know, this is just a virus and he should be fine.

You know, just take some Motrin, keep him hydrated.

But he wasn't eating, which took to us was a big tell.

I mean, it got really, it got really, really dire about four or five days into it, and he was wheezing and just feeling awful.

And yeah, we made an appointment at about four in the morning on a Saturday night after he got sick and we were the basically the first ones in the door and they took one look at him and just said like, his oxygen looks really, really low and it's too much for us.

We actually have to escalate it really quickly.

And so that point was pretty terrifying.

- Now what do you see when this happens?

Well, imagine if you're breathing against resistance.

We will see babies breathing faster, breathing harder, really, really struggling to move air, and using what we call accessory muscles.

So you'll see them breathing and you'll actually see their ribs.

You'll see their shoulders moving up and down.

We'll see their necks pulling inwards as they're fighting against resistance to move air.

- They said, "You need to get in an ambulance right away and go to the ER and take him right away."

So they put some oxygen on him.

He was dehydrated, he has respiratory distress.

We had no idea what was going on, actually, was that he had pneumonia on top of whatever virus he originally had, which we think was RSV.

It was really bad.

- I know it was so scary for you.

And what were your feelings at the moment they told you had to go to the hospital?

- So I went into that mode and Peter, his dad, went into like teamwork mode with the doctors and just started getting information and statistics and like figuring things out.

You know, I stayed in his hospital bed when he was in the hospital for like three days, so I like didn't leave his side.

Yeah, it was very serious.

We thought we were just going in for the afternoon and we were in it for the next three days.

So it was pretty intense.

- So, how's Sonny doing now?

(cheerful music) - He's doing great!

- Oh my God!

Hi, Sonny!

- It's not just RSV, there's still other cold viruses circulating, including rhinovirus and enterovirus D68.

That last one is mostly mild, but in some rare cases it can cause a polio-like neurological illness including paralysis.

And guess what?

COVID?

Yeah, it's still around.

It's still circulating, even though some people choose to ignore it.

- Meanwhile, we still have flu season, which also started early this year.

What are we gonna do?

- Then, there are co-infections.

These are children who are infected with RSV and who also have rhinovirus or who have human metapneumovirus or parainfluenza virus.

It's really a mixed bag.

- It's especially striking when you look at the last two years.

- The first winter of the pandemic in 2020, we saw less than half of the number of kids that we typically see with RSV.

And then in 2021, we saw almost no kids with RSV.

- We saw very decreased numbers of RSV.

As a matter of fact, we saying to ourselves, where did RSV go?

- So what exactly happened?

Here's a theory.

- For the past two to one a half years, the population has really been observing infection prevention practices by masking, hand washing, staying at home.

And our practices are changing, right?

So we're all going outside more.

The chances of exposure go hand in hand with the chance of infection.

- All those precautions meant people were exposed to fewer viruses.

It wasn't just protection against COVID.

- Remember how we said almost every child gets RSV by the time they're two?

Well, that's only under normal conditions, not during a pandemic when you're staying at home and wearing a mask.

- And so he was about six months old when we went into what we consider like COVID lockdown.

He only saw us and like a very close-knit, tight circle of family members.

We kept him super safe, you know, we're always masking, always doing all the precautions.

And he never got sick.

I don't think his entire, really, his entire life.

- So for Sonny even at age three, all of these viruses were new.

- His class is really small.

He goes to a little Montessori school in Austin.

He's got eight other kids in his class, eight or nine, I think it's nine.

All of them seem to have what the teachers thought was the same cold, you know, that week.

But was interesting because the kids who have been in school for a year or two years, unlike Sonny, those kids seem to just do fine with it, just take it in stride.

But other kids who were like brand new like him seemed to really take... His teacher's baby who's six months old spent a night in the hospital as well for low oxygen.

- So big picture, it's not that doctors think that RSV has all of a sudden become more severe.

It's just that all the kids who would've got it last year or the year before are now all getting it at the same time as all the other kids who are getting it as first timers.

- Now I'm seeing way more children coming into the hospital with RSV who are three and four years of age.

- With RSV, which is mostly threatened infants, one little wrinkle is that immunity doesn't originate in the infant itself.

In the first six months of life, before infants are really exposed to all the pathogens in the world, his or her immune memory comes from his or her mother from being inside her body.

The baby gets antibodies from their mother.

- And if mom was stuck at home wearing a mask whenever she went outside, she probably didn't have exposures that would induce antibodies that pass along to the baby growing inside of her.

- But there's still a lot we don't know.

For example, does mask wearing and social distancing fully explain why flu and cold cases were so low during the pandemic?

- One theory says that's only part of it.

It says that if you're exposed to one virus, say COVID, your immune system ramps up right away and makes it harder for other viruses to get a foothold.

- While it's possible for someone to get infected with two viruses at the same time, it's not common.

And it's probably because when you get an infection with a virus, you get both a specific immune response to that virus, but you also get a non-specific immune response of an activated immune system that happens with almost any infection.

And that non-specific immune response prevents you from getting infected with another virus at the same time.

- So the question is, is this what we're gonna see every year?

Is this the new normal, this non-stop wave of sniffles, coughs and worse?

I got good news for you.

Most people we talk to say probably not.

And thank God!

- Next year should look more like respiratory viral season before the pandemic.

All of the kids that have been born in the last year are now being exposed to these viruses this winter.

They will build up the defense as kids pre-pandemic would've built up the defense in the first year of life.

And when they see it again next winter, they're unlikely to have as severe an illness.

- Absolutely, I think so.

I am optimistic.

I'm always optimistic.

- For now, it's those same tried and true precautions you all know about: stay home if you're sick, don't go to work or school if you have cold or flu symptoms if you can help it, and keep sick people away from you.

And also, treat your body right, eat well, rest up, manage your stress and do all those things that your immune system will thank you for.

- And we have vaccines that work and work well.

Go get your flu shot, all ages.

The same thing with COVID.

Both vaccines work.

And if you're sick, don't come to work.

- I know, I know, it's not easy.

It's easier said than done.

You gotta go to work, you gotta go to school.

But if you wanna be extra careful, you can still wear a mask when you go out.

I see a lot of people doing it and it could be life saving.

Unfortunately, there is no RSV vaccine available yet.

But get ready, there are several experimental versions in advanced clinical trials, and in October, Pfizer announced good results.

So, we may have a new tool by the next cold and flu season.

- And also, for any babies who are at high risk for severe complications from RSV, there is potentially a drug available.

It's a monoclonal antibody called Synagis.

It's given monthly throughout fall and winter and it has been shown to prevent severe disease, but it's only for a specific patients.

So chat with your doctor if you have any questions.

And you can read more about this below.

- That does it for us on this week's PBS Vitals.

Tell us what you think in the comments, hit the like button, follow along on all of our socials.

We'd love to talk to you.

- And continue to do what you all do that Sheena and I hope that you're all continuously doing to stay healthy.

We will see you next time.

(bright music) (bright music continues)