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Most People Who Have Respiratory Syncytial Virus Feel This Symptom First

Don't let your guard down, doctors say.
FACT CHECKED BY Emilia Paluszek

Respiratory Syncytial Virus is spiking across the US, putting children's hospitals and doctors offices under tremendous strain. According to the CDC, there is an unseasonably early increase in RSV-associated emergency department visits and hospitalizations. "Certainly, we've seen an increase in our flu and respiratory syncytial virus, RSV numbers over the past several weeks," says Dr. Graham Tse, Chief Medical Officer at MemorialCare Miller Children's Hospital in Long Beach. "We have more flu, currently, locally, and nationally, than we've had in the last five years. So we may see a considerable early and quite significant surge." 

Dr. Tse says the combination of flu, RSV, and COVID-19 is a serious cause for concern amongst medical professionals. "Those are the big three that we're really worried about this winter. We wouldn't want to see any child with all three or more at the same time," Dr. Tse says. "Don't let your guard down. We want you to wash your hands, wear masks where appropriate when you're in close quarters with others and socially distance when you can." 

"Our youngest age group has largely been sheltered from viruses due to the pandemic," says family medicine physician Neha Vyas, MD. "Now, as they're returning to daycare and other pre-pandemic activities, they are being exposed to these viruses and haven't developed the immunity to them that normally occurs. RSV can also occur in adults. It usually looks like the common cold, so pay particular attention to worrisome signs like trouble breathing or dehydration." Here are five sure symptoms of RSV, according to experts. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


Runny Nose

Teacher and children with face mask back at school after covid-19 quarantine and lockdown.

As with the cold or flu, a runny nose is a common and early sign of RSV. There is no treatment for the virus, and in most cases it just needs to run its course. Over the counter medication can be used to help with symptoms. "Rest is important," says Dr. Vyas. "Prioritizing sleep, especially when they are ill, will allow for a quicker recovery, so maintain a proper nap and bedtime schedule."

Parents and caregivers who have young children in school are at increased risk of getting the illness. "There's often that spread from the younger kids that pick it up in school and in the community, and then bring it home," says Dr. Per Gesteland, a pediatric hospitalist at the University of Utah Health and Intermountain Primary Children's Hospital. "The baby may get the brunt of it, and the parent may have just a little bit of an annoying cold, and the school-aged child may have a moderately significant upper respiratory infection."



Respiratory disease. Unhappy cheerless family using paper tissues while sneezing

Coughing is another early sign of RSV, doctors say. "People here have been saying that it felt like Christmas in August, because we've seen quite a large number of kids with RSV through the summer months," says Dr. Ron Keren, chief medical officer at Children's Hospital of Philadelphia. While most children get at least one case of RSV by the time they turn two, the pandemic lockdowns prevented that from happening—so what's occurring now is a perfect storm. All the illnesses that have been deferred thanks to mask wearing and social distancing are being spread as people return to schools and offices.

"This virus occurs in the late fall through early spring months, but can vary in different parts of the country," says Andrea Jones, MD, FAAP. "With mask-wearing and physical distancing for COVID-19, there were fewer cases of RSV in 2020. However, once safety measures relaxed with the arrival of COVID-19 vaccines, a rise in RSV cases began in spring 2021. The spread of RSV and other seasonal respiratory illnesses like influenza (flu) has also started earlier than usual this year. Call your pediatrician right away if your child has any:

  • Symptoms of bronchiolitis (Fast breathing, flaring of the nostrils, head bobbing with breathing, rhythmic grunting during breathing, belly breathing, tugging between the ribs and/or the lower neck, wheezing).
  • Symptoms of dehydration (fewer than 1 wet diaper every 8 hours)
  • Pauses or difficulty breathing
  • Gray or blue color to tongue, lips or skin
  • Significantly decreased activity and alertness



Child girl wearing a protection mask against coronavirus

Fever is an early sign of RSV, experts say. "Typical symptoms resemble the common cold. However, RSV infection can also result in pneumonia, especially in the very young, the very old or those with weakened immune systems. However, mild or unnoticeable illness may occur," says the New York State Department of Health. "Symptoms generally begin four to six days after exposure. Symptoms generally develop slowly over a period of several days. The contagious period is usually less than 10 days after symptoms begin, but occasionally is longer. Symptoms, particularly a cough, may persist for a few days to a number of weeks."

"Fevers are really hit or miss with RSV infections, especially in young infants," says Dr. Priya Soni, assistant professor of pediatric infectious diseases at Cedars Sinai Medical Center. "You may need to take your baby to be evaluated sooner rather than later. Parents should be really astute to any changes, like in their activity and their appetite, and then pay particular attention to any signs of respiratory distress." 


Decrease In Appetite

kids cheeseburger meal

If you find yourself with cold-like symptoms and a loss of appetite, it could be RSV. "Babies with colds can have trouble feeding, because clogged noses make it hard to suck the bottle or breast, and breathe," says Scott Hamilton, MD. "More concerning signs of RSV, when we call it bronchiolitis, are rapid breathing (breathing 60-80 times per minute), wheezing, and worsening feeding. It's important that children drink plenty, to keep mucus moist, thin, and easy to handle. When an infant or toddler can't drink because of congestion, they begin to dehydrate."

"Caring for a sick child can be distressing, and we want to assure parents that RSV is a common childhood virus," says Dr. Judith A. Guzman-Cottrill, a professor of pediatrics at OHSU. "Most cases can be treated at home, but those few children who do require hospitalization receive supportive care and fully recover." 



Busy Family Home With Mother Working As Father Prepares Meal

Sneezing is a typical symptom of rsv, doctors say. "The virus dramatically increases secretions in the airways," says Ira Wardono, MD. "Older pediatric and adult patients are able to cough or sneeze out the extra secretions, but that is not the case for infants. Their muscles are not strong enough to cough up all the extra fluid. It's almost like they are drowning in their secretion, and that's what causes the trouble breathing. Parents or healthcare providers need to do the job for them by suctioning the airways, either at home or, if needed, in the hospital."

"Healthy adults and infants infected with RSV do not usually need to be hospitalized," says the CDC. "But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalized if they are having trouble breathing or are dehydrated. In the most severe cases, a person may require additional oxygen, or IV fluids (if they can't eat or drink enough), or intubation (have a breathing tube inserted through the mouth and down to the airway) with mechanical ventilation (a machine to help a person breathe). In most of these cases, hospitalization only lasts a few days."


How to Stay Safe Out There

Child girl wearing a protection mask against coronavirus

Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don't travel, social distance, avoid large crowds, don't go indoors with people you're not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Ferozan Mast
Ferozan Mast is a science, health and wellness writer with a passion for making science and research-backed information accessible to a general audience. Read more about Ferozan
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