Three San Antonio hospitals are reporting an unusually high number of patients in emergency rooms with respiratory syncytial virus, or RSV, which usually causes mild, cold-like symptoms but can be dangerous and even fatal in infants and the elderly.

There have been no deaths reported due to the virus, according to local hospitals.

“For the past [few] months, there have been much higher volumes of patients in the emergency departments,” said Dr. W. Garrett Hunt, division chief for infectious diseases at the Children’s Hospital of San Antonio.

University Health pediatrician Dr. Dina Tom said that since August, RSV has been the “second most common virus admitted to the hospital in pediatrics,” behind the flu, which is also seeing an early season spike in Bexar County.

Tom said University has counted 175 positive samples of the virus since August. Year to date, she said the hospital has admitted 143 patients with RSV.

Methodist Children’s Hospital is seeing a similar increase, said Dr. Tarek Patel, a pediatric pulmonologist who works there and at other hospitals in the city. 

“We did see a big spike in RSV in the summer and now we’re seeing an unusually high number of patients as well with RSV in the hospital,” on the regular floor as well as in the ICU, he said.

“It’s unusual to have this many RSV patients early,” Patel added. 

How is RSV transmitted?

RSV is transmitted by touching objects that have been contaminated by infected respiratory droplets, or by direct contact through a cough or sneeze.

“So, [touching] a countertop, for example, and then touching their eyes or their mouth,” Hunt said.

Anyone can get RSV and it’s very common. It typically shows up as a mild cold in adults and adolescents, but can be more serious among children under 5 and the elderly.

It is the most common cause of pneumonia in children, causing inflammation in the lungs and congestion in their smaller airways. The virus can keep children from breathing enough oxygen. 

Parents should watch out for symptoms in their children like difficulty breathing or running out of breath while talking. Other symptoms mimic the common cold, Tom said, such as a runny or stuffy nose, watery eyes and high-pitched coughing.

Those infected can also suffer from a decrease in appetite, wheezing, low-grade fever and diarrhea, she added. 

RSV is rarely fatal, but if parents notice children vomiting, breathing hard and fast and their belly moving in and out or sucking in on their sides under the ribs, or if their child become inactive, they should get them to a hospital, because the child may need oxygen, she said. 

Why is RSV spreading so early?

Viral pneumonias are common in the winter because more people are indoors and sharing spaces and items amongst each other, said Tom. 

That hasn’t happened yet in South Texas, which is just now experiencing the first tinges of cooler fall weather. Instead, this early local wave could be yet another result of the pandemic.

Tom and others point to a decrease in RSV and other respiratory infections during the pandemic during which many people stayed home, wore masks and social distanced.

Those protective measures have waned, and in-person attendance in schools and workplaces has risen back to pre-pandemic levels. That and decreased immunity mean the spike in RSV and flu cases is not all that surprising, they say.

Climate change may be another contributing factor, Patel said. Warmer temperatures can affect how viruses travel, and linger.

He also noted that most children will come down with a case of RSV by the time they turn two. Many who might have already gotten it earlier are now being exposed to the virus for the first time. 

Treatment for RSV

Clinical trials are underway for a preventative RSV vaccine for the general public, but currently only children who have extreme prematurity, chronic lung disease or other serious diseases can receive a vaccine called palivizumab, Hunt said.

For most people, even children, who contract RSV, supportive home care that includes rest and hydration is sufficient.

Dr. Hunt recommended a humidifier to help relieve a stuffy nose or break up mucus congestion in the lungs. For little ones, he also recommended a FridaBaby nasal aspirator, a tool that suctions mucus. 

San Antonio doctors also recommended prevention by practicing good hygiene and hand washing, teaching children how to cough without spreading respiratory droplets and staying at home when sick. 

A guide to help prevent RSV.
A CDC guide to help prevent children from catching or spreading RSV. Credit: Courtesy / CDC

At the hospital, children with RSV may be treated with oxygen therapy, suctioning, saline treatments or fluid rehydration. About 2% of children are put on a ventilator, Patel said.

It is possible to get a co-infection of RSV and the flu or RSV and COVID-19, said Tom, so taking preventative measures is recommended. 

“We’re all interacting, coming back together again,” she said. “That’s the nature of interaction and being human, we’re all going to come together and share all of our good things and all of our secretions. Part of that is getting exposed to viruses.”

Doctors recommended getting vaccinated against as many viruses as possible. Most pharmacies, clinics and hospitals offer the COVID and flu vaccines, which are now available for young children.

Raquel Torres is the San Antonio Report's breaking news reporter. A 2020 graduate of Stephen F. Austin State University, her work has been recognized by the Texas Managing Editors. She previously worked...