Future Tense

Why This Year’s Cold Season Has Been So Tough on Kids

“It is just a viral maelstrom out there right now.”

An adult hand holds a thermometer to a young girl's forehead; a second hand holds the girl's hair back.
Kelly Sikkema/Unsplash

Children across the country are being hit with a huge wave of viruses: RSV (respiratory syncytial virus), flu, COVID, and just regular old colds. It’s so bad that many pediatric facilities are at or over capacity. For the past couple of years, many of the public health precautions taken to avoid COVID helped keep other viruses at bay, too. But now, as many kids are getting their first taste of a “normal” fall cold season, cases are growing at an alarming—and, for pediatric care facilities, overwhelming—rate.

Advertisement

On Sunday’s episode of What Next: TBD, I spoke with Katherine Wu, science writer for the Atlantic, about why kids are so sick right now. Our conversation has been edited and condensed for clarity.

Lizzie O’Leary: What is going on right now with non-COVID viruses?

Advertisement
Advertisement
Advertisement

Katherine Wu: It is just a viral maelstrom out there right now. As the weather cools in autumn, and as we head into winter, it’s pretty common for a lot of respiratory viruses, in particular, to pop up. Flu and RSV are two of the most common ones, but also rhinovirus and enterovirus. So that’s not weird, but the volume of infections, and the relentlessness of co-infections, and subsequent one-after-the-other infections, is really pummeling everyone, and the reasons for that are kind of interesting.

Advertisement
Advertisement

RSV is surging pretty dramatically right now. What exactly is it?

It is another one of these respiratory viruses that circulates quite frequently. It is not new, it has been around for a long time and, in fact, researchers have been working on a vaccine. It looks like we may be getting one quite soon, from Pfizer. RSV is one of those viruses that kind of rises in the colder months. It primarily affects really young kids (and much older adults), and that’s thought to be because you can build up immunity after you’ve had a couple infections.

Is this explosion of viruses everywhere in the country, or is it just in places where it’s getting cold, and people are inside more and breathing air together?

Advertisement
Advertisement

Any time you see a wave of respiratory illness, it is going to be a little patchwork. Right now, there’s been a ton of RSV in the Northeast especially, but it really is everywhere. I’ve talked to physicians at hospitals in the middle of the country, the West Coast. The tricky thing is that we have so many things going on at once, and I think that’s primarily the overwhelming thing. It’s not just RSV, it’s not just flu. It’s that we have this especially large and kind of early-arriving swell of respiratory viral illnesses, and now, we have another virus in the mix, SARS-CoV-2, what’s been causing COVID these past few years.

Advertisement
Advertisement
Advertisement
Advertisement

I want to understand if this actually is worse, or if it just feels worse. I think sometimes as the parent of a toddler, you can get myopic, but it sounds like you’re saying it actually is worse.

Yeah. It’s been really humbling and, honestly, flooring to hear a lot of the accounts coming in from pediatricians and people who work in pediatric ICUs and emergency departments the past couple weeks. They are calling it one of the worst surges they have seen in their careers, and some people have been working for decades. It is pretty bonkers right now. The current RSV surge in Connecticut is two to four times what we would’ve considered a super severe season three years ago. Another place in Baltimore has pitched a tent outside of their pediatric emergency department to accommodate overflow. Other places have considered calling in the National Guard to assist them. This is definitely a big surge, and I don’t think every single hospital in the country is overwhelmed, we’re not at that point, but beds are very full, on the whole. And it seems to be this collision of super high demand and maybe not the sort of supply of care that that demand would require.

Advertisement
Advertisement
Advertisement

What are the leading theories as to why there are so many viruses circulating right now?

At the beginning of the pandemic, we took all these behavioral measures to tamp down on COVID transmission, but that also happened to work marvelously against all these other respiratory viruses. Flu actually almost completely disappeared in the winter that spanned 2020 to 2021. It was the quietest flu season that pretty much everyone I talked to had ever seen. There was a similar impact on RSV and a bunch of these other respiratory viruses—we just sort of drove them out. And now that those behavioral measures have been lifting—this is probably the most normal-looking autumn we’ve had since 2019—those viruses have taken every opportunity to come back. They’re sort of overlaying themselves onto a population, especially of kids, who didn’t have the opportunity to be exposed to these viruses during the pandemic and build up the immunity that might have dampened the severity of their first infections.

Advertisement
Advertisement

I was wondering, is this just kids, like mine, who were born during the pandemic? Or is this all kids?

The main thinking, right now, and this is definitely still a hypothesis, is that the kids who were born right before the pandemic, as well as during the pandemic, are some of the most vulnerable, especially with RSV, which is a very useful example to use here. First RSV infections tend to be really, really, really rough, especially for infants. Their airways are small, they don’t have the chest muscles to cough really forcefully to get out tons of mucus that might be clogging the little tubes that make up their airways. But, as they accumulate exposures, their immune systems learn to fight the virus off more readily.

Advertisement
Advertisement

So a lot of hospitals are seeing the infants they would expect having their first exposures, but they’re also seeing toddlers who are having their first exposures later. Normally they would expect toddlers to be able to mostly recover at home, because they were able to build up those first infections when they were 1 or 1 ½, but now it’s like we’re playing all this catch-up with these viruses.

What kind of effect does this surge have on care?

We’re not just seeing increased demand for pediatric care right now. It’s also hitting at a really unfortunate time, when pediatric care capacity has actually shrunk a little bit in this country, for a couple reasons. One is that because there was this massive decrease in more run-of-the-mill respiratory infections, a lot of pediatric hospitals actually shrunk their capacity, and health care has also been going through a bit of a funding crisis. Some hospitals took away beds in their pediatric ICU, for instance, and also, there has been a pretty large exodus of health workers amid the pandemic.

Advertisement
Advertisement
Advertisement

That really, I think, emphasizes how tough it is to care for kids when there’s this extreme imbalance in the number of kids that need treatment and the number of health care workers who can actually provide that care. It is a really rough time, and remember that this is coming after three years of a pandemic that has been incredibly difficult for everyone.

Advertisement
Advertisement

In a story you wrote, a doctor described this crisis as their 2020. Is pediatric care more vulnerable than adult health care to this kind of thing? Is it more thinly staffed, or less profitable? It’s just so striking that this seems to have happened so quickly, and that so many pediatric care centers are struggling.

Advertisement

I think there’s a couple ways to think about that. One is if you stack the adult numbers and the pediatric numbers, in terms of staff and patients being seen, the pediatric stuff is usually smaller. Kids are generally healthier. The specialties are usually smaller, in terms of the number of people going into them and the number of jobs that are open.

When there are these staffing shortages, hospitals may try to call in reinforcements or staff from other departments in the hospital. But it’s not so simple, a lot of the time. Kids are not just tiny adults. Their bodies are still growing. They have different anatomy, different physiology. They have different sets of drugs that are approved for use in them. There are different sorts of safety and efficacy considerations, and we’re talking about different interventions. As one physician put it to me, it’s not so easy to just immediately train someone to care for a 2-year-old.

Advertisement

I think if you’re listening to this and you’re a parent, it might be really scary, and if you’re not a parent, you might think, “Gosh, it still sounds kind of intense.” What should you be thinking about, both for your own family but then kind of larger community questions?

Advertisement

First off, if your kid is sick right now: I’m sorry, and it is probably going to be OK. The vast majority of kids are doing super well. Pediatricians know how to care for these kids, and a ton them are leaving the hospital healthy. That said, there are key things to watch out for. A kid that needs hospital-level care is going to exhibit very clear signs of respiratory distress: wheezing, really rapid breaths like they’re using their chest muscles, they’re struggling to use their whole body to breathe. If their lips are turning blue, if their fingernails are starting to turn blue, call your pediatrician, make absolutely sure that this is emergency-level care, and then take them to the nearest emergency department. We don’t want parents bringing their kids in for every single cough, because hospitals are already overwhelmed right now, but we also don’t want them to wait too long. This can really take a turn for the worse quite quickly.

Advertisement
Advertisement
Advertisement

Make sure your kids are up to date on whatever vaccines they can be getting right now. That includes COVID shots and flu shots. Now is really the time to be getting those. Things like masking, avoiding super packed gatherings, not going to school or work when you’re sick—that all contributes immensely, and hand-washing is also a really big deal for RSV. It’s really a great time for the community to come together and just try to tamp down on transmission the ways that we have really learned how to the past three years. We drove a ton of these viruses out of the community the first year that SARS CoV-2 was here, so we know how to do this. I hope we can replicate some of that this fall.

Future Tense is a partnership of Slate, New America, and Arizona State University that examines emerging technologies, public policy, and society.

Advertisement