COVID or RSV?

Now that kids have gone back to day care, camp and school, at least some parts of life seem to be getting back to normal. But along with their crumpled-up artwork, kids are also bringing home germs. One virus in particular, respiratory syncytial virus (RSV), is causing concern while it circulates during what is typically its off-season.

Two experts offer advice on what parents need to know about RSV, including how to differentiate it from COVID-19.

What is RSV?

RSV is a common virus that affects the upper respiratory system, which includes the nose and throat, and the lower respiratory system, which includes the lungs. In most people, the virus causes a cough, a runny nose, and sometimes a fever.

“We presume most individuals had RSV at some point in their lives, which can occur during early infancy and as young as the newborn period,” says pediatrician Steven Abelowitz, MD, Medical Director of Coastal Kids, a pediatric group practice in Orange County and a member of the Children’s Hospital Los Angeles Care Network. “If they get it again and are healthy with no preexisting conditions, the virus will present like a cold, mostly.”

The virus can be dangerous to some people, though. In infants, RSV can cause pneumonia or bronchiolitis, an inflammation of the small airways in the lungs. People over the age of 50 or those with heart or lung disease are also at risk for complications, and they can catch RSV from babies, toddlers and older kids. If your child gets RSV, keep him or her away from anyone in your family who is at high risk of becoming very sick. Most people with RSV are contagious during the three to eight days that they show symptoms.

RSV is very contagious. It can live on surfaces for hours, although the main way people catch it is by being in close contact with an infected person. The virus typically causes symptoms that last between seven to 10 days, but some kids can develop a cough that takes up to six weeks to clear.

Getting RSV during the summer is unusual. The virus typically circulates first on the East Coast, and then makes its way to the West Coast, where transmission peaks in January and February. But cases have been increasing over the last few months in California and elsewhere. In fact, the Centers for Disease Control and Prevention recently issued an alert to clinicians to let them know about a rise in RSV cases in Southern states.

“It’s hard to quantify the numbers since we don’t test all kids for RSV, but anecdotally, I can say we’ve seen much more bronchiolitis this summer,” says Deborah Liu, MD, Associate Director of Emergency Medicine at Children’s Hospital Los Angeles.

Dr. Abelowitz has also seen an uptick in kids showing cold-like symptoms.

“We’re seeing more winter-like viruses this summer than we’ve ever seen,” he says. “We are speculating that over the last few months, with society opening up after lockdowns, viruses are surging up a bit because kids are now exposed more than they were prior.”

Taking care of children with RSV

Most kids can recover from RSV at home. There is no medicine that works against the virus, but you can comfort children through their symptoms. If your child has a stuffy nose, for example, you can use a saline spray and a bulb to suction out the mucus. A humidifier may help soothe respiratory passages. If your older child is coughing a lot, prop his or her head with a pillow. Keep kids hydrated. If you have a baby, give frequent breastmilk or formula feedings, but don’t overfeed because babies can vomit easily when they have a cough or runny nose. If your baby is irritable or if your child feels extra lousy, you can give a pain reliever such as Tylenol or Motrin. Ask your pediatrician about the correct dose to give.

“For most viruses, the management is the same: Stay home, stay well-hydrated, get lots of sleep and take acetaminophen or ibuprofen for fever,” Dr. Liu says.

One thing to not give your child is a homeopathic medicine. According to Dr. Abelowitz, because homeopathic medications aren’t regulated by the U.S. Food and Drug Administration, there is no way to know if they are safe.

Symptoms to be concerned about

If your child develops a fever above 103 degrees, isn’t eating, is urinating very few times a day, is acting lethargic, or is acting or just looks very sick, call your pediatrician, Dr. Abelowitz advises.

“Always feel comfortable calling your pediatrician when you’re worried about your child’s symptoms. There really should be no limit on that,” Dr. Abelowitz says.

Some symptoms require a trip to the emergency department (ED). Severe dehydration, which can cause a very dry mouth or sunken eyes, should be treated immediately. In babies and toddlers, a warning sign is not having a wet diaper for 8 to 10 hours straight. If your child is struggling to breathe—such as using extra muscles to do it—wheezing, or breathing very fast, those are signs that you should go to the ED.

“Bronchiolitis can cause significant respiratory distress, and some patients require hospitalization and assistance in how they breathe, such as by needing extra oxygen or even a ventilator,” Dr. Liu says.

If your child has had a fever for five days in a row or longer, you should take him or her to the doctor to rule out a secondary infection. Sometimes children can develop a bacterial infection such as pneumonia, or an ear infection on top of a viral infection.

RSV and COVID-19

If your child has RSV symptoms, the first thing to do is to rule out COVID-19 by getting your child tested.

“You don’t want to be responsible for more community spread,” says Dr. Liu, who recommends taking your child for a polymerase chain reaction (PCR) test, which usually returns results in about 24 hours.

Rapid antigen tests have higher false negative rates than PCR tests. This means they are more likely than PCR tests to report that people don’t have SARS-CoV-2, the virus that causes COVID-19, when they actually do. Because not all COVID-19 testing sites will test children, it’s a good idea to reach out to your pediatrician for advice on where to get your child tested.

As for when kids can get back to their regular activities after getting RSV, Dr. Liu points out that most schools, camps and day cares require sick children to be fever-free for 24 hours before returning. If your child has recovered but still has a mild runny nose or light cough and has tested negative for the virus that causes COVID-19, he or she doesn’t necessarily need to stay home since these symptoms can last for three to four weeks.

“It is difficult to distinguish between COVID-19 and other respiratory viruses,” Dr. Liu says. “It’s hard enough for health care providers. Getting tested to determine if it’s COVID-19 or not is something we should advocate for.”