RSV LEVELS COULD RISE RAPIDLY FOLLOWING RELAXATION OF RESTRICTIONS
In a previous article in autumn 20201 we wrote of the potential dangers of managing the usual seasonal winter peak of paediatric viral infections during the COVID-19 pandemic.
In reality, there have been negligible winter rates of respiratory syncytial virus (RSV) and influenza2 due to dramatically reduced social mixing. This is a pattern that has been repeated around the world, with low rates of respiratory viral infections reported in the US, Australia, and Finland.3–5
As restrictions relax, however, not only has the usual summer lull in paediatric infections not occurred,6 but also some paediatric A&Es have even reported becoming overwhelmed.7 This pattern has also been recognised elsewhere in the world, with inter-seasonal peaks in RSV infections in Australia and the southern US.8,9
SOUNDING THE ALARM
Growing concern of an increasing wave of childhood infections has led the Academy of Medical Sciences (AMS) to release a report suggesting that:
‘Our reasonable worst-case scenario modelling similarly suggests that RSV levels could rise rapidly following relaxation of behavioural and environmental interventions, with a peak outbreak in early autumn of between 1.5 and 2 times the magnitude of a “normal” year. This could result in between a 25% and 65% increase in cases in children under 5 years old, and between 30%–100% increase in the youngest infants.’10
It is not clear why these increases are happening but data from a study in the US11 suggest that the interventions put in place to control the pandemic may have reduced the childhood population’s resistance to normal endemic diseases, leading to a ‘build-up of susceptibility’.
This matters because, as the AMS report points out:
‘A peak in RSV would put pressure on primary care, which sees the majority of RSV patients, predominantly in the under-fives.’10
If we have learnt anything from the COVID-19 pandemic it is the importance of being as prepared as possible. As we come out of the worst of the restrictions put in place, it is important that GPs consider how best to manage the paediatric infection surge that is likely just around the corner.
- © British Journal of General Practice 2021
