A GP HAS urged parents to be aware of symptoms of respiratory syncytial virus (RSV) in their children due to a surge in the number of cases, which has put pressure “on all parts of medical care”. 

Dr Máire Finn told The Journal that the virus is “rampant” in communities across the country and while it is not dangerous for everybody, it is very contagious and can make small babies very sick. 

RSV is a common, seasonal virus that causes coughs and colds. It is the main cause of bronchiolitis and pneumonia in very young children.

According to the Health Protection Surveillance Centre (HPSC), there were 985 cases of RSV recorded between 27 November and 3 December, up from 730 cases notified the previous week. 

The HPSC said 368 were hospitalised with RSV, with almost half (46%) of those below 12 months of age

“Respiratory syncytial virus (RSV) circulation remains at very high levels and RSV hospitalised cases continue to increase with the highest rates in those aged less than one year old, followed by the 1-4 year age group,” the HPSC added. 

Finn, a GP based in Ennis, said the true number of cases is likely to be much higher. 

RSV (respiratory syncytial virus) is a common virus that causes coughs and colds for babies every winter. Almost all children get RSV by the time they are 2 years old. Find out what parents need to know about RSV by watching this video from Dr. Ciara Martin. #HSEMyChild |… pic.twitter.com/yHGv5U7AMn

— HSE Ireland (@HSELive) December 9, 2023

“There’s been nearly 1,000 cases notified to the virus laboratory, but the problem is there’s multiples of that in the community because not all of them are going to be notified, so it really is rampant in the community,” she said.

“It’s a very contagious virus. It isn’t dangerous for everybody, thankfully, but for very young babies, babies under the age of six months, or any child under the age of a year, we’d be very cautious with them.”

Symptoms

The main symptoms of RSV are mild, such as a runny nose, coughing and sneezing. People usually recover within two to three weeks without treatment. 

Other symptoms include wheezing, a fever, a sore throat, difficulty feeding or decreased appetite. These symptoms will typically appear in stages, and not all at once.

After four or five days with the virus, babies and young children can develop bronchiolitis, a common chest infection in babies and young children.

Their symptoms may worsen at this point, and include increased breathing (more breaths per minute), fewer wet nappies and wheezing.

These symptoms usually remain for three to four days before slowly getting better. Some babies and young children may develop a cough with RSV that will persist for weeks after the start of the infection. This cough will not typically require antibiotics.

Finn said her practice has seen a lot of children in recent weeks, including as emergency appointments. 

“Most of our on the day emergency appointments are children now with symptoms that would correspond with RSV. We can’t be certain it is RSV but the presumption is that it is, so we’re definitely seeing more than the norm,” she said.

“Thankfully most of them don’t have to be admitted into hospital, but some do.”

She said it was difficult to say what caused the surge in cases, citing the bad weather, spending more time indoors and the impact of the Covid-19 pandemic.

“Over the last few years, because of Covid, there was a lot less other viruses circulating, so there’s a bit of a what we call virus naivety.

“The normal populations that would’ve gotten those viruses in the years of lockdown didn’t, and that’s actually really interesting, because it just shows that those kinds of measures that we used for Covid stopped all viral spread.”

‘Not something to take chances with’

Finn said that while parents should not worry about the spread of the virus, they should be aware of the signs and seek further treatment for their child if they are distressed, if their breathing is rapid, if they’re not wetting their nappies, if they are lethargic or struggling with their breathing.

“It’s not something to take chances with because some of the very small babies do become incredibly unwell,” she said. 

“If you have a child that’s unwell try and keep them out of childcare settings. If you have a newborn or a baby under the age of six months, I would try and avoid having too much contact with strangers or anybody who may have any signs of illness or any signs of a virus themselves.

“If somebody comes into your house and they are sniffling or have a cough or a cold, really they shouldn’t be picking up your baby and kissing them. It’s a difficult thing to say because it goes against all our instincts, but at the same time, they are vulnerable to this.”

RSV can also be serious for adults with a weakened immune system or those who are aged 65 or older, something Finn said can lead to a spread in infection.

“Parents who are trying to juggle work and a baby that isn’t able to go into their normal childcare or creche or school might have an elderly parent that’s minding the child as a result, who may be very vulnerable too, particularly if they have a weakened immune system or an underlying chest condition, like COPD,” she said.

“It’s something to be aware of. We don’t want to be alarmist, but just be very careful.”

She urged people to practice regular hand washing and good cough etiquette, to avoid crowded public places and to wear a mask if they are symptomatic.

“We still do that here in surgery. Anybody who’s symptomatic puts on a mask coming in, and we wear one if we have anything ourselves as well. You just don’t want to spread it around.”

She also said that parents should always follow their gut instinct if they’re worried.

You’re never wasting somebody’s time if you’re worried, and especially with small children. We always want to see them. 

Pressure on services

Finn also said that the surge in cases is putting pressure on GP services. 

“We do know and anticipate these surges every winter, and when they get out of hand, it’s very hard to manage and we have to manage on our normal routine,” she said.

“All the preventative medicine work, family planning, chronic disease management, menopause, all of this stuff needs to be managed, but when we’re under pressure with all the acute stuff, it is really difficult,” she said.

“Then there’s a a workforce crisis, as everybody knows in medicine and particularly in general practice. So it’s hard. We just have to go ahead and do it and hope that we manage it as well as we can.”

She said GPs are also “very aware” that surges such as these can lead to hospital overcrowding, something they do their best to help to prevent.

“We try and manage everything as much as we can here and when children are to be reviewed, we review them back here in our surgery again rather than sending them into the hospital.”

On RTÉ’s Today with Claire Byrne programme yesterday, Professor Suzanne Crowe, a Consultant in Paediatric Intensive Care at CHI Crumlin, said that while the number of cases is similar to last year, it seems this year’s surge would continue for longer. 

Crowe said that children who are hospitalised with RSV would usually spend around a week on a hospital ward, while children in intensive care would stay on a breathing machine between three and ten days. 

She also spoke about the impact a surge in RSV cases can have on the hospital, including planned surgeries being postponed or cancelled.

“The knock-on effect in terms of the cancellation or the postponement of major surgery is an uncaptured cost to the whole thing. If you’re waiting to get that call that your bed is available, you can come in and have your surgery, and then if you get the phone call that you’re now being postponed, it’s a terrible stress and disappointment for the family,” she said.

“The parents may have taken time off work to be ready to look after the child to get better after the surgery, and that all has to be put on ice until the bed is available.”

Crowe said they review their resources each day to see if they will need to postpone surgeries, something she described as “very stressful for everybody”, including staff. 

“As I was walking into the hospital this morning, I could see the night staff leaving and they all just looked exhausted. This has been going on now for five or six weeks.”

The HSE has said RSV is currently “at very high levels” in Ireland and is urging people to help limit the spread of the virus. 

In a statement to The Journal, a spokesperson for the health service said: “Sometimes RSV can be more serious and children will need to be cared for in hospital. You can usually treat RSV symptoms at home without needing to see a GP.

“Parents should be vigilant of their children’s symptoms, trust their instinct and always contact their GP if they are worried, especially if the symptoms get worse quickly,” the spokesperson said.

In order to curb the spread, the HSE is advising parents and caregivers to try to cocoon babies and avoid having them in large crowds, or visiting/being visited by those with cold and respiratory symptoms.

“When we are sick ourselves or have children who are sick, keep away from other children where possible and to ensure that we and young children use respiratory etiquette for coughs/sneezes,” the HSE continued. 

“It’s vital that children with cold- or flu-like illnesses don’t go to crèche or school until they are feeling better to try to avoid spreading these viruses.”

More information on RSV is available on the HSE website.