Unseasonal, severe RSV outbreak baffles Mass. doctors

WORCESTER, Mass. — Last winter, UMass Memorial Medical Center didn’t see any cases of Respiratory Syncytial Virus, also known as RSV.

“The season was skipped,” said Tim Gibson, MD, Chief of the Division of Pediatric Hospital Medicine. “And we presume that it’s because of masking and social distancing. But it really was incredible. On any given day, we would have seven or eight patients admitted with RSV bronchiolitis.”

That pneumonia-like illness would also usually keep three to four of those patients in the intensive care unit, with some requiring supplemental oxygen or even assistance with breathing.

“And last winter we saw no RSV,” Gibson said. “It was really the most amazing infectious disease issue I’d ever seen other than Covid.”

It was the same situation at Baystate Medical Center in Springfield.

“Last year at Baystate, we did not have one child admitted with RSV bronchiolitis in the winter,” said Charlotte Boney, MD, chair of the Department of Pediatrics. “We saw our very first case in May. And since about early June, we’ve seen Christmas in July.”

And RSV is the kind of gift that keeps on giving. The virus spreads through droplets, can survive on hard surfaces for hours and while most infected people stop transmitting after a week, some can remain contagious for a month, according to the CDC.

Fortunately, most children and adults weather RSV infections without a problem. But newborns, especially those born premature, and children under one year of age can become extremely ill from the virus. As can anyone who is immunocompromised or has congenital or acquired defects of the heart or lungs.

What worries Gibson is that the current outbreak of RSV, at least in Worcester County, seems not only extensive -- but severe.

“Kids seem to be sick for longer, their fevers seem to be higher and persisting longer, such that we start to think, could it be other things,” he said. “It’s really been a very interesting phenomenon in the world of pediatrics.”

What’s also concerning is that just as doctors couldn’t predict RSV altering its normal seasonal pattern and emerging in summer -- they also can’t say whether it might get back to “business as usual” once the weather begins to cool down.

“I think the fear is that RSV is just going to continue unabated through our normal winter respiratory season, and we’ll have just one massive, prolonged RSV season,” Gibson said.

Down at Hasbro Children’s Hospital in Providence, Michael Koster, MD, director of the Division of Pediatric Infectious Diseases, said the RSV wave there is getting worse, with recent weekly case counts soaring to the 70 to 100 range.

Only a small number of children require hospitalization, he said, and the one benefit to infection is short-term immunity.

“Typically, when you have RSV, you’re protected for the rest of that season,” Koster said. For now, that season shows no sign of letting up.

“Number one, it’s increasing,” said Koster. “Number two is that it’s persistent. It’s staying with us.”

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