Kristopher Head’s godmother grew more and more worried about him with each breath that he struggled to gulp down last week.
A pediatrician had given the 20-month-old baby antibiotics and a breathing treatment, but he seemed to be getting worse. After a particularly worrisome night, his godmother and guardian, Victoria Spain Robinson, promised that she’d take him to the hospital come daylight.
They drove from Denham Springs to Baton Rouge, and in the emergency room of Our Lady of the Lake Children’s Hospital, medical providers diagnosed him with a case of respiratory syncytial virus, better known as RSV.
The diagnosis was a paradox, both surprising and anticlimactic at the same time. RSV cases are surging across Southern states — Louisiana’s Department of Health has officially deemed it RSV season — and the Centers for Disease Control and Prevention issued a warning about the spread.
But RSV does not usually skyrocket in the summer. It’s actually known as a winter virus that’s the leading cause of hospitalization among babies under age 1. For hospitals to be chock-full of little ones with RSV in the middle of July is unprecedented, providers say.
“This is the first time that I’ve ever seen a large-scale outbreak in the summertime in the past 20 years,” said Dr. Jay Hescock, who works for Children’s Hospital in New Orleans as an LSU Health Hospitalist Section chief.
Pediatricians say they are drained, working longer hours and extra shifts, burning through personal protective equipment and wondering whether the surge in cases will let up. Louisiana children’s hospitals are scrambling to find enough beds and staffers to take care of all of the RSV cases, and many have had to stop accepting transfers from other hospitals with their own buildings brimming past capacity.
As the coronavirus delta variant moves through Louisiana — largely affecting adults so far — RSV is sweeping through children, many of whom have been cooped up for more than a year amid coronavirus restrictions that have recently been lifted.
“We knew RSV was coming back and it would be bad,” said Dr. Andres Carrion, a pediatric pulmonologist for Our Lady of the Lake Children’s Hospital. “We’re seeing it early. The thing that worries me is we may not have a flattening. It could be a very long winter.”
Lilliana Credeur’s mother grew more and more worried about her as the 3-week-old infant’s breath sped up.
Our Lady of the Lake Children’s Hospital, for example, has been averaging 90 inpatients in recent weeks, with as many as 10 to 15 waiting for inpatient rooms to free up at any given time. At time last summer, though, the hospital was averaging numbers that were half — or even three-fourths — lower, with their average census ranging from 32 to 45.
The state’s Department of Health deems it RSV season when the percent positivity rate of RSV tests is more than 10%. The state stayed under that number until mid-May, when positive RSV cases jumped nearly 10 percentage points to just under 20%. Cases have continued to climb since then, and positive RSV cases at the beginning of July reached nearly 30%.
Those numbers still don’t capture the full picture of the state’s outbreak. Hospitalized children are tested for the virus, but some pediatricians don’t recommend testing for milder cases of RSV because there is no cure. Confirming its diagnosis does not usually change the treatment for typical symptoms of a virus: making sure children are properly hydrated, not struggling to breathe and keeping their airways clear.
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More cases, worse cases
As people wore masks, avoided large gatherings and washed their hands more than usual to stem the spread of the coronavirus last year, other viruses fell off as well. RSV was one of them, as was the flu.
But “as soon as things loosened up with COVID restrictions, we’ve had one thing after the other,” said Dr. Ashley Lucas, Our Lady of the Lake’s medical director of pediatric primary care.
First it was croup, a virus that affects upper airways. Then it was hand, foot and mouth disease, also caused by viruses that can lead to rashes around the mouth along with coldlike symptoms.
But the RSV surge has been the worst yet. For adults and older children who’ve had it before, RSV generally feels like a regular cold. But for babies and toddlers, it can lead to pneumonia and bronchiolitis.
“The cases we’re seeing right now are definitely more than what we’re used to seeing during regular season, and the severity is definitely worse than before,” said Dr. Reynaldo dela Rosa, a Lafayette pediatric intensivist who oversees the pediatric intensive care unit at Our Lady of Lourdes Women's and Children's Hospital.
“We’re hoping it will trickle down, but there’s no signs of it,” he added.
He advised that parents and guardians should keep a close eye on babies if they aren’t eating, have high fever or seem to be straining when they try to breathe. Seeing muscles contract in their backs or chest as they breathe is a sign that “the baby’s trying as much as they can to suck in air to breathe and survive”
That’s what worried Robinson, 44, about her godson, Kristopher. He was a micropreemie at birth, weighing just a little more than a pound, so he already had lung problems. His family lovingly calls him “fat daddy,” a moniker of just how much he’s grown since he was born.
When Robinson brought him to the hospital, there were no free beds to admit him immediately because of all of the other RSV cases — and various other maladies — filling up the hospital. They spent the night in an emergency department room, and Kristopher was admitted the next morning.
That’s become a recurring theme of the latest outbreak: Hospitals don’t necessarily have enough beds, or enough staff, to keep up.
“Most hospitals that take care of pediatric patients were not necessarily well equipped to deal with this summertime surge,” Hescock said. “It’s creating problems with finding places that’ll care for kids with this as well as other conditions.”
“They’ve all been full,” said Dr. Catherine O’Neal, Our Lady of the Lake’s chief medical officer. “No beds available for weeks, because they are full of critically ill kids who have respiratory viruses, most of it RSV.”
And while cases in adults are usually milder, they’re getting sick with RSV, too, O’Neal said. She said that as patients are confused about whether their symptoms are for COVID-19 or RSV, it puts “blinders on a little bit to the rising COVID that’s here.”
As Kristopher stayed at Our Lady of the Lake Children’s Hospital — the fullest it's been since its opening in late 2019 — providers gave him oxygen, intravenous fluids and upped the frequency of his Albuterol, which helps him to breathe. Robinson stayed by his side.
“I was like, Kristopher, you’ve got to get off this oxygen; Nanny’s ready to go home,” she said with a laugh.
'Them babies are precious'
Most children get RSV for the first time before they turn 2 years old. But the providers seeing them say that their patients span the gamut of newborn to toddler to child, largely because most haven’t been through the cycle of outbreaks — and immune system building — during the winter months.
“These kids have been so well-protected, they haven’t been exposed,” said Dr. Erin Hauck, the vice chief of Our Lady of the Lake’s pediatrics division.
Dr. Brooke Dismukes, a pediatrician at Ochsner Hospital for Children in Jefferson, said she’s seeing more 3- and 4-year-olds with more severe cases of RSV this summer who have never had it before.
“This looks exactly how it would look in our winter months,” she said.
They were fishermen, artists, basketball coaches, bus drivers.
One of the youngest hospitalized patients with RSV in the state was Lilliana Credeur, of St. Martinville, hospitalized at just 3 weeks old. Her mother said that a sibling picked up the virus at day care, which is probably how it spread to the newborn. Lilliana was released after more than a week of treatment at Our Lady of Lourdes Women’s and Children’s.
“Poor baby couldn’t eat for four days; they just had her on fluids,” said her mother, Ashley Credeur, 38.
Despite its high hospitalization rate, RSV is rarely fatal in the United States, though it can be particularly serious in children who already struggle to breathe, and the sickest might require intubation. Even for those with milder cases, it can be a miserable slog with no easy remedies. Children who have it often have fever, coughs and little appetite.
It also spreads easily — through respiratory droplets, like coughs, and on infected surfaces. Once Kristopher was hospitalized, Robinson said she started warning her neighbors and friends to keep their babies home and to stay out of crowds. She said she wanted to share his story in hopes of helping another family avoid having to hospitalize their little one.
“Them babies are so precious,” she said. “I’ve been trying to warn people: Stay away.”
Staff Writer Emily Woodruff contributed to this report.