With the best scientific minds focused on Covid-19, it’s easy to forget about other dangerous viruses.
On Wednesday, the British Lung Foundation warned that young children in the UK may be at extra risk this winter from respiratory syncytial virus (RSV), an infection that can in rare cases make it difficult for children to breathe. And lockdown may be partly responsible.
In a normal, non-pandemic year, RSV causes about 20,000 hospital admissions in England in children aged below one, according to data from the charity. Cases are currently still low: during the last three months, roughly 1,000 children were admitted to hospital with RSV in England. But the RSV season started much earlier than usual this year, causing experts to worry that cases could rise sharply over the next few months.
RSV is extremely common. In most cases it causes mild symptoms – a runny nose, a cough, and sometimes a raised temperature – and about 80 per cent of children are infected by the age of two. “You wouldn’t know it from the common cold,” says Dr Andrew Whittamore, a GP and clinical lead at the British Lung Foundation. Indeed, the only reliable way to distinguish it from a cold is via a lab test, but most people won't reach that stage and RSV will clear up on its own.
But in some cases the virus attacks the lower section of the airways, known as the bronchioles. This can cause the airways to inflame – a condition known as bronchiolitis. For adults this is rarely something to worry about, but bronchiolitis can cause breathing difficulties for young children due to their smaller airways. About three in 100 children who contract RSV are admitted to hospital.
In terms of symptoms, the American Lung Association says you should look out for: “Short, shallow and rapid breathing. This can be identified by ‘caving-in’ of the chest in between the ribs and under the ribs ... ‘spreading-out’ of the nostrils with every breath ... and abnormally fast breathing.”
Chloe Ann-Ford, 22, a mother-of-two from the Isle of Wight, recalls her fear when her 12-week-old son Teddy was admitted to hospital with bronchiolitis in November. “[He] deteriorated so quickly,” she says. “One minute he was kicking away in his cot, the next he went all pale and clammy and was really struggling to breathe. He kept holding his breath and his ribcage seemed to be heaving. We were so frightened that my partner, Matthew, called an ambulance.
“We had to spend five nights in hospital and Teddy was kept on oxygen. On one occasion, he stopped breathing for 28 seconds, which was terrifying. I thought Teddy had Covid as I had tested positive, but he had RSV.”
Doctors told Ford her son may have caught the virus from his five-year-old sister, Charlotte, who probably picked it up at school. Teddy is now fully recovered – and his was an extreme case – but his mother is keen to make other parents aware of RSV.
Lockdowns have clearly disrupted the normal cycle. Infections normally rise in the early months of the year, with a particular spike in January, says Dr Whittamore. But last winter there was very little RSV, probably as a result of lockdowns. Then, when restrictions were lifted in early 2021, doctors saw a resurgence in RSV-caused bronchiolitis in July. “That’s really unusual – we never normally see summer peaks,” he says. “Because of all the Covid restrictions, we’ve been spreading viruses less, so we think that everybody's natural immunity to viruses like RSV has gone down.”
Since then, he says: “It’s been bumbling along at a reasonably high level for a few months. Our worry is that it’s now going to kick off and cause a big spike towards the end of January.”
Dr Whittamore predicts that RSV will affect more children this year and that those children may on average suffer more serious symptoms. Doctors fear an increase in RSV-caused hospital admissions this year.
Already, the British Lung Foundation has seen a 400 per cent increase in calls related to bronchiolitis-like symptoms over the last three months, compared to the same period a year earlier (though some of this rise might be explained by increased media attention on the virus).
Other experts believe the increase in parents reporting respiratory issues in their children may in part be explained by psychological factors. Parents have probably lowered their “threshold for anxiety” after 18 months of Covid, Damian Roland, professor of paediatric emergency medicine at the University of Leicester, told The Telegraph earlier this week.
So what can be done? In most cases, mild symptoms will go away by themselves after about five days, though a cough may linger. “As long as those children are not struggling with their breathing, they’re feeding fine, they’re not getting dehydrated, then they’re absolutely fine to be looked after at home,” says Dr Whittamore.
“However, if the child's breathing becomes more laboured, if they’re starting to feed less well, or they’re more sleepy than normal, or they’re getting dehydrated, or even if the parents are just a bit anxious about a child, then I’d encourage them to contact their GP or call 111 for some advice.”
Dr Whittamore also suggests that adults suffering from a respiratory infection should consider avoiding young children if possible this winter. “With Covid, we have learned a little bit more about not spreading viruses. Around young children, you don't really want to be giving them an illness that could make them very unwell and put them in hospital, even if for most people it is a mild illness.”