Transcription:

Scott Webb: So if you're keeping score, we've got to worry about colds, flu, and COVID, and that would be enough for anybody, right? Now, we have to worry about RSV. As RSV cases are on the rise, especially in children, it would seem like we need to have an expert on to help educate us who's at the highest risk, what we can do to protect ourselves and so on. So, I'm joined today by Dr. David Ramos. He's an emergency medicine physician at Salinas Valley Memorial Hospital, and he's here today to tell us about RSV.

This is Ask the Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So, doctor, thanks so much for your time today. This is a particularly timely podcast because cases of RSV, you know, in addition to cold, flu and perhaps COVID, but RSV in particular is our focus today and they've been on the rise. So, let's start here just a little baseline, what is RSV?

Dr. David Ramos: RSV is a virus. Respiratory syncytial virus is it's full name and we've dealt with it for years. It's been around forever. And used to raise up our blood pressure as clinicians in the six-week-old crowd because that used to be kind of the first time they may get exposed to it. And because how six-week-olds react to it and then the nature and small airways that they have, they could get things that other people didn't get. So, I mean, RSV can be gotten by anybody in the population. But after a certain age, we were used to it just kind of manifesting as a cold, you know, one of, I don't know, 267 viruses that can cause symptoms attributed to the common cold. But RSV, where we can see it, besides six-week-olds hurting people is, you know, ends of the spectrums of age. So, six-week-olds and it can also get folks later in life who have immunocompromise, or they're aged or have other things like emphysema superimposed on the RSV. So, those are the things that you'll look at in terms of what is RSV.

Scott Webb: Yeah. And do we know, doctor...? It just seems like it's sort of being talked about more, right? Media, social media, word of mouth, whatever it is, it just seems like it's more prevalent right now. And I don't know if that's just in California or everywhere, but do we have a sense, do clinicians have a sense of why it seems so prevalent at the moment?

Dr. David Ramos: There's a couple of reasons. One, you know, RSV can just sometimes do things a little worse one year than the other. It's kind of like flu. I mean, not so much as specifics-driven as influenza, but it can do that year to year. We can have a bad year and a good year. I would tell you that it's happening everywhere in the US right now. I mean, I'm talking, you know, the colleagues not only up the road from us here at our tertiary care centers, but folks back home. I went to school in Kansas, University of Kansas and talking to colleagues around the pediatric emergency room there, they're inundated. Everybody in the nation is inundated. And reasons, one, I think we're having a worse season, but two, it's kind of a backlash of our COVID restrictions, right? And I don't want to blame COVID, I don't want to blame anybody's restrictions. It was just kids have been apart. So, we're seeing it mostly in kids. We're seeing, you know, the adults get the colds, but being that we've had kids away from each other, they haven't been able to mix up the way that they used to two or three years ago when they're going to daycare and going to school, and we've had mask mandates. They don't mix up these things and they don't get to step in the water the way they used to early and a little more gently as it were from an immunologic standpoint. Does that make sense the way I'm saying it?

Scott Webb: Yeah, it does.

Dr. David Ramos: We're just used to doing things a certain way, our bodies are used to it, and we've removed that. And now, they haven't had the exposures to RSV and other viruses, and so now they're kind of thrown into the deep end and we're seeing what this looks like. And kids in particular have to catch up immunologically, and this hits them harder than we've seen in a long time with any other virus, but RSV in particular. And not only are we seeing it in the six-week-olds, but we're seeing it in older, you know, four or five years, because these folks, like I said, they weren't getting exposed in six weeks or two years or anything else. So that's, I think, what we're seeing.

Scott Webb: Yeah, doctor, that makes total sense. And when we think about the signs and symptoms, you've mentioned that for most folks, RSV normally presents like a cold, right? Is that different now with RSV, especially in the younger population? So basically, what are the signs and symptoms? Are they different from cold, flu and COVID?

Dr. David Ramos: No, not at first. You know, they get a little fever and they get a little cough and things like that. And again, like I was telling you before, you know, what we ran into when you get these sort of things in a small level, you get a bit of inflammation in your airways and a lot of secretions. And as you get older, those airways can handle that a lot better. You cough, you clear things. They don't cause the problems that they do in a younger population. The problem that you have with younger populations, those bronchials, those airways, as they move smaller down, they don't have the area and wherewithal to resist particularly the secretions that these things cause. And so, they run into problems not clearing, they can develop, you know, plugged airways that can cause pneumonias and things that show up on x-rays as pneumonia. And that's kind of the critical issue. And again, like I said, when they get these incremental exposures, we've at first saw, you know, folks having RSV problems, like I said, over the years at the six-week mark and I use that as an arbitrary number. You know, it can go plus minus either way on that. But now, what we're seeing is these kids are getting blasted. So, we're seeing them come out to two years, three years, five years, and their airways, although bigger and like what we're used to traditionally seeing with RSV down at the six-week level, we're seeing in upper higher ages, similar reasons. It's just that the airway that used to be able to compensate for this now isn't because it's kind of a more overwhelming response to that age group. So, we got to watch them as well. We're seeing older age groups come in and be sick, and some of them critically sick.

Scott Webb: Yeah. Let's talk about that a little bit. I wanted to ask, you know, what things have been like at the hospital, at the ED the last couple of weeks regarding RSV, flu, COVID, you know, are folks, children being hospitalized for RSV? What have you been seeing in the emergency department?

Dr. David Ramos: First of all, we're seeing lots of people come in because lots of people are getting blasted, but you know, most of the older kids and adults we're able send home. But yes, we're seeing numbers, we're seeing a lot more hospitalizations with children. And so, it kind of became an all-hands-on-deck response where usually our pediatric wards aren't that filled because we can handle so many of these things and send them home. Now, we are keeping them. And the thing to remember, you know, here's a number for you to remember, there are 5,000 intensive care unit beds, pediatric intensive care unit beds in the nation. And when you look at that number against the population of 300 million people in the US and then scatter those 5,000 beds over all the major cities in the United States, that's not very many.

Scott Webb: Right.

Dr. David Ramos: We're used to being at a certain number of beds filled with kids for varying reasons. And now, the system's kind of overwhelmed. So, what we're seeing is this surge and the places that we usually send to Lucile Packard or UCSF Children's and stuff up and down this coast, up towards San Francisco, they're just overwhelmed and filled. All of these hospitals, we're just one, there's many other hospitals that are being surged like this and forced to hold their own kids and do more intensive care than they are used to doing. And that means either holding them in the emergency room or using our wards and trying to treat them as best we can.

And there's Dr. Wen, W-E-N, over at Lucile Packard that has been great with his team coaching us on what to do, giving us protocols, and then trickling it down through the chair of our department, Mr. Navarro and Kristina Martinez. Those folks have been working together with Dr. Wen and the critical care teams on what we can do best and how we can hold them best to which times the beds can open up. Everybody's working, you know, around-the-clock to figure out how to best safely do this. And then, we're working with our local pediatricians and family practice docs. If they have somebody that we've admitted and they get worse on the wards where they usually didn't, then we're training them up to take care of these patients as well.

So, an answer to your question, yeah, we're seeing surges like we've never seen before where I usually counted in our emergency room, a busy day is considered 180. A record day a month ago, a month and a half ago, would be 200 people coming through our ER in a 24-hour period. We are now seeing commonly every day about 240, 250 people. A record day is 300 people. That's a lot. That's a lot for our emergency room. And we run into things that a lot of ERs do. And ours in particular, we're a very efficient ER because we're in a very small footprint. And so yeah, it's been very challenging to say the least.

Scott Webb: You said 5,000, you know, pediatric beds. If you just said 5 million, I probably would've thought that still wasn't enough. So, it makes me wonder, because, you know, there's so much mirroring of symptoms between RSV, flu, cold, COVID. So obviously, a lot of people are heading to the ED, but a lot of people probably aren't because they're chalking it up to a cold or whatever, you know? I'm wonder ing can or does RSV kill? You know, is it that serious, especially in the most vulnerable populations, the children, the smaller people with the smaller airwaves or the immunocompromised? Can it be a killer if they just ignore the symptoms and chalk it up to being a common cold?

Dr. David Ramos: Well, what kills them is their inability to breathe, right? Yeah, RSV can be a killer. We've always been sensitized to that, again, traditionally, younger age groups. But it's like anything, parents are pretty good at, you know, depending on how many kids they have, if it's the first kid, you know, then every little bit, they come in and we're okay with that. You know, they're learning how to be parents. And then, you have five kids and, you know...

Scott Webb: The last one, you know, "You're fine. Rub some dirt on it."

Dr. David Ramos: You know, mom looks at the kids, she's on the phone. She says, "Is your hair on fire? No? Talk to me later." And so, you know, you got those spectrums of responses, but the thing is I think most folks get it when they're looking at their kid and they see colds, they see that their child might look a little panicked or looked like they may be pale or a little dusky. And before that, they got a good idea that my kid is working hard to breathe. And so, those are the things that usually guide them coming to educational things like this, you know, will sensitize them to come in more. You know what? I'm okay with that, even if it is a false alarm, you know? Yeah, it makes my day a little more busy, but together, I can sit there with mom and dad and look at their child and help them. A lot of my job, when I say physicians as the collective, our job is to reassure. And so, I'm good with that, but we can collectively, all of us look together and say, "This is okay. This is not okay. And this is when you come back. And if you're in doubt, come back. We'll see you."

Scott Webb: It's like a cold is a cold, right? And a cold may also be COVID or might lead to flu and, you know, just sort of like get my mind around this a little bit, but RSV's a little bit different, if I'm understanding you, that, yeah, there may be initially some of the symptoms that mirror cold and flu and perhaps COVID. But if your child is struggling to breathe, if they clearly are having trouble breathing, they have that sort of panicked look on their face, as you say, better to be safe than sorry, head to the ED, right?

Dr. David Ramos: Correct. You know, what's different with RSV, traditionally it hasn't killed that many. It could be that serious that we watched for it. But now, like I said, we're seeing more and more kids are seriously ill with it. And so, our awareness and our clinical expertise is in terms of assessment and treatment are heightened right now in this season, because of all the stuff that we discussed while and when we're seeing it hit kids so hard.

Scott Webb: Doctor, I appreciate your time. We had some laughs along the way, but RSV is serious and we want folks to take it seriously. If it looks like your child is struggling to breathe, that's a great time to head to the ED and better to be safe than sorry. And as we've talked about, you know, for things where there are vaccines, get those. Wear your mask, even if it's optional, because that can help. Wash your hands and so forth. So doctor, thanks so much for your time today. You stay well.

Dr. David Ramos: Likewise, you take care.

Scott Webb: And for a complete list of all of our podcasts, please visit svmh.com. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate, and review this podcast and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.