Pittsburgh mom Paris Saunders hasn’t yet decided whether her 3-year-old should receive the RSV vaccine.
Preschooler Mae’Ana got a flu jab earlier this fall, but respiratory syncytial virus cases are on the rise, and Saunders wants to be prepared. But before putting her daughter through the discomfort of another shot, she wants to do a little more research and speak with Mae’Ana’s pediatrician.
“I just want to keep my baby healthy,” Saunders said.
Many Pennsylvania families are making such calculations ahead of winter, a time of both warm gatherings and infectious maladies. Physicians told Spotlight PA that they don’t anticipate the surges of patients they saw during the first winters of the COVID-19 pandemic, but noted that viruses are unpredictable and encouraged vaccinations.
Drawing on lessons from the pandemic, Pennsylvania clinicians and health systems have also changed some of their protocols to better handle any waves of infection.
The current picture is familiar. Though rates of influenza remain relatively low in the commonwealth as of Nov. 30, data from the state Department of Health show that cases of RSV are increasing more rapidly. If previous trends hold, flu infections will spike later. COVID-19 is still a bit of a wild card, though there’s likely to be an increase in cases this winter.
RSV infection rates rise earlier than those of other respiratory viruses, said Amesh Adalja, an infectious disease physician and researcher at the Johns Hopkins Center for Health Security.
Infants are particularly at risk. RSV is the leading cause of hospitalizations for them in the United States, according to the CDC. Pennsylvania data show that kids younger than five are most likely to become infected compared to other groups
That’s concerning because medical facilities tend to have limited bed capacity for pediatric patients.
“It takes much less stress on a pediatric hospital to put it into a surge type of situation,” Adalja said. “And we have seen those surge-type of situations with RSV when there’s a lot of children hospitalized.”
That was the case during the falls of 2021 and 2022, when demand for pediatric emergency care was so high that UPMC Children’s Hospital of Pittsburgh set up a tent in its ambulance bay.
However, those were weird years for not only RSV but respiratory illnesses in general.
COVID-19 mitigation measures such as social distancing and masking disrupted the transmission patterns of other respiratory illnesses. One strain of influenza even disappeared.
“It was something unlike we had ever experienced before,” said Timothy Friel, an infectious diseases doctor and chair of the Department of Medicine at Lehigh Valley Health Network.
But when COVID-19 restrictions were lifted, RSV and influenza came roaring back. Kids who were born or very young during the COVID-19 lockdown had little to no immunity against RSV, so severe illness among pediatric patients spiked.
This turn of events hit the medical system like an “unexpected punch,” said Friel. The resurgence of the virus also wreaked havoc on older adults.
Now that viral cycles are returning to normal, health systems in the commonwealth say they are better poised to handle infections.
At Penn State Health Cocoa Outpatient Center in Hershey, staff try to isolate patients with respiratory infections as soon as possible, said medical director Emily Link, an internist.
Penn State Health also expanded the use of telemedicine, which is especially beneficial to people who are immunocompromised, Link said. Clinicians are now more likely to stay home when they’re unwell.
“There used to be a culture of, like, ‘Unless you’re dying, you better come to work,’” Link said. “That has really changed in terms of, “Hey, if you’re sick … you cannot be spreading that to patients.’”
Jeffrey Jahre said COVID-19 taught him that health systems must be self-sufficient during a crisis. Jahre is senior vice president of medical and academic affairs at St. Luke’s University Health Network, a 15-hospital system with facilities in eastern Pennsylvania and New Jersey.
To weather the severe shortage of masks in the early months of COVID-19, for instance, the health system 3D-printed its own supply. It also partnered with Lehigh University to invent a process that uses ultraviolet light to sterilize masks so a staff member can reuse a mask multiple times.
“The government is not the cavalry. Don’t rely on the government to come and save you,” Jahre said. “We are responsible for our community.”
Such readiness helps clinicians prepare for the unpredictability of these viruses, particularly influenza.
“Every year it can do different things as far as when it’s going to really rear its ugly head. And that can be as early as November, or as late as March and April,” Friel said.
St. Luke’s collects its own epidemiological data to stay vigilant, Jahre said. The system shares this information with clinicians across the network, who can use it to guide treatment and testing.
Some U.S. health systems now mandate masking on floors with immunocompromised patients, Adalja said. Generally, he noted, medical facilities have increased coordination between themselves and done more to promote vaccinations among health care staff.
“COVID, really I think, had a lot of hospital administrators realize … how precarious that balance can be during respiratory virus season,” he said, adding that health systems learned they can become stressed quickly.
Regarding vaccines, the CDC reports that just 20.0% of U.S. adults have received the updated COVID-19 vaccine this year, and 38.6% have gotten a flu shot. These numbers are comparable to those from December 2023.
There are complex cultural, social, and political reasons for why only a minority of people take these preventive health measures, said Graham Snyder, medical director of infection prevention and hospital epidemiology at UPMC. “People are making choices for their own health, and I respect that.”
However, he emphasizes that the flu, COVID-19, and RSV vaccines are all safe, effective, and well-researched.
Another infectious disease that physicians are keeping their eyes on is a strain of avian influenza that’s been circulating in cattle and poultry.
As of Dec. 6, the CDC has reported 58 confirmed cases of the virus in the United States this year]. Illness here has tended to be mild, though a teen in Canada was recently hospitalized.
This virus could eventually mutate, however. That might occur if a person or animal is simultaneously infected with bird flu and a strain more often found in humans. The viruses could then share genetic material to create something far more deadly — which was the case with the 1918 pandemic.
Some infectious disease researchers say whether such a virus emerges is not a matter of if but when.
“We always have to be respectful of nature, science, viruses … it doesn’t care that we just had a massive COVID pandemic.” Friel said.
In the meantime, Saunders hopes Mae’Ana doesn’t bring home too many bugs from preschool. The girl has previously been hospitalized for croup and bronchiolitis, scenarios Saunders doesn’t want to repeat.
