San Juan Regional Medical Center officials keeping an eye on RSV cases locally
FARMINGTON – One year ago the staff of San Juan Regional Medical Center was dealing with the peak of the pandemic's COVID-19 case levels.
This year, while COVID-19 cases are still part of the mix, the hospital is planning for a different unknown – a wave of mostly pediatric RSV cases that may or may not slow down in the coming weeks.
While seasonal surges in RSV cases in the past followed a usual six-week cycle, SJRMC's Chief Medical Officer Dr. Robert Underwood said on Nov. 23 that all bets are off as to how the caseload will grow or shrink in the near future.
RSV is not a new virus, and pediatricians consider it among the most galling to treat as there is no vaccine and the treatments for serious cases involve tools like supplemental oxygen. The virus hits hardest among very young children and the elderly.
“Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms,” according to the Centers for Disease Control and Prevention (CDC). “Most people recover in a week or two, but RSV can be serious, especially for infants and older adults."
While the virus is usually most actively spread starting in December, this year federal health officials say it made an early appearance. In some areas it caused a crisis for health care workers as pediatric care units filled up or overflowed well before the usual start of the cold and flu season.
In October, Underwood and others watched closely as coastal communities from the East Coast to Texas first reported the growing numbers of RSV cases among children. Doctors knew it was likely that areas like San Juan County would face the same situation eventually.
“It’s kind of here now,” he said.
There’s no way to compare today’s numbers to past numbers because of the disruption in disease transmission patterns that happened as a result of the pandemic.
“Anyone who tells you that they know is probably wrong,” Underwood said of what the near future holds. “…We’re always wary, we’re always paying attention.”
While the trends seem unforecastable, Underwood said it’s clear how everyone got here. With precautions taken to stem COVID-19 transmission such as masking and social distancing “we got so good at it we prevented a lot of folks from getting common illnesses in the way they usually would.”
This has led to an increased number of respiratory diseases during a time when there’s usually more of a lull.
“This is a little early,” Underwood said.”
On Nov. 23 SJRMC had 20 COVID-19-positive patients admitted, two of whom were on respirators.
On the same day, there were 11 RSV cases being treated. The day before there were 13, 10 of whom were children.
Underwood said the thing hospital administrators have their eyes on is the number of pediatric beds available across the state. To that end Underwood said he was recently on a call with other hospitals across the state to discuss plans should the pediatric RSV case numbers grow.
While SJRMC has 14 adult ICU beds, it has only 12 pediatric beds – beds set up specifically to treat the youngest of patients.
A virus that spreads fast but usually isn’t serious
Knowing how he virus spreads and knowing how it usually progresses are tools for understanding it.
SJRMC Pediatrician Dr. Brad Scoggins said RSV spreads rapidly but usually leaves one with symptoms similar to a bad cold.
“It is like any other virus,” Scoggins said in a prepared release. “Often spread in communal settings, schools daycares pass it around… I would assume at any given point that at least 1 kid in your kid’s class probably has it.”
Hand washing, and other common-sense precautions like staying away from people who appear to be sick or isolating oneself if one has symptoms, are recommended measures. But they only go so far.
“Washing your hands never hurts. But overall, there are not good ways to avoid getting viruses, I think we learned that over the last couple of years,” Scoggins said. “You can’t avoid it but you can have yourself well prepared so your immune system can deal with them if you do encounter them. Those are basic things. Make sure you get adequate night’s sleep, eat a good, varied diet, stay well hydrated and get regular exercise. That’s not a problem for most 2-year-olds, they can’t sit still!”
Preventative maintenance: Stay hydrated, get rest
“What I tell parents with all the headlines covering RSV and overwhelming children’s hospitals... This season is shaping up to be pretty rough,” Scoggins said. “There’s decreased immunity overall in our population from trying to sterilize our environments over the past couple of years. We will see a bad season as kids catch up with the infections they should have been getting all along.
“I tell parents to stick to those mainstays of health, make sure their kids are getting an adequate night’s sleep, 10-12 hours per night, adequately hydrated with water,” Scoggins continued. “Limit sugars. Make sure kids are eating a good variety of food.”
Easy to catch, the treatments are old school
“Even if you weren’t around a sick person, respiratory droplets when you cough or sneeze, especially in our dry climate, will stay suspended in the air for up to 24 hours,” Scoggins said. “So if you walk down the grocery aisle where someone previously sneezed, you can get it just like that.”
Former preterm infants and kids with immune system deficiencies are at higher risk, Scoggins said.
“Most kids will stay home and be fine. Most people will get an ugly cold,” he said. “It will follow the same pattern so they will get a little bit worse on day 3-5 and then shortly after that, they will cough a whole bunch. They turn around pretty quickly. The cough can linger.”
New evaluation policies have cut down on the number of young patients who must be hospitalized, Scoggins previously told the Daily Times.
“Even kids we have hospitalized, I’m usually able to let them go often within 12 hours of admission,” Scoggins said last week. “Sometimes we discharge them on home oxygen which really helps us keep kids out of the hospital and I feel like they get a lot better at home faster. We usually see them in the office the next day. By and large they do fantastic.
Scoggins said one should care for a child with RSV like one would for any other cold.
“My favorite mainstays are Vicks VapoRub, cool mist humidifier, hot tea with honey (for kids over 1 year) it’s the best cough suppressant and there are little to no side effects,” he said.
Knowing when a case becomes serious is key.
“RSV could turn into bronchiolitis, so we discuss worker breathing with parents. If kids start to breathe really quickly, use their accessory muscles, you can see pulling of the muscles in between the rib cage,” Scoggins said. “ If the child isn’t’ feeding properly, sleepy or lethargic, they need to be seen.”
State issues guidance
The state’s top health official on Nov. 23 urged New Mexicans to take precautions while enjoying the holiday season.
“People can take simple steps to avoid exposure as we all look forward to gathering with friends and family this holiday season,” said David R. Scrase M.D,, acting Department of Health cabinet secretary. “I encourage all New Mexicans to embrace common sense measures we know are effective at reducing the spread of respiratory illnesses. Stay up-to-date on vaccines, including COVID-19 boosters and flu shots, wash your hands, stay home if you’re ill and seek treatment from your primary care provider.”
Later that day the state issued another announcement.
“Gov. Michelle Lujan Grisham tested positive for COVID-19 late Wednesday afternoon,” a news release from her office stated. “Per state and CDC guidance and protocol, Gov. Lujan Grisham is currently isolating at the governor’s residence and will not celebrate the upcoming Thanksgiving holiday with family.”
Lujan Grisham had recently returned from a trip to Egypt where she represented New Mexico and the United States at the 27th United Nations Climate Change Conference.
“I am very grateful to be experiencing only mild symptoms after being fully vaccinated and boosted against COVID-19, including the latest bivalent booster,” she said in a statement. “While testing positive just before the Thanksgiving holiday is disappointing, I know that I am protecting my loved ones by isolating and not joining them for holiday festivities.”
“I encourage all New Mexicans to take steps to reduce the risk of respiratory illnesses this holiday season, particularly as area hospitals are experiencing a surge of pediatric respiratory illnesses – consider testing before holiday gatherings, and please stay home if you’re sick,” she continued. “I especially encourage all New Mexicans to get the latest bivalent COVID-19 booster in order to stay best protected – you can schedule shots at vaccinenm.org.”
Gov. Lujan Grisham first tested positive for COVID-19 on Aug. 25, 2022.