Children are getting sick again from a variety of respiratory illnesses that have been largely absent during the COVID-19 pandemic, so now is not the time to let up on taking precautions against viruses, a top pediatrician warned.

“The measures we put in place to keep COVID from spreading basically made all of our usual respiratory viral friends that come and terrorize our communities every year disappear for a couple of years,” said Dr. Per Gesteland, a pediatric hospitalist with University of Utah Health and Intermountain Primary Children’s Hospital.

But illnesses like respiratory syncytial virus or RSV have returned.

“They have come back, in some cases quite remarkably in force because we had a bunch of kids build up that had no immunity to these things they normally see in their first couple years of life,” Gesteland said, so children aged 3 and 4 are getting their first RSV infections.

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What he termed an “unusual pattern of respiratory viral activity” also means some viruses are showing up earlier than usual.

There was a “quite sizable” outbreak of RSV last summer that continued into the typical fall start time for the virus. This year, Gesteland said the United States is seeing early RSV activity again in the East and Midwest. While it usually takes more time for the virus to make its way to Utah, it’s already appearing, he said.

Last week, he said there were about 100 pediatric patients with RSV throughout the Intermountain Healthcare system, the region’s largest health care provider, with an average of between six and 12 young patients ending up in the hospital.

“What’s weird is that we’re seeing it pretty early,” the doctor said. “We’re only seeing a handful of kids in the hospital so far, but we expect that will start to pick up and heading into November and December, we should be in pretty deep into RSV season.”

There was a late summer uptick in cases of rhinovirus, typically associated with the common cold, that stretched into September, Gesteland said. The hospital saw a lot of rhinovirus patients in respiratory distress, with asthma-like symptoms and wheezing, similar to outbreaks of a related enterovirus in 2014, 2016 and 2018.

When samples from a few of those patients were sent to the Centers for Disease Control and Prevention, he said a majority came back as positive for what’s known as enterovirus D68, which can cause severe symptoms such as difficulty breathing, as well as an uncommon but serious neurologic condition that weakens muscles.

“It basically missed one cycle,” Gesteland said of the virus that is usually mild in adults, according to the CDC. During the surge in cases, Primary Children’s Hospital was admitting “easily between 10 and 15” children with that illness weekly over several weeks, but that’s since dropped off and “luckily, that’s looking a lot better now.”

Now, Gesteland said, he’s bracing for influenza cases to jump “sometime in the next several weeks. It could be at any time.” There were about 60 flu cases systemwide last week, he said, although none of the children required hospitalization.

“It’s out there,” the doctor said. “We’re just waiting for the right conditions to have it kick into sustained community transmission. You can imagine when we get into wintertime, some cold weather, some bad air, a Thanksgiving get together, then flu’s got a great opportunity to take off.”

When it comes to COVID-19 and children, Gesteland said the coronavirus “has been pretty quiet, relatively, especially for pediatrics. But it’s still out there smoldering along. We’re not sure what’s going to happen with that this fall and winter. So that’s kind of an unknown.”

He’s advising parents to “get educated” about viruses they may not have had to worry much about before for their young children during the pandemic, suggesting they go to “Germ School,” part of an Intermountain Healthcare website focused on tracking disease activity in Utah, to learn more about what’s out there.

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The same mitigation measures that had been used to slow the spread of COVID-19 work against other viruses, too, Gesteland said, such as frequent and thorough hand washing with soap and water by children and everyone around them, keeping them away from people who are sick and masking when that’s not possible.

“People are kind of tired of that,” he said, even though COVID-19 remains “ever present” and is expected by many to flare up again this winter. “If you want to keep yourself or your family members from getting hit with influenza, RSV and other illnesses, those things will work.”

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Vaccinations, too, are key for all ages. Both flu and COVID-19 shots are available for children as young as 6 months old, and there are monthly injections available to protect children at the highest risk for RSV that usually aren’t given until December but will probably be offered earlier this year, he said.

Just how bad could it get this winter? Already, the hospital is seeing more patients than is usual for this time of year, Gesteland said, and “depending on when influenza hits and influenza and RSV line up, it can be pretty rough on the hospital systems. So we’re planning for things to be really busy.”

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