While nothing about this year has been normal, leaders across the country are reporting respiratory illnesses returning to more typical levels.
As COVID-19 precautions become less stringent, some organizations have seen a rise in respiratory illness visits. While perhaps not atypical compared to "normal years," the rates are higher than last year, particularly among pediatric patients.
Here's what four leaders are seeing:
Editor's note: Responses have been lightly edited for brevity.
Scott W. Long, MD, PhD. Pathologist and Researcher at Houston Methodist: At the moment, our organization is not seeing a higher number of respiratory illness visits or admissions. We have been following a downward trend as the delta variant eases. Respiratory syncytial virus has come down after an unusual summer peak, and rhino/enterovirus colds have come down some after the start of the school year, but remain higher than RSV. The levels are low, but it's still very early in the season.
Our low flu level is also tracking national and global trends. This time of year we'd be seeing a little more flu activity than we are now, though flu activity and peaks vary greatly each year. So, it's too early to say what will happen, that activity will remain low, though it is worldwide compared to normal levels. In comparison though, there's been more flu activity globally than in 2020.
In Houston, we typically see RSV peaking in winter — seeing it peak this summer was pretty unusual compared to other years. A lot of this had to do with us all being masked, distanced, and children not being in school. Pre-delta, it seemed like COVID-19 was calming down, and made the case for relaxing some pandemic requirements. As COVID-19 containment measures were relaxed, the first non-COVID respiratory viruses to return to pre-pandemic levels were members of the rhinovirus/enterovirus family. After the complete removal of COVID-19 precautions at the state level, including an end to mask mandates, there was a robust return of seasonal coronaviruses, parainfluenza virus and RSV. Whatever immunity we had against these viruses pre-COVID has waned and allowed those viruses to transmit.
Becca Reeves, RN. Employee Health and Infection Control at CenterPointe Hospital of Columbia (Mo.): Among staff, we've seen generalized upper respiratory symptoms that test negative for flu, COVID-19 and strep. They tend to be long-lasting (more than two weeks) and tend to maintain strength of severity over the duration. Frequently these symptoms are accompanied by a bowel component. Flu trends remain minimal in the area. COVID-19 cases are on a slow decline. I'm not certain our uptick is significantly out of line with what we would normally see as we enter fall and winter.
Lisa Wells. Quality and Infection Control Manager at Neighborhood Health (Fort Wayne, Ind.): We are seeing a higher number of respiratory illness visits and/or hospitalizations among pediatric patients. Symptoms typically include severe nasal congestion and secretions, sore throat, occasional vomiting and fever for two to three days. These symptoms are followed by a dry, persistent cough. Nothing is atypical about these symptoms. Our respiratory trends seem to be average when compared to local trends.
Elizabeth Ristagno, MD. Pediatric Infectious Disease Physician at Mayo Clinic (Rochester, Minn.): Over the last two months, we have seen an increase of respiratory illness and associated hospitalizations of pediatric patients, mainly related to RSV and COVID-19. Symptoms in children include similar symptoms to adults — runny nose, congestion, cough, fever — but in younger children you can see difficulty with feeding, respiratory distress (with grunting and retractions, using extra muscles to help breathe), and apnea. There is nothing particularly atypical about these symptoms.
While we do not test all patients who exhibit cold symptoms for the common cold virus, there are similar symptoms in people who test positive for RSV and COVID-19. We haven't seen a significant flu surge yet — in Minnesota it tends to occur in November/December. We saw a significant spike in COVID-19 cases in pediatric patients in September, which is similar to national trends.