Ask the Pharmacist – answering the RSV question

Q. What is this RSV virus I keep hearing about and should I be concerned?

A. By now, most of us are tired of hearing about viruses that are wide spread and want this COVID-19 pandemic to finally end. Though many of us are no longer requiring hospitalization from COVID-19 (although wastewater levels indicate that it is 9 times more prevalent now than it was a year ago), other infections have now come to the forefront of concern, RSV being one.

RSV stands for Respiratory Syncytial Virus which, as the name implies, affects the respiratory tract and the lungs. Though adults can contract RSV, it is more commonly seen in children. In fact, it is so common that most children have been infected with RSV at least once by age 2. For most older children and adults who get infected with RSV, it usually is very mild and many think they just have a cold and have no need to seek medical help.

Unfortunately, for younger children and those individuals of any age that are immunocompromised or have heart or lung disease, RSV can develop into a severe infection of the lungs and airways such as bronchiolitis (infection in small airways) or pneumonia (infection in the lung). The reason infants in particular, but also those better defined as young children, are more susceptible to complications with RSV is two-fold.

First, they do not have any immune system generated antibodies to RSV until they experience their first infection. With each subsequent infection that they get, the more antibodies they will have to ward off and reduce the severity of future infections. Secondly, their lungs and chest muscles are not fully developed and are therefore not strong enough to be able to combat lung ailments.

As you may have heard on various news sources, the hospitals are now getting inundated with RSV cases. One news source stated that triple the normal number of children are visiting Emergency Rooms than what is typically seen in November. Part of this influx might be due to the lack of liquid acetaminophen and ibuprofen on the pharmacy shelves (as well as most other drugs indicated for kids such as children’s Gravol, cough and cold liquids, saline drops, the antibiotic amoxicillin….etc.) so parents are bringing their children to the ER to help combat the high fevers.

Just when we thought we were nearing the end of all of this nonsense, the saga continues with rising cases of RSV and influenza (which has hit harder and earlier than usual) which has led to some experts coining the term “multidemic”.

RSV symptoms usually arise about 4 to 6 days after being exposed to the virus and becoming infected. As mentioned earlier, most symptoms are mild and may include

· Coughing
· Sneezing
· Runny nose
· Fever (mild)
· Sore throat
· Headache

You may notice that these symptoms are quite similar to other ailments we discussed last week, namely COVID-19, the common cold and the flu. It is recommended to rule out COVID-19 by performing a Rapid Antigen Test at home.

Regardless of the cause, you can manage symptoms with acetaminophen or ibuprofen to reduce fever and drink plenty of fluids to avoid dehydration. With the ongoing supply issues that continue to wreak havoc on both acetaminophen and ibuprofen production, this can be challenging. Phone around to various pharmacies and ask if they are able to supply a small amount of liquid acetaminophen. Otherwise, speak to a pharmacist to get an appropriate dose using adult strength tablets based on the weight of your child.

It is important to monitor for signs of dehydration which can arise fairly quickly. Symptoms to look out for are dry mouth, little to no urine output, sunken eye sockets, extreme fussiness or sleepiness. Infants are more susceptible to dehydration so keep a very close eye on this age group and seek medical help quickly if needed.

As for RSV, most cases will resolve on their own in about one to two weeks. There are some cases, however, that will progress to a more serious infection. Symptoms to be on the look out for that indicate medical attention is required immediately include:

· Fever (higher grade)
· Severe cough
· Wheezing
· Difficulty breathing
· Rapid breathing
· Blueish colour to skin due to reduced amount of oxygen
· Lethargy/ unresponsiveness

In very young babies, diagnosing RSV may be more challenging since they may not have the typical array of symptoms stated above. Rather, the parents may only notice the following:

· Irritability
· Decreased activity
· Breathing difficulties (chest muscles and skin pull inward with each breath)
· Short, shallow, rapid breathing
· Poor feeding
· Lethargy/ unresponsiveness

Since complications may arise with serious cases of RSV, continue to keep a watchful eye on the symptoms and go to the ER or your family doctor when warranted.

An antibiotic may be required if the RSV progresses to a bacterial respiratory infection. The scary thing about this whole situation is that RSV typically peaks in late December to January, the ongoing shortage of children’s (and adults’) medications is expected to continue to be an issue for months, not weeks, and we are all about to congregate more than usual for the Christmas season. In short, the worst may be yet to come.

There is no doubt that this multidemic is, in part, a result of all the social isolation of the past few years where kids and adults were not exposed to the usual viruses that go around. There is no medical or ethical case to be made for a society-wide shutdown.

The case for masking is different though. Masks are not impenetrable screens against virus exposure. Wearing one still means your immune system will get exposed to viruses and build up immunity. But it should reduce the viral load you are exposed to (or expose others to when you are the spreader) allowing your immune system a much better chance to successfully combat the infection. Wearing a mask at work is tiresome. We get it. Some of us wear one daily at the pharmacy and it’s not an enjoyable experience over the course of a 9-hour shift. But if we all did this more often when indoors, we might just be able to clear the backlog in our hospitals (where non urgent surgeries are being delayed indefinitely, which is incredibly stressful for those individuals and their families) and doctor’s offices (where health conditions are not being properly assessed and treated in a timely fashion) and help make our neighbours lives just a little bit better.

For more information on this or any other topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.