Respiratory Syncytial Virus (RSV) is currently causing a public health crisis among infants and children in Portland, OR, as well as around the country. RSV, which is highly contagious, is the most common cause of Pneumonia and Bronchiolitis, and affects the respiratory tract. Its symptoms are usually mild but can become dangerous, especially for infants, young children, and elderly people. In late November and throughout December, Portland’s hospitals’ resources were being stretched dangerously thin by the current influx of patients infected with RSV. Even with case numbers diminishing and decreased public attention and coverage in the media, hospitals remain under significant stress and the issue remains serious for the city and all residents.
In late November, both Doernbecher Children’s Hospital at OHSU and Legacy Randall Children’s Hospital reached capacity and announced their transitions to crisis standards of care. This gives hospitals the capability to change staffing plans in order to use every physical bed. While helpful, it is not a solution. A registered nurse working on the front lines, given the alias “Jane Doe,” states, “I think it is fair to say that it is called ‘crisis care standards’ for a reason. It is a stressed system doing the best it can for patients.”
Doe attributes this season’s spike in cases to the fact that fewer people were exposed to RSV throughout the COVID-19 pandemic, leading fewer people to develop immunity to the virus. Doe explains that RSV can be very serious for younger children and that it is “not uncommon for kids to get a secondary bacterial infection, such as otitis media, conjunctivitis, or pneumonia.” She says these infections are treated with antibiotics which were in short supply in liquid versions that children can swallow, along with tylenol, ibuprofen, and steroids. “Staff, hospital space, treatment, and medications were all limited by supply [at the peak of the crisis in November].” She observes that “nurses working in pediatrics are typically very familiar with caring for RSV patients throughout the winter [but] this year has been complicated by the increased number of cases, combination with flu and COVID-19 as well as staffing shortages throughout healthcare.”
Multnomah County released a statement on Dec. 2, 2022, recommending all Portland citizens, including K-12 schools, wear masks in public indoor spaces throughout at least Jan. 1 of 2023. While RSV is usually mild for older children and adults, they are still contagious and can spread the virus to more “at risk” individuals. When asked her opinion on whether or not to continue to wear a mask in public indoor spaces, Doe says no. “Given the decreasing number of RSV cases and how common it is, I don’t believe masking is the right solution,” she says. She notes that protecting kids under the age of 5, those highest at risk, with masks is challenging, also pointing out that “we never wore masks in the community for RSV or flu in the past. I don’t get the impression that people are eager to go back to mask mandates.” The CDC officially advises masking on a county to county basis and Multnomah County currently does not recommend masking, however many experts encourage masking for those in high risk households, and other sources, including the New York Times and CNN, have written pieces recommending the use of masks for the entire population.
While the issue remains serious, things are improving. When asked about how long she predicts until hospitals return to pre-RSV crisis conditions, Doe says that while case numbers are now more typical, this can still feel intense to nurses who lack the typical RSV season experience due to three years of COVID-19 precautions. However, she still remains optimistic, and is hopeful for an RSV vaccine in the near future. In the meantime, she encourages people to get vaccinated for COVID-19, and to stay safe and healthy throughout the remainder of the winter sickness season.