Sore throat, runny nose and coughing: Colds and other respiratory infections are again infecting people in Maryland and around the country now that many coronavirus pandemic restrictions have lifted and people resume mixing at work, camp and social settings.
The symptoms can be similar to those of COVID-19 but are turning out to be respiratory syncytial virus (RSV), adenovirus and other infections that are surprising doctors because they are normally seen in colder months.
Some doctors fear outbreaks of influenza will be next and even other vaccine-preventable diseases, such as measles, because so many parents skipped routine doctor’s office visits for their children in the past year.
This comes as the more contagious delta variant is fueling a resurgence of COVID-19 across the country after a steep drop in cases since winter.
“We were worried that people would be on or off — very careful or free-for-all — and we went very, very rapidly from under CDC directions to unmasking altogether and going out,” said Dr. Susan Lipton, head of infectious diseases as the Herman & Walter Samuelson Children’s Hospital at Baltimore’s Sinai Hospital.
“We knew there would be viruses that would fill the void,” she said. “An awful lot of kids have come in here in the last two weeks.”
The U.S. Centers for Disease Control and Prevention still advises that unvaccinated adults and children continue to wear masks inside or when they are in crowds. But with emergency orders lifted in Maryland and across the country, there are no mandates, except in a few cases such as health care settings or when businesses choose to require them.
Public health experts largely credit the masks, distancing and other precautions for preventing flu and other infections last winter. But few, including Lipton, believe there will be another season so free of viruses of all manner, with the rise in respiratory cases already putting officials on alert.
Of particular concern now is RSV, the most common cause of bronchitis and pneumonia in young children. The virus is normally seen from October to April, but CDC data shows cases began rising this year in March and kept going up into the summer.
The CDC called for broader testing of patients for RSV after they test negative for COVID-19 because it can make kids and older people severely sick. The disease normally causes an average of 100 to 500 deaths among children under age 5 and 14,000 deaths among seniors annually, along with tens of thousands of hospitalizations.
Maryland has not escaped the trend. The Maryland Department of Health reports a recent uptick in cases.
There were just 28 hospitalizations for RSV recorded during the most recent October-to-April season, compared with the previous season when there were 1,570. But since June 1, there have been 97 hospitalizations.
“We have alerted Maryland clinicians to this increase in RSV infections and urged them to be aware of typical RSV symptoms and to conduct appropriate testing and reporting,” said Charles Gischlar, a state health department spokesman.
Most respiratory infections cases are likely unreported because people go untested and recover at home. Some kids, such as Sarah Wilen’s 5-year-old son, Easton, was tested only for COVID-19 when he woke with a fever earlier this month.
His mother, a pediatric nurse in Sinai’s children’s hospital, said took him to an urgent care center near their Lutherville home. The clinic doesn’t routinely test for RSV and other infections. Easton recovered in a couple of days and when his 7-year-old sister, Sydney, soon complained of head and jaw pain, Wilen didn’t bother getting her tested.
Same for when she and her husband followed with symptoms.
Wilen said she didn’t used to worry much when the kids got minor cold symptoms, but since they can’t be vaccinated yet, every sniffle or cough causes worry about COVID.
“It’s the first thing you jump to,” she said.
The children’s hospital has had few COVID cases, but Wilen said she has seen a rare but serious COVID-related malady called multisystem inflammatory syndrome and some children on ventilators.
“Not a lot, but enough to be scary,” she said.
Wilen said most kids don’t get so sick, but no one knows the long-term effects of COVID infections on children even from mild infection. So, she plans to continue strict mask rules for her kids, though she said it’s not always easy to control, like when they are at camp.
“I’m probably more of a jerk about the kids wearing masks,” she said. “I don’t want them to get anything, certainly not COVID. ... The delta variant is so contagious. I’m hoping everyone puts their masks back on.“
She and Lipton say they are unsure of what to expect in the fall, the traditional start to the cold and flu season, because everyone’s immune systems have been out of practice for 18 months.
Lipton said it’s unclear what would happen if a lot of people were infected with both COVID-19 and the flu at once. She said many people, particularly young people, don’t appreciate that they can each pose threats even to healthy people and are not getting vaccinated for either and are no longer taking many precautions.
“I’m really disappointed when people say we should get rid of masks because they are so terrible,” said Lipton, who nearly died from flu when she was a young, healthy medical student. “Anyone who has needed a nasal cannula for oxygen or a ventilator can tell you about a real burden.”
And then there are those missed routine vaccinations leaving children vulnerable.
A new report from the American Academy of Pediatrics and the Georgetown Center for Children and Families found 11 million routine vaccines were missed during the pandemic as parents skipped taking kids to well-child visits with their doctors.
The researchers estimate that there was a 27% decline in pediatric office visits in 2020, and they are urging families to make up the vaccinations before students return to in-person learning in the fall.
Some communities will not reach what’s known as herd immunity for some preventable diseases, when enough people are vaccinated to protect everyone, the report said.
“When you miss vaccines during the pandemic, it means you’re not protected from diseases like measles and whooping cough that we know can be deadly,” said Dr. Lisa Costello, a West Virginia physician and a member of the American Academy of Pediatrics Committee on State Government Affairs.
Maryland last had a measles outbreak in 2019, one of 23 states at the time to report cases among people who had not received a measles-mumps-rubella, or MMR, vaccine. There were hundreds of cases reported that year, the most since 1994 and since the disease was considered eliminated in the United States.
She said parents should talk to their children’s doctors about how they can catch up on missed vaccines, and they should do it now because some vaccines are required for children to attend school in person. Costello said the doctors understand how to put children who missed a series of vaccinations on a makeup schedule suitable for them and their families.
They also can coordinate flu shots, which are not generally required for school, as well as COVID-19 shots for those age 12 and older. Pfizer’s COVID vaccine is expected to be authorized for those age 5 to 12 in the fall.
Costello said everyone should continue their pandemic precautions to prevent all of the illnesses. That includes frequent hand-washing, staying home when sick and masking when appropriate. And, she said, get vaccinated.
“We want children caught up before they go to school or camp or other in-person settings,” she said. “We want everyone to get caught up now on routine vaccines and the COVID vaccine when they are eligible.”