ODH: State seeing summer surge in respiratory illnesses

By CALLAN PUGH 

City editor 

More Ohio children are being hospitalized due to an unexpected summer surge of respiratory illnesses, Ohio Department of Health Director Bruce Vanderhoff said in a press conference Monday. 

“With COVID-19 on the rise, we may be approaching a perilous situation,” Vanderhoff said. 

Vanderhoff addressed the wave of coronavirus cases in Ohio spurred by the delta variant. 

“Our cases per 100,000 over a two-week period — which just a month ago were less than 50 — are rapidly approaching 300 (per 100,000 people),” Vanderhoff said. “Not surprisingly in just a month our adult hospitals have seen their hospitalizations jump almost five times higher, creating real stress and challenging their ability to maintain some services.” 

But among children, in addition to COVID, the Ohio Children’s Hospital Association is seeing a wave in respiratory viruses including in illnesses that typically are seen in winter, rather than summer. 

“Mainly rhinovirus, parainfluenza virus and respiratory syncytial virus better known as RSV — all on top of COVID-19,” Vanderhoff said. 

Rhinoviruses are the leading cause of the common cold and can trigger asthma attacks and sinus and ear infections, Vanderhoff said. Parainfluenza virus causes upper and lower respiratory illness in infants and young children as well as in older adults and those with weakened immune systems that can cause acute bronchitis, bronchiolitis, and pneumonia. 

RSV in older children and adults mostly causes minor cold-like symptoms, but in younger children such as toddlers and babies with smaller airways, RSV can cause more serious issues, such as trouble breathing, pneumonia and bronchiolitis. 

“RSV infections typically occur in late fall, winter and early spring,” Vanderhoff said. “This unseasonably early increase in RSV, coupled with rising pediatric cases of COVID-19, is a recipe for disaster.”

While children’s hospitals are not yet at critical levels in the state, Vanderhoff said the ODH is very concerned to see levels at emergency departments, ICUs and hospitalizations like what would be seen in the winter at this time in August.

“It’s likely that the worst is ahead of us,” Vanderhoff said. “On top of this wave of respiratory viruses, based on the pattern seen elsewhere, we can expect further increases in COVID-19 case rates driven by the highly contagious, dangerous delta variant.

“It’s not really a matter of children being at risk for COVID or one of these respiratory illnesses — in fact, it’s not uncommon for children to come down with two respiratory illnesses at once.”

Vanderhoff said national reports have shown cases of children coming down with both COVID and RSV. While not enough is known about how the two viruses interact and if COVID makes RSV worse, Vanderhoff said he believes most parents don’t want to find out how the viruses might interact and instead would prefer to take preventative measures, so children don’t get sick.

“As we’re sending children back into the classroom and into extracurricular activities, we have to be cognizant of how we can keep our children safe and healthy,” Vanderhoff said. “The very best way to prevent COVID-19 is vaccination. Vaccination is simply the best way to protect eligible youth from getting COVID-19. And for younger children not currently eligible for COVID-19, the adults and teens around them can substantially insulate them by choosing to be vaccinated.”

Vanderhoff said the ODH is continuing to see eligible individuals getting vaccinated with levels coming close to 60% for Ohioans 12 and older having started their vaccines.

“We know people are tired of dealing with COVID-19,” Vanderhoff said. “I think people were hoping that we were finally done with having to deal with the masks and that we could get life back to what we remember before COVID-19. But now with the highly contagious delta variant, it’s really not the time for us to put those safety measures behind us, particularly for our young children who can’t get the COVID-19 vaccines.”

Additionally, Vanderhoff said he believed with the tools available — the vaccine, masking, increased santization — that children in the state have “every reason” to be returning to an in-person school setting this fall. Addressing questions about if Gov. Mike DeWine should reinstitute mask mandates or require vaccination, Vanderhoff said “no mandate is going to be able to have impact without the people of Ohio being behind the measures.”

Masking and respiratory illness

Vanderhoff said in 2020 there were “remarkably low numbers” of other respiratory illnesses including RSV and influenza at a time when everyone was wearing masks.

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“As we discussed before, mask wearing significantly reduces the risk of spreading respiratory viruses from one person to the next,” Vanderhoff said. “When you’re infected with COVID-19, many times unknowingly, you can pass the virus to someone else simply by talking. That’s because COVID-19 spreads from person to person by way of respiratory droplets released when an infected person sneezes, coughs or talks. When worn properly the mask blocks your respiratory droplets from reaching another person.

“And it isn’t just COVID-19. Other respiratory illnesses are spread by droplets as well. There were simply far fewer cases of other respiratory illnesses like the flu, RSV and colds. But when the masks came off, people started getting sick again.”

Vanderhoff said the high numbers of summer RSV cases among children at the same time there is a “tremendous delta wave of COVID-19,” the ODH is continuing to urge caution.

“There are steps we can all take today,” Vanderhoff said. “First, choose to be vaccinated from COVID-19. This flu season get your flu shot. Wear a mask. Wash your hands. Practice social distancing. Do it to protect yourselves, to protect the children around you and to protect the babies too young to protect themselves who are vulnerable to severe cases of RSV.”

Michael Forbes, a pediatric intensive care specialist at Akron’s Children’s Hospital, said typically RSV strains from the year before give people some “degree of background immunity” to the next season’s RSV strain. While there is a flu vaccine, there is no vaccine for RSV, Forbes said, and still RSV was almost eliminated in hospitals in 2020. 

“It wasn’t the vaccine, it was the masking — so it’s a really important … observation that we virtually eliminated RSV just by masking and distancing and keeping our hands clean last year,” Forbes said. “… What we have this year are a group of children who have no background immunity — and when I refer to background immunity, among children and adults because RSV affects adults as well. So, you have a group of vulnerable populations … once we lifted our restraints and people began to interact again — and folks were vaccinated against COVID, so we didn’t see certainly a spike in COVID right away — but we saw what was in the background and that was the RSV spike in the middle of summer, which is unusual. We’re usually at 1% positivity this time of year. We’ve been as high as 40% in Akron and around the state.”

He said pretty much every child has been infected with RSV by the age of two, but babies born pre-term and with certain heart and lung conditions are considered high risk for severe RSV disease.

Impacts to pediatric hospitals

Cincinnati Children’s Hospital Chief of Staff Dr. Patty Manning-Courtney said her staff has been paying close attention to the south as it is seeing the rising number of COVID in children with both more cases and more severe cases among those children. Cincinnati is beginning to see similar trends as well with a pattern that seems to be moving north.

Courtney said a higher volume of sick children would affect everything children’s hospitals do, including the flow of patients through the emergency rooms or filled up hospital beds, especially intensive care units, affecting how the hospital can care for the sickest patients, how it might receive transfers from other areas and how “elective surgeries” such as for cancer, tumors, fractures and other critical conditions that aren’t considered urgent by comparison.

“We’re worried we’ll have to delay care because the volume of children that need us is so great that we have to make some hard decisions about what we can and cannot do,” Manning-Courtney said. “We just don’t want to be there.”

Pfizer approved by FDA 

Vanderhoff discussed the announcement by the FDA on Monday morning that the Pfizer vaccine has received full FDA approval for ages 16 and older, an announcement Vanderhoff said will give Ohioans an added layer of confidence when choosing to be vaccinated.

“The Pfizer COVID-19 vaccine was built upon decades of MRNA vaccine research and was thoroughly evaluated and tested in one of the largest vaccine clinical trials in history,” Vanderhoff said. “The world’s most comprehensive vaccine safety monitoring system has closely observed the more than 200 million doses that have been administered in the United States, including more than 6 million doses administered right here in Ohio. This action by the FDA validates the confidence of so many physicians, scientists and public health experts in the safety and efficacy of the Pfizer COVID-19 vaccine.”

Vanderhoff said the initial step for the 5- to 12-year-old age group vaccine eligibility is likely to be conducted as it was for other age groups with emergency use authorization initially followed by the process that results in full approval.

“Emergency use authorization still represents an approval for utilization that reflects robust safety and efficacy review by the medical and scientific community,” Vanderhoff said. “I think that parents should have a very high degree of confidence when that authorization comes.”