Why Are Kids Getting RSV and COVID at the Same Time?

Healthcare workers are noticing that the two infections are occurring at the same time in some children who end up hospitalized with severe respiratory complications: respiratory syncytial virus (RSV) and COVID-19.

RSV is a common viral infection that can cause serious infections in infants and young children. COVID-19 can also cause severe illness, though this is less common in kids than in adults.

According to the Houston Chronicle, Texas Children’s Hospital in Houston has reported 25 cases—“and counting”—of children with both RSV and COVID.

The respiratory illnesses caused by the two viruses can have similar symptoms, and both can lead to bronchiolitis or pneumonia—complications that usually require hospitalization.

Why the Viruses Are Happening Simultaneously

Currently, RSV is circulating (alongside the more easily transmissible Delta variant) at a time of year when healthcare workers usually do not see it.

Mary T. Caserta, MD, a professor of pediatrics in the division of pediatric infectious diseases at the University of Rochester Medical Center, Rochester, New York, tells Verywell that RSV is "a very common respiratory infection that usually comes every winter season.”

While there is variability in the seasonal pattern depending on where you live, Caserta says that RSV "is an annual problem" for healthcare workers in pediatrics.

“Until 2020, RSV was quite reliable in its appearance and its disappearance in our area,” says Caserta, noting that in Rochester, RSV had not been as widespread as usual and that they "had lower rates" of the virus until recently. Now, Caserta says that "rates have really spiked up for RSV."

The reason for the increase might be linked to COVID. Last winter, the pandemic had more people socially distancing and wearing masks when they were in groups. “The reason [for the spike now] is everybody's taking their masks off and mingling more," says Caserta. "That's speculation, but it seems to make a certain amount of sense.”

RSV: Common, But Can Be Complicated

According to the Centers for Disease Control and Prevention (CDC), almost every child catches RSV infection by the time they are 2 years old. While it's common, RSV is not always a mild illness—even if it starts out that way.

Caserta says that with most cases of RSV, “kids just get a cold, and you can't clearly distinguish it from other colds." However, "when they go from having just upper respiratory symptoms to lower respiratory symptoms, it causes a fairly distinctive syndrome of bronchiolitis."

Bronchiolitis is inflammation of the bronchioles, the smaller airways in the lungs. “Classically, the children start with a cold and after about three or four days then parents start to notice that they're working harder to breathe,” says Caserta.

RSV is not the only respiratory virus that causes bronchiolitis in children, but it's a major cause of bronchiolitis in babies. “It is the number one reason infants get readmitted to the hospital in their first year of life," says Caserta. "It's a very significant cause of respiratory illness.”

According to Caserta, bronchiolitis has been reported in children with COVID-19, as well as in kids with COVID and another respiratory illness at the same time—which is not that uncommon. Caserta says that during a typical RSV season, "about 10% to 15% of kids will have other viruses identified along with RSV.”

Treatment for RSV

There is no treatment for RSV, only supportive care. Caserta says that infants or children end up hospitalized if they are in "significant respiratory trouble." In the hospital, a child can "get oxygen and IV fluids if they can't drink because they're breathing too fast."

Currently, there are more options for preventing and treating COVID than for RSV.

“There's no vaccine currently available for RSV," says Caserta. "But there is a vaccine currently available for COVID. So, we'd like everyone who's eligible to get vaccinated.”

Vaccinating as many adults and children over the age of 12 against COVID-19 as soon as possible will help prevent the spread of the virus and protect infants and younger children who cannot yet get vaccinated yet.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.