Respiratory Syncytial Virus

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As we enter the winter season, outbreaks of infections like flu, COVID, and respiratory syncytial virus (RSV) become a concern. In California, all three have come together to make the state a possible site for a triple epidemic, or “tridemic.” Some areas are experiencing an earlier flurry of flu cases than usual, and others a rebound of COVID-19, which may become a regular seasonal event. RSV is another contagious virus emerging in a number of outbreaks throughout the state.


While many have personal experience with the flu or with COVID, respiratory syncytial virus is less well-known to the general public (strange for a virus so contagious that almost all children get the infection by age two). It usually presents as a mild cold, although it can be life-threatening to premature infants. This year, it’s severe enough to have parents worried, and it should: RSV is the second leading cause of death during the first year of a child’s life, after malaria.

RSV isn’t just a children’s’ virus. It can affect adults as well, and those over 65 can develop pneumonias requiring hospitalization. Orange county has recently declared a health emergency due to a surge in cases. Los Angeles County tests of phlegm and mucus are testing positive for RSV about 20 percent of the time. This is a five-year high, up from 6-7 percent a year ago and 1 percent the three years previous to that. Almost 10% of L.A. County ER visits among children younger than 5 are associated with respiratory syncytial virus.

Like a cold virus, respiratory syncytial virus affects your nose, eyes, throat, and, possibly, lungs. It spreads (like many airborne viruses) when droplets from a cough or sneeze get in someone’s eyes, nose, or mouth. Other ways to get RSV include direct contact, such as kissing the face of an infected child or touching a surface contaminated with the virus.

There are various strains of RSV, making it unlikely you will become immune. Some people even get it more than once in the same year.


RSV symptoms usually begin 4-6 days after infection and include:

  • Nasal Congestion
  • Coughing/sneezing
  • Sore Throat
  • Earache
  • Fever
  • Muscle aches

Infants may be difficult to diagnose, but you’ll notice a lack of energy and a poor appetite. In severe cases, wheezing may be a symptom. Indeed, RSV is the most common cause of pneumonia in kids under one year of age.


There is no cure, vaccine, or even a specific treatment for RSV. The caregiver should perform measures that relieve the symptoms. Fortunately, most infections with respiratory syncytial virus go away on their own after one to two weeks.

One basic way to help is to encourage good hydration. Those who become dehydrated easily, like very young infants and the elderly, will have the worst outcomes.

Manage fever and muscle aches with fever and pain meds like acetaminophen or ibuprofen, but avoid giving aspirin to children (or anyone under 20, due to the risk of a rare but serious disease known as “Reye’s Syndrome.”

Symptoms of respiratory syncytial virus that should raise the level of concern include shortness of breath, chest or stomach pain, vomiting, and dehydration. These patients may require oxygen, IV hydration, and advanced care.


It’s as hard to keep from catching an RSV infection as it is to avoid a cold. Following a strategy known as “respiratory hygiene,” however, can lower the risk:

  • Cover your mouth and nose when coughing or sneezing.
  • Have tissues or other barrier available at all times. If none is available, cough or sneeze into your elbow or upper arm.
  • Keep no-touch trash containers available for safe disposal of tissues and other materials.
  • Wash your hands or use a hand sanitizer whenever you touch your mouth or nose.
  • Provide materials for hand washing in areas where infected persons may be housed.
  • Symptomatic patients should wear masks and avoid close contact with healthy individuals.
  • Keep infected persons away from high-traffic areas in the home.

The above precautions are good advice for any outbreak of respiratory infections, including RSV, flu or COVID.

Hopefully, RSV cases will peak soon. Even so, close observation of your children and elderly relatives is important to prevent severe cases from leading to bad outcomes.

Joe Alton MD

Dr. Alton

Learn more about respiratory infections and 200 other medical topics with a copy of the award-winning 4th edition of “The Survival Medicine Handbook: The Essential Guide For When Help Is NOT On The Way.” Plus, check out our entire line of medical kits and individual supplies at You’ll be glad you did.

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