As cases of the flu and RSV decline at Cook Children’s, we are experiencing an increase in positive cases of COVID-19. Families are encouraged to remain vigilant against respiratory illnesses and make sure their children have the latest COVID booster vaccines, especially as a new dominant subvariant appears to be more contagious.

From Dec. 25 to Dec. 31, Cook Children’s saw a COVID positivity rate of 9.2%, which has been increasing since November. From Jan. 1 to Jan. 7, the positivity rate increased to 11.2%.

As children return to school from the holiday break, there could be an increase in respiratory viruses and illnesses over the next two weeks and beyond, so it’s important to remain watchful and proactive. If your child is feeling sick, keep them at home from daycare or school and wear a face mask when in public to stop the spread.

Influenza A and B cases have declined since November. From Jan. 1 to Jan. 7, we had a positivity rate of 9.9% for Influenza A. This doesn’t mean that the flu season is over, it’s possible to see another increase in cases, so be sure to get vaccinated against the flu. The flu vaccine works to prevent you from catching the flu – or, reduce the severity if you do come down with the illness.

“It is very encouraging to see cases decline,” said Laura Romano, D.O., hospitalist at Cook Children’s. “However, this does not mean that RSV and flu season is over. There is a very likely possibility of a second peak occurring later this winter.”

Respiratory syncytial virus (RSV) cases are declining compared to high cases in October and November. We currently have a RSV positivity rate of 7%. There are limited treatments for RSV. Right now, there is no vaccine available to prevent RSV. Synagis, a monoclonal antibody, can be given to prevent severe infections but this is reserved for premature infants, etc. We are also seeing positive cases of rhinovirus and adenovirus in our patients.

COVID-19 Subvariant

The World Health Organization said that it’s concerned with how quickly the XBB.1.5 subvariant of COVID is spreading in the northeast U.S. The subvariant makes up 40% of submitted specimens to the national SARS-CoV-2 surveillance system. There's still a lot that is unknown about this subvariant.

“This subvariant may be able to slip past our immune defenses and might be more contagious, but it is not clear yet if it causes more severe disease or if the vaccine can effectively prevent severe infections from this strain,” said Mary Suzanne Whitworth, M.D., medical director of infectious diseases at Cook Children’s. “We do know that masking and good handwashing will still be helpful to avoid infection.”

The Centers for Disease Control and Prevention tracks the community spread of COVID-19. For the week of Jan. 1, Tarrant County is rated “high” transmission spread.

Prevention & Precautions

The biggest thing the community can do to help is to take precautions against COVID-19, including masking indoors if you or your child feel sick, frequent hand washing, and getting the COVID-19 vaccine and booster.

Get updated flu and COVID vaccines – these will help prevent infection and reduce the risk of hospitalization. You can call your pediatrician to schedule an appointment to receive vaccinations.

• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
• If you or your child is sick, wear a mask in public.
• If your child is sick, keep them home from daycare or school. Make sure your child drinks lots of liquids, gets plenty of sleep and takes over-the-counter meds to alleviate symptoms.

Flu vaccines help prevent infection and can prevent serious outcomes in people who are vaccinated but still get sick with the flu. The vaccines also reduce the risk of hospitalization.

There’s no guaranteed way to avoid the flu. But getting the vaccine every year can help. At Cook Children’s, we believe that flu vaccinations are the safest, easiest way to protect everyone age 6 months and older from serious flu symptoms. And a flu vaccination during pregnancy helps protect your newborn baby from flu for several months after birth.

Flu immunizations, COVID-19 immunizations and other services are available at Cook Children’s neighborhood clinics and primary care sites across Fort Worth and beyond. Find a location near you: Primary Care Offices/Neighborhood Clinics (cookchildrens.org)

For COVID, at-home tests and community testing locations are also great options.

This is resulting in longer wait times. Our emergency department is seeing between 400-500 children each day. Our Urgent Cares are seeing 600-700+ children each day.

A high number of our hospital admissions are RSV cases. RSV can range from mild upper respiratory tract infections to severe lower respiratory tract disease, including bronchiolitis or pneumonia. The increase in RSV and influenza A is happening much earlier this year.

From Oct. 2 to Oct. 8, there were 210 positive RSV cases at Cook Children’s, a positivity rate of 24%.

One week later (from Oct. 9 to Oct. 15), there were 288 positive RSV cases, a positivity rate of 29%. During the same time period, there were 47 positive influenza A cases, a 4.7% rate.

RSV cases normally spike much later in the respiratory season, such as in December or January.

RSV is a very common respiratory virus. Some children require hospitalization, but most do not.

Parents should not go to the Urgent Care or Emergency Department for only a flu or a COVID test. See your pediatrician, who can test for flu, RSV, strep throat and COVID. Adults can also use at-home tests or tests at a pharmacy.

Laura Romano, D.O., a hospitalist at Cook Children’s, urges parents to keep their children at home when they are sick to prevent the spread of illness, especially to vulnerable populations. Flu, COVID and rhinovirus are also circulating in our community.

Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic, Dr. Romano said. Children who haven’t been previously exposed to respiratory viruses are getting sick.

There are limited treatments for RSV; most are available for premature infants, infants with other lung diseases, infants who are considered immunocompromised, or patients with a congenital heart disease.

What are the symptoms of RSV?

In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or episodes where they stop breathing with or without fever.

In older infants and young children, a runny nose and decreased appetite may appear one to three days before cough, often followed by sneezing, fever, and sometimes wheezing. RSV, COVID, and the flu can all worsen a child’s asthma and lead to an increase in asthma symptoms such as wheezing, waking up at night coughing, and shortness of breath.

Symptoms in adults are typically consistent with upper respiratory tract infections, including runny nose, sore throat, cough, headache, fatigue, and fever. RSV can be a very serious illness for anyone who is immunocompromised. But for most children, it is a minor upper respiratory infection.

If parents begin to see any RSV symptoms in their child, it is important to keep them well hydrated.

Call your pediatrician if:

• You are concerned that your child might have been exposed to either the flu, RSV, or COVID.
• If your child is experiencing mild respiratory symptoms but is not having difficulty breathing and is well-hydrated.
• If you need to have your child tested for RSV, the flu, or COVID.

Seek immediate medical care if:

• Persistent fever for more than two or three days. However, any temperature greater than 100.4 in an infant under two months of age is considered a medical emergency.
•  Concerns for dehydration.
•  In dehydrated babies, parents will see fewer wet diapers or a lack of tears. Their flat spot can also appear more sunken.
• Breathing faster than usual or can see the skin between the ribs being sucked in.
• If your child is requiring frequent use of their albuterol rescue inhaler or is having worsening asthma symptoms.

Prevention

•  Get the flu vaccine and stay up to date on the vaccine schedule from the Centers for Disease Control and Prevention.
• Get the COVID vaccine.
• Teach your children to cough or sneeze into their elbow.
• Use hand sanitizer.
•  If you’re sick, wear a mask in public and stay home.

"I swear he looked worse when I called."

"She hasn't been this active in days."

"She felt so hot when we left the house."

I get it. I've always tried to understand when I hear parents say these kind of things and this week I was personally reminded how this happens.

After getting a worried text from my wife, I left a Cook Children's Physician Network board meeting and hurried home to rush my daughter off to urgent care. After a few minutes there and a trip to the bathroom...we were as good as new. Back to asking a million questions. Back to telling me to look at the screen to see the same scenes in the same movies we've been watching for years. Back to getting on the table, climbing off the table.

Has this happened to you? Most likely, yes.

But, we got our results back, everything checked out great and we were on our way.

Why does this happen? Maybe no one knows.

Here are my 5 suggested possibilities:

1. Time has passed. Kids can get rapidly better and rapidly worse. That's one of the amazing (and absolutely terrifying) things about working in pediatrics. Kids often get better within hours. So, it's possible they were just due for some improvement after you called for the appointment.

2. Your child's medicine has had time to kick in. Kids can look terrible when they have fever and can pretty much bounce right back to normal when it goes down. If their fever is down, they are going to look much, much better.

3. You're in the presence of trusted professionals. (all modesty aside) When you're really scared, it's nice to have anyone around. Having that someone be a pediatrician who's trained for years to handle just this situation might make them look "better."

4. Kids often look better in the daytime. If you were worried about your child at night but bring the child in the next morning, they often look much better. Viral illnesses often look worse at night. Also, when you are tired, you might be more prone to worry and less able to put your fears in context.

5. I have always joked with my parents that we have a magic spray in the waiting room that decreases fever, fussiness and otherwise just makes kids look better before they get back to the room. What I learned from posting about my experience with my daughter is that I'm not the only pediatrician who does so...some of them call it magic pixie dust, some magic spray but apparently we all have something that does the same thing.

Ironically, there were many other pediatricians who responded by saying that their kids often did the same thing. I wasn't alone.

So, the next time your child looks tragically ill at home and perfectly fine in the office, you can rest comfortable knowing that your doctor has probably experienced the same thing.