It started out as a runny nose and a cough — typical cold symptoms.
Then things took a turn for the worse.
Courtney S. Martin noticed that her 19-month-old son, Calvin, was having coughing fits. He started breathing rapidly, his nostrils flaring. He refused to eat or drink.
"Every time he took a breath you could see he was working hard — you could see his rib cage sucking in," said Martin, a mother of two in Rutledge, Penn.
Calvin's pediatrician advised Martin to head to the emergency room, where she learned that her son had respiratory syncytial virus, or RSV.
By the age of 2, nearly every child has contracted RSV. In most children, it presents as a bad cold. But for others, it can cause breathing problems and dangerous lung infections — and many parents have never heard of it until their child becomes ill.
WHAT IS RSV?
Every winter, RSV becomes a common and potentially serious illness, said Dr. Ethan S. Wiener, associate chief of pediatric emergency medicine at NYU Langone Health.
While it affects both children and adults, it is most dangerous — and can even be fatal — in babies who are born prematurely and people with weak immune systems, heart disease or lung disease. But even babies who were born full-term and healthy can develop severe symptoms, like Calvin or like Andre, a toddler from Mission Viejo, California, who contracted the virus in 2016 when he was three weeks old.
"It was really scary seeing your son hooked up to so many monitors and not knowing what's going on," said Andre's mother, Alexandria Salahshour, who wrote about the illness to raise awareness.
They spent Christmas that year at the hospital, where Andre was admitted with a blood oxygen level of 70 percent. It should be close to 100 percent.
Like many parents, Salahshour was unfamiliar with RSV. "I remember just being in the corner, kind of hyperventilating a little bit," she said.
In otherwise healthy patients, RSV can usually be treated at home. Children who have been infected with the virus produce antibodies that help reduce its severity if they become reinfected. But RSV can turn into acute lower respiratory infections such as bronchiolitis, a viral respiratory illness that is the most common cause of hospitalization in infants, Wiener said. It can also lead to pneumonia.
Each year, on average, the virus results in more than 57,000 hospitalizations among children younger than 5, according to the Centers for Disease Control.
Martin's son was discharged after staying overnight at the hospital, where he received fluids and oxygen. "When I left it was literally a room full of tiny kids coughing, coughing, coughing," she said.
WHEN TO WORRY
"When we get concerned is when we're seeing that kids are having more trouble breathing and they're not feeding well," said Dr. Robert Adler, chief medical officer of the Children's Hospital Los Angeles Health System.
Other worrisome symptoms include dehydration, fever, fussiness, signs of dehydration or distress, and lethargy.
Children who are managing their cold symptoms well should avoid the emergency room.
"That's where you're going to get sick again," Adler said.
People infected with RSV can spread the virus for anywhere between three to eight days, and the virus can live on hard surfaces for as long as six hours, Adler said.
There is no antiviral therapy for RSV, and there isn't a vaccine: Children are typically treated with hydration, nasal suctioning and oxygen.
"Really I do not think there's a need for unnecessary hysteria around RSV," Dr. Shari Platt, the chief of pediatric emergency medicine at NewYork-Presbyterian/Weill Cornell Medical Center, said.
Other respiratory viruses, like influenza, are also prevalent during this time of year, she added.
Part of the reason people are less aware of RSV than the flu is because there's not a lot you can do to avoid RSV, said Dr. Demetre Daskalakis, the deputy commissioner for the division of disease control at the New York City Department of Health and Mental Hygiene.
"We're constantly harping about the flu vaccine because we can do something to prevent it," he said.
To lessen the risk of contracting RSV, Platt recommends "lots of hand washing."
"You walk in the house, wash your hands," she said.
PROTECTION FOR $5,000
An immunoglobulin therapy called Synagis can help protect children from RSV, but insurance only covers it for children who have certain lung or heart conditions.
Sam Green of New York City said his twins, who were born in 2016 at 23 weeks, were both given Synagis during their first winter. But this winter, insurance refused to cover the therapy because the children were older, Green said. So he and his husband decided to pay for the treatment out of pocket. It cost about $5,000 per child for each of the monthly injections administered during RSV season, which generally lasts from November to April.
"I would rob my 401(k) to make sure that they have that extra protection," Green said.
The twins received doses of Synagis in November, but one of them, Kate, came down with RSV the following month, when she was 15 months old.
"She just went from mild cold symptoms to going downhill very rapidly," Green said.
Kate spent seven days in the hospital, where she was treated with an IV and a bronchodilator, which stabilized her oxygen levels and increased air flow to her lungs.
The Synagis most likely lessened the severity of Kate's illness, Green said. And now that she has contracted RSV once, she no longer needs to take it.
Salahshour, whose son was born during the winter, is expecting her second child this month. She's on "very high alert," she said, and is planning to take a more cautious approach.
"This time around, we are not leaving the house for at least a month to two months," she said. "And in the beginning, we're only going to have our family members hold her."
In Platt's view, it's safe to go outside.
"Out and about is good," she said. "But I do think you shouldn't have everybody hold the baby."