Since the beginning of November, RSV activity has increased rapidly across Oregon and the country, severely straining pediatric emergency departments and hospitals. Providers can help by creating more same-day appointments for sick children and educating families about how to
- manage symptoms at home when appropriate
- recognize concerning symptoms
- slow spread through good hand hygiene and surface disinfection.
Background
Oregon met RSV season onset criteria in late October and RSV activity has increased rapidly since then, straining pediatric hospital capacity in Oregon.
RSV can cause severe disease in both young children and the elderly. Children under 2 years, and especially under 6 months, as well as children with underlying medical issues are at increased risk for hospitalization. Adults 65 years and older, those with chronic heart and lung disease and those with weakened immune systems are at increased risk for hospitalization.
RSV is transmitted through respiratory droplets, direct contact and by touching contaminated surfaces. The risk of RSV is reduced by respiratory hygiene (e.g., covering coughs and sneezes), hand hygiene, disinfection of high-touch surfaces, and likely also by masking.
We recognize that many providers may be affected by the surge and have limited capacity. However, in order to preserve some critical services, we are asking Multnomah, Clackamas, and Washington County health care providers to:
Help take pressure off Emergency Departments
- For practices that care for children, consider extending clinic hours or creating more same-day appointments to ease pressure on urgent cares and ED’s for the next 4 weeks.
- Teach caregivers of children with respiratory symptoms how to clean out the nose, assess hydration, and assess work of breathing. See these educational resources.
- Emphasize the importance of hand hygiene, frequent disinfection of surfaces, and avoiding touching the face as important ways to slow the spread of RSV.
Only test for RSV or influenza in the outpatient setting if it will inform management
- Outpatient testing for RSV is generally discouraged.
- Local health departments do not recommend or require a negative RSV test for return to school or child care.
- Reserve influenza testing for those at high risk of complications who may benefit from prompt antiviral treatment; remember that influenza antivirals (Tamiflu) should be prescribed based on clinical presentation and should not be delayed for test results.
- Prioritize SARS-CoV-2 testing for those at high risk of complications who may benefit from prompt antiviral treatment; patients can access no-cost telemedicine care for COVID antivirals via the Oregon Health Authority’s partnership with Color Health via this link or by calling 1-833-273-6330.
Provide education and direction to patients who are ill with undifferentiated respiratory symptoms
- Patients should contact their employer, school or child care for specific advice or instructions regarding return to work or school (some sites have specific guidance).
- If no specific advice is available, individuals can generally return to work, school, and other activities when all of the following are true:
- They have been without a fever for at least 24 hours without use of fever-reducing medications.
- Their symptoms are definitely better.
- They are eating and drinking well.
- Their runny nose and cough are mild enough that they can participate in activities and keep their hands clean.
- Individuals returning to work/school/daycare who are able to mask should consider continuing to mask until cough and nasal congestion have resolved.
Actively support ongoing vaccination efforts
- Make sure you and your clinic staff are vaccinated for influenza and up to date on COVID vaccines.
- Use every opportunity to vaccinate. Have your staff check Oregon’s “ALERT” immunization information system for each patient you see, regardless of the reason for the visit. Strongly recommend influenza and COVID vaccination including for those with prior infection.
- Promote community vaccine events your patients may want to attend.
Model good infection control precautions
- Stay home if you are sick even if you are vaccinated.
- Continue masking in all indoor areas where patients are present, as required by the Oregon Health Authority.
- Maintain adequate supplies of PPE and use appropriately for all patient care.
Resources:
American Academy of Pediatrics / Healthy Children RSV education and bronchiolitis education
Clackamas County vaccination clinic information
Multnomah County vaccination clinic information
Washington County vaccine information
COVID vaccine and testing resources in Oregon
Thank you for your partnership,
Christina Baumann, MD, MPH
Health Officer, Washington County
Teresa Everson, MD, MPH
Deputy Health Officer, Multnomah County
Sarah Present, MD, MPH
Health Officer, Clackamas County