You may have noticed an uptick in kids and adults suffering from nasal congestion, sore throat, cough and fever. And while these symptoms can be caused by COVID-19, there are plenty of other viruses that result in similar symptoms. These viruses are typically seen during the winter months, but this year is different… we are seeing them in the summer!
Respiratory syncytial virus (RSV) causes nasal congestion and cough. The body responds to the virus by making lots of mucus and creating inflammation (swelling) in the deep parts of the lungs. Older children and adults typically experience this as cold-like symptoms. However, young babies have a more difficult time because their airways are so small. For them, a little mucus and swelling cause big problems. To make matters worse, babies only know how to breathe through their nose. When congested, they struggle to move air through the nostrils even though it might be easier to breathe through the mouth.
RSV infections can become severe and sometimes life-threatening in babies and young toddlers. When it causes wheezing and difficulty breathing, we call the condition bronchiolitis. These babies may also have trouble taking fluids because they are working so hard to breathe.
Because it is a virus, RSV is not treated with antibiotics. And unlike asthma, breathing treatments and steroids do not help the wheezing. Instead, treatment consists of keeping the nose clear of mucus, offering plenty of fluids and using fever-reducers when needed. Children with trouble breathing or poor fluid intake need to be seen right away. Sometimes babies with RSV require admission to the hospital for oxygen and IV fluids.
Parainfluenza virus is also making an unusual summer appearance. This virus causes nasal congestion and swelling near the vocal cords, which results in a sore throat, hoarse voice and a cough that sounds like a seal barking. When swelling is severe, a high-pitched sound, known as stridor, may be heard with each breath taken in. This collection of symptoms is called croup.
Although croup is not treated with antibiotics, there are some medications that can ease the symptoms. A steroid medicine can reduce throat swelling, and an aerosol treatment with epinephrine helps those with trouble breathing. These treatments are done in a doctor’s office, urgent care or emergency room. Children who receive an epinephrine treatment need to be watched for a few hours because severe symptoms may return after the medicine wears off. In this case, another aerosol treatment is given, and the child will likely need admission to the hospital.
Rhinovirus is a frequent cause of the common cold. This virus results in nasal congestion, cough and mild sore throat. Treatment is supportive and includes plenty of rest, fluids and fever-reducers when needed. Like RSV and parainfluenza virus, rhinovirus is not typically seen in summer… but this is not a typical year!
So Why Are We Seeing Winter Viruses in Summer?
We are not 100% certain why these viruses are making an early appearance. However, we can use what we know about respiratory viruses to make a smart guess. Respiratory viruses are transmitted between people who are in close contact with one another. Last winter, we saw very few cases of these illnesses because of masking and distancing guidelines. This summer, many people removed their masks and began gathering again. And because our immune systems have not seen these viruses in over a year, we are prone to infection.
Here’s Some Good News
Each time we get sick with a virus, our immune system gets better at fighting it off. This means that many people who are experiencing bronchiolitis and croup and the common cold now may have milder symptoms the next time that particular virus comes along. And those who have mild symptoms with a current infection can thank their immune system for learning how to fight the virus in the past.
And a Word of Caution
The delta variant of SARS-CoV-2, which causes COVID-19 illness, is currently circulating in our community. The symptoms of COVID-19 can be similar to bronchiolitis, croup and the common cold. If your child has these symptoms, it is best to contact their medical provider for advice on testing and treatment. The best way to prevent severe COVID-19 illness is to get vaccinated, if eligible, and to follow your local health department’s recommendations for wearing masks and physical distancing.
Dr Mike Patrick is an Assistant Professor of Pediatrics at the Ohio State University College of Medicine and Medical Director of Interactive Media for Nationwide Children's Hospital. Since 2006, he has hosted the award-winning PediaCast, a pediatric podcast for parents. Dr Mike also produces a national podcast for healthcare providers—PediaCast CME, which explores general pediatric and faculty development topics and offers free AMA PRA Category 1 Credit™ to listeners.
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