Review: The good news and bad news on RSV, America’s newest viral villain

Editor’s note: Kent Sepkowitz is a physician and infectious disease expert at Memorial Sloan Kettering Cancer Center in New York. The opinions expressed in this comment are his own. Read more reviews on CNN.


In recent weeks, a new viral nascent has emerged in the US: respiratory syncytial virus, or RSV. Right now, children’s hospital beds are full, classrooms are empty of RSV and similar viruses, and parents are even more worried than usual.

To explain this, many experts have proposed The masking and social isolation implemented to ward off Covid-19 has created an unnatural time without exposure to RSV or other viruses. The result has been called the “immunity gap,” a weakness in our ability to respond to the latest virus or bacteria with the necessary high-precision choreography simply due to lack of practice. It turns out that to protect against an infection, we need to be exposed early and often.

It has entered the world of infectious problems where too much exposure is a pandemic and too little is a setup for future problems. In this world, the golden mean does not exist and equipoise is a dream. The headache problem was evident at the beginning of the pandemic and will plague us for the duration of our interactions with Covid-19 and any other infection.

The modern way to sidestep this problematic relationship is to substitute a fake infection – a vaccine – for the real infection. All the benefits without any of the sniffles. The problem is that we do not yet have a vaccine available to prevent RSV and stop the rise in cases we are experiencing.

Of note, there may be some promising news next year about RSV protection for use in infants and newborns. This vaccine approach closely resembles the monoclonal antibodies used to treat Covid-19 immunocompromised people to prevent this from conventional flu vaccines or the new mRNA vaccine platform for Covid-19. These injections do not improve a person’s immune repertoire in the way that a conventional vaccine does; instead, it replaces a missing piece with a synthetic antibody that can protect it for weeks or months.

A more traditional vaccination is also possible for the next season; this should be given to expectant mothers to produce antibodies that would naturally cross the placenta into fetal blood: a new approach using traditional vaccination knowledge.

The current RSV outbreak, complete with very sick children across the country, is a particularly brutal way to show that masks and social distancing can and do work well. The so-called immune gap is nothing if not a true direct proof of the effectiveness of this kind of old-school maneuvering. A double-blind, placebo-controlled trial is not required.

In addition to adding much grief to America’s parents, the current chaos is sending a loud and clear message about the future of our ongoing battle with Covid-19. A lot of crystal ball gazing is based on our experience with influenza to model various scenarios. This makes sense: a vaccine for each and an approved, albeit imperfect, oral antiviral.

But this vaccine is all that stands between us and a future RSV-like spread of a strain of Covid-19. Sure, our vaccines against Covid-19 do a wonderful job of preventing death and serious illness, but they only have a modest effect on the risk of catching the infection itself.

But in many important ways, RSV is a good comparator for figuring out what might be next in the world of common infectious diseases (especially because there are important similarities between RSV and the coronavirus family, including SARS-CoV-2, the virus responsible for our virus). pandemic). For three of these respiratory diseases (Covid-19, RSV and influenza), the elusiveness of the virus, coupled with the short duration of our antibody response, results in a steady rise in disease.

This means that what we’re observing for RSV may help inform what we can expect from this trio of infectious diseases in the future: annual disease (not just infection). Some years will see more disease than others. Compounding the problem is the fact that around 20% of the US population rejects the Covid-19 vaccine. A large pool of non-kickback vaccine-provided antibodies will suffer year after year. And not only will they get sick, but they will spread the virus to the rest of the population, constantly balancing new mutations and all.

There is some good news, however. This year’s immune-deficiency-driven surge in RSV cases is clear evidence that the best way to manage SARS-CoV-2 is not a fleet of better vaccines and powerful antivirals, but wearing masks and avoiding crowded indoor spaces. Today’s RSV crisis is tomorrow’s way. In other words, in the “too much exposure, too little exposure” problem, it’s always best to prevent now and worry later. There is no other choice to make, as the deaths of more than a million Americans from Covid-19 show.

So what does this mean for the upcoming Thanksgiving dinner? Does everyone have to sit 6 feet apart and stuff turkey bites under a mask? While I don’t know what the official recommendations will be, here’s what I’ll do: When I take the subway or the bus to the grocery store, I’ll wear a mask. When I’m in the store, I’ll wear a mask. When I walk from one place to another in the city, I will take off my mask and enjoy the fresh air. And, in addition to asking attendees to be vaccinated only and begging family members to stay home if they feel sick, I will be enjoying my Thanksgiving dinner at a crowded dining room table, 100% mask-free.

I hope you are right.