Looking at the Tip of a Respiratory Virus Iceberg

Looking at the Tip of a Respiratory Virus Iceberg

Last week, there were dozens of stories about American children flooding emergency rooms in 10 states; they were infected with a cold-like virus that devastated their respiratory systems.

This week, the list of states reporting cases of the virus, now classified as Enterovirus D68, has risen to 12:

Since mid-August, the Centers for Disease Control and Prevention has confirmed more than 100 cases of Enterovirus D68 in 12 states: Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Montana, New York and Oklahoma.

Yet the real number of severe respiratory illnesses caused by this virus is probably even higher, the CDC says.

Enterovirus D68 is related to the common cold virus. However, children who have asthma face potentially life-threatening symptoms without the proper treatment. Additionally, there are indications that the virus is already impacting other states beyond the 12 formally recorded.

The respiratory virus that’s been sweeping the nation and sending asthmatic children to the hospital may have only been officially reported in 97 children, but experts say that’s just the tip of the iceberg.

Dr. Claudia Hoyen said the virus, called enterovirus D68, probably affected thousands of children — and that’s just in Cleveland, where she works. The virus has been reported in 21 states, according to state health departments.

At UH Rainbow Babies and Children’s Hospital in Cleveland, about 20 children normally go to the intensive care unit each month with respiratory symptoms, said Hoyen, who heads the hospital’s pediatric infection control program. But for the last two months, the hospital’s intensive care unit has treated 80 children per month, she said.

The rare enterovirus starts out like the common cold but can quickly turn more serious — especially in children with asthma. Enteroviruses often appear in the summer and fall, but an outbreak like this hasn’t occurred since the 1960s, Hoyen said.

An ABC New Report provides a description of how devastating an infection is to an asthmatic child:

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We are leaving the golden age of easily treatable infectious diseases. Part of this trend is self-induced; for example, areas of California have vaccination rates less than that in the Sudan because of parents filing “Personal Belief Exemptions”.

In some schools, up to 60 to 70 percent of parents have filed these PBEs, indicating a vaccination rate as low as that of Chad or South Sudan. Unlike in Santa Monica, however, parents in South Sudan have trouble getting their children vaccinated because of an ongoing civil war.

And lo, it is these very same L.A. neighborhoods that are experiencing a resurgence of diseases like whooping cough, otherwise known as pertussis. Measles cases have also hit a high in California this year.

In the Wall Street Journal, Dr. Scott Gottlieb, a former Food and Drug Administration deputy commissioner and Tevi Troy, president of the American Health Policy Institute, analyze America’s lack of pandemic preparedness through the lens of what is happening with the Ebola virus in Africa. They also mention Enterovirus D68 in their detailed and worrisome analysis:

While Ebola may still be contained, other potentially calamitous threats are out there. MERS, SARS, avian flu and other illnesses could re-emerge at any time. In the American Midwest, for instance, a novel virus classified as Enterovirus 68 has recently sent some 300 children to the hospital in respiratory distress, with no available antiviral therapy or vaccine. We need to rethink our preparedness and adopt a more modern approach for dealing with these and other looming outbreaks.

The failure thus far to confront and fight Ebola comes from shortfalls in three areas: gauging the true scope of the outbreak, deploying therapeutics to effectively combat the virus, and delivering medical equipment and personnel. Fixing these limitations should be the priority in dealing with this epidemic and the next one.

While we wait for our government develop a workable pandemic response plan, parents with young children should make themselves aware of Enterovirus D68 symptoms , and learn when to seek medical attention if those symptoms present:

However, if a child gets a respiratory illness, particularly if they are coughing continuously, short of breath or breathing fast, wheezing and not able to sleep, parents should seek assistance with a physician or the emergency department, said Queen’s University infectious diseases expert Dr. Dick Zoutman.

“A significant proportion of these children are having difficulties needing extra oxygen, fluids and a significant number are ending up in intensive care units and so we want to make sure that those symptoms are picked up early,” he said.

If this is the tip of the iceberg, then it is going to be a long, deep drop into cold and flu season.

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