An Important Health Advisory from the Lake County Health Services Department and First 5 Lake County

NOTE: This Advisory was first distributed to local healthcare providers Friday, November 18.

Local health officials are concerned about the potential of a substantial year-over-year increase in respiratory illnesses as this holiday season is beginning. Increases in the activity of respiratory syncytial virus (RSV), influenza, the common cold, and of SARS-CoV-2, have the potential to inhibit access to healthcare locally. Of particular concern, is how coinciding waves of these illnesses may prevent vulnerable young children and elderly members of our community from receiving care. At this time, it is advised that healthcare facilities consider expanding their capacity to evaluate and treat pediatric patients in order to manage an increase in patient volume.

Healthcare facilities in neighboring Sonoma County report experiencing more than three times the amount of respiratory syncytial virus (RSV) during the latter half of October than was experienced during the same period last year. This early wave has led to increased hospitalizations among children and has contributed to stresses in the pediatric healthcare system. Because there is no requirement that hospitals report cases of RSV, the number of cases Lake County is experiencing cannot be estimated. Typically, respiratory illnesses are most common between fall and spring, peaking in late December.

The current risks stand in contrast to the lower activity of these viruses seen during the past couple of years when various mitigation measures for SARS-CoV2 were suppressing transmission. Currently, statewide levels of RSV are similar to seasonal peaks witnessed in prior years as many children are being exposed to other respiratory viruses for the first time. Most children experience a mild version of RSV before the age of 2 years. The virus typically leads to a cold, but in children younger than 1 year, RSV is the most common cause of bronchiolitis and pneumonia.

In order to mitigate any potentially severe outcomes, it is very important that the local healthcare and childcare communities stress the importance of influenza and SARS-CoV2 vaccinations for every member of our community that is 6 months and older. While there is no vaccine for the common cold or RSV, everyday preventative actions like staying home when sick, frequent hand washing, covering your cough or sneeze, avoiding contact with sick individuals, and wearing a mask in public indoor spaces can help protect our community. Respiratory illnesses have overlapping symptoms, so parents and caregivers of children should watch for concerning symptoms of RSV including breathing more quickly than usual, labored breathing, nose flaring, and long pausing between breaths. Irritability, increased activity, and decreased appetite are also concerning signs of infection in infants which parents should seek advice for upon discovery. Currently, the American Academy of Pediatrics (AAP) is recommending the application of prophylactic palivizumab for infants and young children at high risk for RSV.

Healthcare providers caring for children and adults with respiratory illnesses in inpatient and congregate setting should test for respiratory viruses, including influenza, SARS-COV-2, and RSV. For high-risk patients with suspected influenza, it is advised they begin influenza antiviral treatment immediately, without the delay of laboratory confirmation of influenza. The California Department of Public Health (CDPH) recommends clinicians prescribe the influenza antiviral chemoprophylaxis during outbreaks in long-term care facilities. As RSV and other respiratory virus activity continues to evolve and new evidence emerges, County of Lake Health Services will collaborate with local healthcare providers and childcare facilities to assess and provide additional updates as they become available.

Sincerely,

Jonathan Portney, CPH, MPH

Health Services Director

County of Lake

Additional Resources

American Academy of Pediatrics (AAP) Use of Palivizumab Prophylaxis to Prevent Hospitalization From Severe Respiratory Syncytial Virus Infection: www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/interim-guidance-for-use-of-palivizumab-prophylaxis-to-prevent-hospitalization/ 

California Department of Public Health (CDPH) Pediatric Vaccinations: www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Babies.aspx 

Centers for Disease Control and Prevention (CDC) COVID-19: www.cdc.gov/coronavirus/2019-ncov/index.html 

Centers for Disease Control and Prevention (CDC) Influenza: www.cdc.gov/Flu/Index.htm 

Centers for Disease Control and Prevention (CDC) RSV: www.cdc.gov/rsv/index.html