WEBVTT - Ep 111 RSV: What’s syncytial anyway? 0:00:00.120 --> 0:00:04.200 In October twenty nineteen, our family doubled in number from 0:00:04.240 --> 0:00:07.120 three to six when our triplets were born at thirty 0:00:07.160 --> 0:00:10.479 five weeks gestation. We already had our two and a 0:00:10.520 --> 0:00:13.640 half year old daughter, Annie, and then we had Isabelle, 0:00:13.720 --> 0:00:17.880 Lennie and Teddy. Their weights ranged from four pound two 0:00:17.960 --> 0:00:20.840 to four pounds seven at birth. They were small, but 0:00:21.000 --> 0:00:25.000 everyone agreed they were good sizes for triplets. Because they 0:00:25.040 --> 0:00:28.000 were born early. They needed some help with breathing and 0:00:28.080 --> 0:00:31.880 maintaining their own temperatures, but all were discharged from NICKYU 0:00:32.080 --> 0:00:35.480 two weeks later. We had a lot of visits from 0:00:35.520 --> 0:00:38.879 community nurses to check on their health. They checked their 0:00:38.880 --> 0:00:42.120 weight and for any signs of infection. I was told 0:00:42.159 --> 0:00:44.440 a number of times to watch out for a virus 0:00:44.520 --> 0:00:47.800 called RSB, as it was a risk this time of year, 0:00:48.440 --> 0:00:52.000 especially for very young babies, and especially for those with 0:00:52.040 --> 0:00:56.000 a sibling who was attending nursery or school. I understood 0:00:56.040 --> 0:00:58.560 that we tipped a few of these risk boxes, but 0:00:58.960 --> 0:01:02.520 I wasn't concerned. I thought would be okay. When Lenny 0:01:02.680 --> 0:01:05.480 was five weeks old and not yet the weight of 0:01:05.600 --> 0:01:09.720 most newborn babies, he seemed more sniffly than usual. He 0:01:09.760 --> 0:01:12.720 was drinking his milk more slowly, and he had been 0:01:12.800 --> 0:01:16.479 sick a couple of times. I thought he had a cold. 0:01:16.800 --> 0:01:19.240 I thought he would get better in a few days. 0:01:19.640 --> 0:01:22.360 One morning, we woke up and I went through the 0:01:22.480 --> 0:01:27.000 usual morning routine. Lenny seemed like he was okay, but 0:01:27.640 --> 0:01:30.000 he still had a cold. So I left him till 0:01:30.040 --> 0:01:32.080 last so I could feed the others and spend a 0:01:32.080 --> 0:01:34.880 bit more time with him. But as I picked him 0:01:34.920 --> 0:01:37.440 up to feed him, I thought he looked pale. He 0:01:37.520 --> 0:01:40.880 seemed maybe a bit colder than usual. I felt panic. 0:01:41.280 --> 0:01:44.560 I was worried. I still couldn't drive, having only had 0:01:44.560 --> 0:01:47.680 a sea section weeks ago, so I phoned my husband 0:01:47.840 --> 0:01:50.000 and he came home and took us to the hospital. 0:01:50.480 --> 0:01:53.040 By the time we got there, and after only a 0:01:53.080 --> 0:01:57.360 ten minute drive, Lenny had gotten much worse. In fact, 0:01:57.360 --> 0:02:00.520 he was rushed straight through to reesos and what felt 0:02:00.560 --> 0:02:03.520 like tens of staff rushed into the room to help him. 0:02:04.000 --> 0:02:07.520 He had become so sick so quickly that they thought 0:02:07.520 --> 0:02:10.600 he could have sepsis. He was tested for a number 0:02:10.600 --> 0:02:14.520 of illnesses, and the swabs later came back positive for RSB. 0:02:15.880 --> 0:02:18.440 By this time, Lenny had been admitted to the High 0:02:18.480 --> 0:02:22.040 dependency unit. He had been put on a seapap machine 0:02:22.040 --> 0:02:24.320 to help with his breathing. It was later switched to 0:02:24.360 --> 0:02:29.120 BiPAP and he narrowly avoided being intubated. After he stabilized, 0:02:30.160 --> 0:02:33.640 he needed support with nutrition and hydration and was given 0:02:33.680 --> 0:02:37.000 a cocktail of drugs. The other two triplets were admitted 0:02:37.040 --> 0:02:40.520 to Award over night for observations, but were discharged the 0:02:40.560 --> 0:02:43.959 next day. We were advised to keep Isabelle and Teddy 0:02:44.000 --> 0:02:47.519 away from the hospital so they wouldn't pick up any infections. 0:02:47.960 --> 0:02:51.640 It was a heartbreaking logistical nightmare caring for our three 0:02:51.639 --> 0:02:56.240 apparently well children on our critically ill baby all at once. 0:02:57.000 --> 0:03:01.240 Lennie spent five nights in hospital, which was amazing considering 0:03:01.280 --> 0:03:04.440 how ill he was when he'd got there. He recovered 0:03:04.480 --> 0:03:07.160 as quickly as he had got sick, and I felt 0:03:07.240 --> 0:03:10.959 so positive and thankful to take him home. Little did 0:03:10.960 --> 0:03:13.639 I know that we were only midnightmare at this point. 0:03:14.320 --> 0:03:16.960 Less than a week later, isabel seemed to not be 0:03:17.040 --> 0:03:20.840 drinking her milk very well. After what had happened with Lennie, 0:03:20.880 --> 0:03:23.160 we had learned to watch out for signs that babies 0:03:23.160 --> 0:03:26.240 were struggling to breathe and Isabel was exhibiting a number 0:03:26.280 --> 0:03:29.239 of red flags. She was sucking in a little around 0:03:29.240 --> 0:03:32.119 her rib so that we could see the slight outline 0:03:32.160 --> 0:03:34.560 of her rib cage, and there was a little recession 0:03:34.800 --> 0:03:37.600 in the front of her neck too. It suggested she 0:03:37.680 --> 0:03:41.000 was struggling to breathe. I took her to hospital. I 0:03:41.120 --> 0:03:44.640 was concerned, but not really worried, as she seemed nowhere 0:03:44.720 --> 0:03:47.840 near as sick as Lennie had been. But while she 0:03:47.920 --> 0:03:51.560 was being examined she had napnia and it was clear 0:03:51.600 --> 0:03:54.840 that she was starting to struggle significantly with her breathing. 0:03:55.520 --> 0:03:58.400 She was admitted to the high dependency unit where Lenny 0:03:58.480 --> 0:04:02.160 had been and given oxygen support. All night long, the 0:04:02.240 --> 0:04:05.680 machines beaped endlessly and the nurse would rush over to 0:04:05.720 --> 0:04:11.200 do what she could. The following day, Isabel deteriorated. Her 0:04:11.280 --> 0:04:14.560 tiny body struggled to breathe so much that now her 0:04:14.760 --> 0:04:18.800 entire rib cage would be visible at points. Despite all 0:04:18.839 --> 0:04:22.440 the support, her oxygen levels were too low and she 0:04:22.480 --> 0:04:25.279 went from seepap to BiPAP and then was moved to 0:04:25.320 --> 0:04:29.800 PICU and intubated. The procedure was a struggle because she 0:04:29.920 --> 0:04:32.320 was so small, and she was left with a bloody 0:04:32.320 --> 0:04:35.680 nose and a collapse lung. She was so sick that 0:04:35.760 --> 0:04:37.800 I asked the doctors as much as I could bear 0:04:37.880 --> 0:04:40.680 to if I was going to lose her, and no 0:04:40.760 --> 0:04:44.680 one could give me the reassurance they wanted. Slowly she 0:04:44.720 --> 0:04:49.000 became stable on the ventilator, which she didn't improve as 0:04:49.000 --> 0:04:52.720 the days passed. We sat beside her bedside and the 0:04:52.800 --> 0:04:55.520 nurses took so many samples of blood from her feet 0:04:55.600 --> 0:04:58.279 to check her blood gases that her feet looked like 0:04:58.360 --> 0:05:02.479 pin cushions. Anula after canula came out and it became 0:05:02.640 --> 0:05:05.719 harder for the doctors to find places to fit new ones. 0:05:06.760 --> 0:05:09.920 Her body convulsed as it couldn't expel the mucus from 0:05:09.920 --> 0:05:12.719 her lungs, and the nurses would rush to suction it 0:05:12.760 --> 0:05:16.479 through the endotracheal tube. It hadn't made sense to me 0:05:16.560 --> 0:05:19.919 why Isabel was so much sicker than Lennie, but it 0:05:19.960 --> 0:05:24.520 transpired that Isabel had had RSV and she'd developed bronchiolitis 0:05:24.720 --> 0:05:29.240 like a brother, but she developed a complication pneumonia. Thanks 0:05:29.240 --> 0:05:32.040 to the amazing care she received at the Royal Manchester 0:05:32.160 --> 0:05:35.800 Children's Hospital, Isabel recovered and she came home in time 0:05:35.839 --> 0:05:39.200 for Christmas with her brothers and her big sister. On 0:05:39.279 --> 0:05:42.719 our last day in Picu, I remember a doctor telling 0:05:42.760 --> 0:05:44.640 me to be careful for the rest of the winter 0:05:44.920 --> 0:05:48.599 and for next winter two and she was right. Isabel 0:05:48.720 --> 0:05:52.120 was admitted to hospital with bronchiolitis the following winter, but 0:05:52.200 --> 0:05:55.000 as a much stronger one year old, and it was 0:05:55.040 --> 0:05:58.760 not so scary this time around. She needed some help 0:05:58.800 --> 0:06:02.479 with breathing and new Trician, but she was okay. As 0:06:02.480 --> 0:06:05.320 she started to feel better, she even began to enjoy 0:06:05.400 --> 0:06:07.920 all the attention from the lovely staff as they came 0:06:07.960 --> 0:06:11.680 into her room. Each one who came in looked right 0:06:11.760 --> 0:06:15.640 at her and said hello. And after she was discharged, 0:06:15.760 --> 0:06:18.039 I was putting her to bed one night and she 0:06:18.120 --> 0:06:19.960 stood up and she looked at me and she said 0:06:19.960 --> 0:06:24.279 her first word hello. I will be forever thankful to 0:06:24.320 --> 0:06:47.040 the incredible medical and nursing staff. You saved my babies. 0:07:12.120 --> 0:07:18.240 Oh my gosh, I what a horrifying, terrifying experience. 0:07:18.600 --> 0:07:18.880 I know. 0:07:19.840 --> 0:07:23.440 Thank you so much, Lucy for sharing your experience with 0:07:23.520 --> 0:07:27.600 us and our listeners. It's ah, it's terrifying. 0:07:27.400 --> 0:07:31.800 It is. I'm so glad that everyone is now doing well. 0:07:32.040 --> 0:07:32.400 Me too. 0:07:34.120 --> 0:07:38.400 Hi, I'm Aaron Welsh and I'm Aaron Allman Updike, and. 0:07:38.280 --> 0:07:40.560 This is this podcast Will Kill You. 0:07:40.680 --> 0:07:43.120 Welcome to season six. 0:07:43.720 --> 0:07:44.520 Season six. 0:07:45.280 --> 0:07:47.960 Whoever would have thought that we could make it this far? 0:07:48.560 --> 0:07:53.080 You and I certainly did not think that. But it's 0:07:53.120 --> 0:07:56.320 funny like when we first started out, we thought, oh, 0:07:56.360 --> 0:07:59.160 we've got like two seasons maximum, We like laid out 0:07:59.200 --> 0:08:02.680 all of the topics, and then over the years, especially 0:08:02.720 --> 0:08:05.840 thanks to listeners who have reached out and suggested things, 0:08:06.160 --> 0:08:08.800 that list just keeps getting longer and longer and longer, 0:08:08.840 --> 0:08:11.520 and now it's like we don't see an end in sight, 0:08:11.560 --> 0:08:14.400 which is which is scary because it's like there are 0:08:14.400 --> 0:08:17.440 a lot of things that can kill you, but it's 0:08:17.520 --> 0:08:20.840 also really great because we get to talk about them all. 0:08:21.000 --> 0:08:24.560 Yeah, and we love getting to make this podcast. So 0:08:24.680 --> 0:08:28.880 thank you all again for listening, yeah and sticking with. 0:08:28.920 --> 0:08:30.920 Us for our sixth season. 0:08:31.040 --> 0:08:32.360 It's going to be a good one. 0:08:32.800 --> 0:08:36.280 It is. We've got a lot of very interesting topics 0:08:36.320 --> 0:08:38.840 planned for this next season, so you'll just have to 0:08:38.880 --> 0:08:41.480 stay tuned to see what we're going to be talking about. 0:08:41.320 --> 0:08:44.160 Right and who knows what global pandemics will be thrown 0:08:44.160 --> 0:08:47.920 at us next that will change our order of topics, etc. 0:08:48.720 --> 0:08:54.720 Aaron, I'm sorry, no too soon. Yes, yes, we'll always 0:08:54.840 --> 0:08:58.760 be too soon. But we're kicking things off with a 0:08:59.120 --> 0:09:03.680 very hot topic, very timely topic, and that is rs 0:09:03.840 --> 0:09:08.959 v R s V. It's huge, it is and erin. 0:09:09.000 --> 0:09:13.240 I hope you're going to tell me how to pronounce sensicial. 0:09:12.760 --> 0:09:18.839 Sensicial respiratory sensicial virus. But yeah, it's gonna be. It's 0:09:18.880 --> 0:09:20.560 gonna be a good episode. I'm excited. 0:09:21.000 --> 0:09:24.360 Yeah, there's definitely a lot that I want to know 0:09:24.480 --> 0:09:27.280 about this virus, so I'm excited to dig in. Yeah, 0:09:27.520 --> 0:09:30.560 but first first, it's quarantiny time. 0:09:30.679 --> 0:09:31.960 It's quarantin any time. 0:09:32.480 --> 0:09:35.400 Exciting. What are we drinking this week? 0:09:35.559 --> 0:09:39.920 We're drinking Hold your Breath because you know it's a 0:09:39.920 --> 0:09:41.679 respiratory virus. We'll get into it all. 0:09:41.920 --> 0:09:43.480 Yeah, yeah, we'll get there. 0:09:44.120 --> 0:09:45.640 And what's in Hold your Breath? 0:09:45.720 --> 0:09:51.160 Erin spiced cranberry syrup, orange juice, and bourbon. 0:09:51.160 --> 0:09:56.280 Yum, it's sunsty Yeah. We'll post the full recipe for 0:09:56.320 --> 0:09:59.559 that quarantine as well as our non alcoholic plusy Brita 0:09:59.640 --> 0:10:01.840 on our w website. This podcast will kill You dot 0:10:01.840 --> 0:10:04.960 com and of course all of our social media channels. 0:10:05.240 --> 0:10:08.679 We certainly will on our website. I guess I do 0:10:08.760 --> 0:10:10.680 have to do the spiel because this is the beginning 0:10:10.760 --> 0:10:12.400 of the season. I don't know, I feel like I need. 0:10:12.440 --> 0:10:16.000 We might have new people listening. Welcome. We have spiels 0:10:16.040 --> 0:10:16.480 that we do. 0:10:17.000 --> 0:10:20.840 Yeah, here, Welcome to your first website spiel. If you 0:10:20.960 --> 0:10:23.640 go to this podcast will Kill You dot com, you 0:10:23.679 --> 0:10:28.199 can find all sorts of great resources, including the resources 0:10:28.240 --> 0:10:32.359 that we mentioned in every one of our episodes, including transcripts, 0:10:32.760 --> 0:10:36.720 including our bookshop, dot org affiliate account, our Goodreads list, 0:10:36.880 --> 0:10:40.920 links to merch our, Patreon, just so much stuff that 0:10:40.960 --> 0:10:42.440 you can find, so check it out. 0:10:42.760 --> 0:10:46.360 Also shout out our merch got recently revamped in the 0:10:46.440 --> 0:10:49.520 last couple of months. Shout out to our incredible artist 0:10:49.559 --> 0:10:53.280 Abigail Irvin Penner who did all of this incredible artwork. 0:10:53.320 --> 0:10:56.120 And the merch is clutch. If you haven't got your 0:10:56.160 --> 0:10:57.880 hands on it yet, you can. 0:10:58.400 --> 0:11:01.280 Okay, do we have any other business think so let's 0:11:01.360 --> 0:11:04.840 get into it. Let's do it right after this break. 0:11:30.760 --> 0:11:34.120 I'm excited that we're starting out this season with RSV, 0:11:34.440 --> 0:11:39.880 especially because we ended last season with Influenza. Yeah, it 0:11:40.080 --> 0:11:44.000 feels very you know full circle in a weird way. 0:11:45.040 --> 0:11:47.240 Yeah. 0:11:47.280 --> 0:11:53.079 So, RSV, or as it's properly called, respiratory sensicial virus. 0:11:53.760 --> 0:11:58.120 It's one of the other really big name respiratory viruses 0:11:58.240 --> 0:12:04.680 that hospitals and hospitals and many parents especially know all 0:12:04.720 --> 0:12:08.360 too well. We are recording this and this will be 0:12:08.400 --> 0:12:11.800 released smack dab in the middle of what is typical 0:12:12.000 --> 0:12:16.120 RSV season here in the Northern Hemisphere, which usually goes 0:12:16.240 --> 0:12:21.760 from about November ish until the end of February. Spoiler alerts. 0:12:22.400 --> 0:12:25.120 This year we saw a really early start to the 0:12:25.240 --> 0:12:28.520 RSV season, and I will not be surprised if it 0:12:28.600 --> 0:12:31.280 ends up having a pretty long tail as well, so 0:12:31.360 --> 0:12:34.120 we might end up seeing cases well into the spring. 0:12:35.120 --> 0:12:38.440 But we'll get into all of that later. First, what 0:12:38.559 --> 0:12:42.680 the heck is RSV. Yeah, obviously it's a virus, it's 0:12:42.679 --> 0:12:45.800 in the name, but specifically it's a virus in the 0:12:45.840 --> 0:12:51.800 family Numoviridae, which includes viruses in the genus metaanumavirus, which 0:12:51.840 --> 0:12:55.680 is another common cause of human respiratory infections like common 0:12:55.760 --> 0:12:59.880 cold type infections, and then RSV, which is in the 0:13:00.120 --> 0:13:05.400 genus orthoneumovirus. So these are RNA viruses. They have an 0:13:05.520 --> 0:13:10.080 envelope much like influenza. They have a non segmented genome, 0:13:10.240 --> 0:13:14.240 unlike our friend influenza, which remember has multiple little chunks 0:13:14.280 --> 0:13:18.680 of RNA uh huh, And just really off the bat, 0:13:18.720 --> 0:13:23.760 I want to emphasize how incredibly important of a virus 0:13:23.920 --> 0:13:27.320 RSV is. It is one of, if not the single, 0:13:27.480 --> 0:13:33.840 leading cause of acute lower respiratory tract infections and hospitalizations, 0:13:34.360 --> 0:13:37.479 especially in kids underage five globally. 0:13:39.120 --> 0:13:43.440 I have a question about this already. I love it. Yeah, well, 0:13:43.520 --> 0:13:46.400 and maybe it's more of like a rhetorical question or 0:13:46.559 --> 0:13:50.680 just like an open discussion point. But I feel like, 0:13:51.000 --> 0:13:54.800 even though I went to get an undergrad in biology 0:13:54.880 --> 0:13:58.360 and had to take classes on diseases, did grad school 0:13:58.400 --> 0:14:00.720 and stuff like that, really the first time I started 0:14:00.720 --> 0:14:03.960 hearing about RSV was when we were doing the podcast 0:14:04.080 --> 0:14:07.240 and talking about all these different viruses and stuff. And 0:14:07.320 --> 0:14:10.040 I really feel like, suddenly, now it's all over the 0:14:10.120 --> 0:14:12.480 news and you can't avoid it. And I know that 0:14:12.559 --> 0:14:15.200 part of that is because we're just seeing a really 0:14:15.360 --> 0:14:20.440 unusual number of cases, But is there anything else to that? Like, 0:14:20.640 --> 0:14:24.120 why do I feel like people have only started hearing 0:14:24.160 --> 0:14:25.160 about RSV now? 0:14:25.480 --> 0:14:27.600 Yeah, it's a good question. I don't have a perfect 0:14:27.640 --> 0:14:30.760 answer for you. I can tell you, based on the 0:14:30.800 --> 0:14:34.080 epidemiological data that I've seen out of the past ten 0:14:34.200 --> 0:14:40.840 years or so, we used to greatly underestimate RSV burden, Okay, 0:14:41.000 --> 0:14:43.240 And a lot of that was probably because we just 0:14:43.240 --> 0:14:46.480 weren't testing for it, so we weren't distinguishing RSV from 0:14:46.520 --> 0:14:51.200 any other particular respiratory infection. So when a kid or 0:14:51.280 --> 0:14:54.600 a grown adult or an older person got infected with 0:14:54.640 --> 0:14:58.280 a respiratory virus, it was like influenza or something else, 0:14:59.040 --> 0:15:01.120 and that was kind of the only distinction that was made. 0:15:01.440 --> 0:15:03.000 So part of it might just be that we're doing 0:15:03.080 --> 0:15:06.760 better diagnostics so we can understand just how important this 0:15:06.880 --> 0:15:10.640 individual virus is. I think that might be a big 0:15:10.680 --> 0:15:11.120 part of it. 0:15:11.480 --> 0:15:13.040 Okay, Okay, that makes sense. 0:15:13.160 --> 0:15:17.720 Yeah, But so being respiratory in nature, it's probably unsurprising 0:15:17.840 --> 0:15:20.520 to know that this is a virus transmitted mostly by 0:15:20.680 --> 0:15:25.920 respiratory droplets, so coughs, sneezes, that sort of thing. It 0:15:25.960 --> 0:15:28.880 can also survive for a really decent amount of time 0:15:29.040 --> 0:15:33.440 on surfaces, especially in colder weather, and so it can 0:15:33.480 --> 0:15:37.080 be transmitted very easily by fomites, things like door handles, 0:15:37.480 --> 0:15:41.720 crib railings that kids love to suck on, even your hands, 0:15:41.800 --> 0:15:44.760 all of those kinds of things, toys at daycare centers 0:15:44.840 --> 0:15:45.520 for example. 0:15:46.240 --> 0:15:48.680 You know, I have a question about durability, Like I know. 0:15:49.600 --> 0:15:52.960 Yeah, I literally wrote how long Aaron? Such a good question. 0:15:56.040 --> 0:16:00.280 So I don't know, largely because it depends so much 0:16:00.360 --> 0:16:01.680 on environmental factors. 0:16:01.880 --> 0:16:02.960 Okay, that makes sense. 0:16:03.040 --> 0:16:05.120 Yeah, but from the data that I have been able 0:16:05.160 --> 0:16:08.040 to gather, it's a good number of hours, like even 0:16:08.160 --> 0:16:12.239 several hours under not that great of conditions, and potentially 0:16:12.280 --> 0:16:15.920 several days under good conditions for viral survival. And what 0:16:16.040 --> 0:16:18.840 those conditions are depend on if the virus stays wet 0:16:18.920 --> 0:16:22.200 versus if it dries out, and so it's really complicated. 0:16:22.600 --> 0:16:25.280 Yikes, though several days is I kind of terrifying. 0:16:25.400 --> 0:16:27.880 Yeah, maybe maybe a couple of days. I shouldn't maybe 0:16:27.880 --> 0:16:29.680 say several makes it sound like a week, but like 0:16:29.720 --> 0:16:33.920 probably at least forty eight hours depending on certain conditions, right, right, 0:16:34.360 --> 0:16:39.480 And some of this complication and environmental durability helps explain, 0:16:39.600 --> 0:16:42.640 at least in part, some of the differences in seasonality 0:16:42.640 --> 0:16:48.120 that we see in different latitudes, where in temperate regions, cold, 0:16:48.320 --> 0:16:52.440 low humidity winter months where we're also all gathered inside 0:16:52.520 --> 0:16:55.520 and potentially spreading germs that way tend to have much 0:16:55.600 --> 0:17:00.000 higher RSV transmission, whereas in tropical latitudes it tends to 0:17:00.160 --> 0:17:03.160 be the rainy season, which is obviously a lot more humid, 0:17:03.480 --> 0:17:07.880 that tends to see higher transmission. So it's the seasonality 0:17:08.119 --> 0:17:13.600 aspect is really interesting. In general, the incubation period for 0:17:13.720 --> 0:17:17.320 RSV that I've seen most commonly reported is between four 0:17:17.359 --> 0:17:20.200 and six days, could be a little less, could be 0:17:20.240 --> 0:17:26.080 a little more. And then let's talk about the symptoms. Yeah, 0:17:26.119 --> 0:17:28.399 and for this, I'm kind of almost going to tell 0:17:28.600 --> 0:17:33.720 another little first hand account here because I remember very 0:17:33.800 --> 0:17:38.680 vividly when my kid got his first RSV infection, and 0:17:38.840 --> 0:17:42.280 I remember what the doctor explained to us, and I 0:17:42.400 --> 0:17:45.639 just think it was such a good explanation of the 0:17:45.760 --> 0:17:48.359 course of RSV that I'm going to tell it to 0:17:48.400 --> 0:17:51.800 you now. So when my kid got RSV, he was 0:17:51.840 --> 0:17:55.159 probably three months old. He was definitely under four months 0:17:55.400 --> 0:17:57.840 because he only had one dose of Protestis vaccine and 0:17:57.880 --> 0:18:00.800 I was convinced that it was Protestant. Oh god, it 0:18:00.880 --> 0:18:03.720 wasn't protests. I made him test for it. But anyways, 0:18:04.400 --> 0:18:07.399 I remember that he definitely had a fever, but it 0:18:07.440 --> 0:18:09.080 came down with a little bit of til and all. 0:18:09.520 --> 0:18:13.919 He didn't seem all that miserable at first, but then 0:18:14.080 --> 0:18:18.760 he was just coughing so much, just coughing, coughing, coughing 0:18:18.840 --> 0:18:23.360 his brains out, and he was so snotty, like an 0:18:23.480 --> 0:18:28.960 epic amount of snot And intermittently I started hearing him wheeze, 0:18:29.600 --> 0:18:31.840 And of course I was in med school at the time, 0:18:31.920 --> 0:18:34.399 so I would listen to him with my stethoscope, and 0:18:34.440 --> 0:18:36.520 I was like, he's wheezing. That seems bad, Like we 0:18:36.560 --> 0:18:38.200 should at this point, we should go to the doctor. 0:18:38.200 --> 0:18:40.720 What do I do? I need a real doctor. So 0:18:40.800 --> 0:18:43.040 I brought him to see his doctor, and his doctor said, 0:18:44.040 --> 0:18:47.159 this is almost certainly RSV. It was like November peak. 0:18:47.600 --> 0:18:52.000 Here we go RSV season. At the time. The doctor said, 0:18:52.040 --> 0:18:55.119 he's not wheezy at this moment, but I believe you 0:18:55.200 --> 0:18:58.120 that he was wheezing at home, because he will probably 0:18:58.160 --> 0:19:02.960 continue to wheeze intermittently. He's been sick now for two 0:19:03.040 --> 0:19:07.160 or three days, So here's what's going to happen over 0:19:07.200 --> 0:19:10.040 the next two or three days. So like days four 0:19:10.080 --> 0:19:13.439 to six of illness, he's either going to start to 0:19:13.440 --> 0:19:17.520 get better or he's going to get worse. And if 0:19:17.560 --> 0:19:22.080 he gets worse, here's what you'll see. He'll start breathing fast, 0:19:22.640 --> 0:19:26.399 a lot faster than usual. It'll look like he's working 0:19:26.480 --> 0:19:31.560 hard to breathe. What you'll see are retractions, which mean 0:19:31.680 --> 0:19:33.840 that if you take off his clothes, you'll be able 0:19:33.840 --> 0:19:37.520 to see his ribs where his belly pulls in underneath 0:19:37.560 --> 0:19:40.280 his ribs when he tries to breathe, Oh my god, 0:19:40.600 --> 0:19:42.680 or in the little v of his neck right above 0:19:42.720 --> 0:19:45.200 his chest, you can see it kind of sucking in 0:19:45.280 --> 0:19:48.000 as he takes in a breath. Those are called retractions. 0:19:49.119 --> 0:19:51.560 If that starts to happen, you'll take him to the 0:19:51.560 --> 0:19:56.240 emergency room and they will do care for him. And 0:19:56.280 --> 0:19:58.440 those are the two ways that this disease is going 0:19:58.480 --> 0:20:01.919 to go. And that's what the doctor told me. And 0:20:01.960 --> 0:20:07.359 it sounds terrifying, yeah, and it is terrifying, but I 0:20:07.400 --> 0:20:09.840 will say that it was one of the most reassuring 0:20:09.920 --> 0:20:13.400 things to know. Here's what to look out for, here's 0:20:13.440 --> 0:20:14.960 the things that are going to happen, and here's the 0:20:15.040 --> 0:20:16.719 kind of two ways that it's going to go, and 0:20:16.760 --> 0:20:18.240 what to do in both scenarios. 0:20:18.720 --> 0:20:21.200 Yeah, yeah, and it turns. 0:20:20.920 --> 0:20:24.000 Out that it's a really accurate description of the course 0:20:24.160 --> 0:20:29.920 of RSV. Kids especially are susceptible to RSV infections, and 0:20:30.080 --> 0:20:35.280 kids especially in their first round with RSV, because this 0:20:35.440 --> 0:20:38.480 is a virus that tends to infect us over and 0:20:38.560 --> 0:20:42.159 over through the course of our lifetimes, but especially in 0:20:42.200 --> 0:20:46.680 that first year of RSV infection. For a kid, they 0:20:46.720 --> 0:20:52.119 tend to get a fever. RSV is a very snotty virus, 0:20:52.440 --> 0:20:55.600 So you have a lot of mucus production. You're going 0:20:55.640 --> 0:20:58.280 to have a lot of coughing because of that mucus production. 0:20:58.800 --> 0:21:04.560 And in kids, especially babies, they're not good at coughing yet. 0:21:04.720 --> 0:21:06.679 They just don't have the muscles and they don't have 0:21:06.720 --> 0:21:10.239 the reflex to get up gunk when they cough, so 0:21:10.280 --> 0:21:13.840 they don't produce a lot when they're coughing. And then 0:21:13.880 --> 0:21:17.560 they either get better over time or they get worse. 0:21:17.640 --> 0:21:21.120 And it's often that days four to six or so 0:21:21.320 --> 0:21:23.600 is when they might start to get worse. So this 0:21:23.680 --> 0:21:26.239 is a long disease that we're talking about. That's a 0:21:26.280 --> 0:21:29.280 long time to be watching a kid like a hawk 0:21:29.359 --> 0:21:31.119 and wondering kind of which way it's going to go. 0:21:31.640 --> 0:21:37.680 Yeah, absolutely, Okay, question real quick uh huh. What are 0:21:37.720 --> 0:21:41.520 some of the factors that decide whether a kid is 0:21:41.640 --> 0:21:43.920 going to get better or going to get worse? 0:21:44.119 --> 0:21:47.119 Oh, we will absolutely get into it, Okay, Okay, yeah, 0:21:47.200 --> 0:21:49.080 in as much detail as I can give you. 0:21:49.280 --> 0:21:51.960 Okay, So, I guess not a quick question then. 0:21:53.280 --> 0:21:55.399 But it's the it is the important question. 0:21:55.600 --> 0:21:56.480 Yeah. 0:21:56.800 --> 0:21:59.159 So, But to talk a little bit more about what 0:21:59.200 --> 0:22:02.280 the symptoms can look like in other age groups, because 0:22:02.359 --> 0:22:05.399 what I just described is how the course of RSV 0:22:05.560 --> 0:22:09.359 tends to go in kids, say age especially zero to 0:22:09.440 --> 0:22:12.760 six months or a year, or kids who are being 0:22:12.800 --> 0:22:16.880 exposed to RSV for the first time. In older kids, 0:22:17.240 --> 0:22:20.119 it can look similar or it can look more like 0:22:20.160 --> 0:22:23.239 what RSV looks like in adults, which is just the 0:22:23.280 --> 0:22:28.639 common cold, right, So, cough, runny nose, sinus, congestion, sore throat. 0:22:29.080 --> 0:22:33.040 Usually RSV, even in adults, is a pretty snotty type 0:22:33.080 --> 0:22:35.000 of cold. So you might have quite a lot of 0:22:35.119 --> 0:22:40.639 congestion in very very little babies, like under six weeks old, 0:22:41.359 --> 0:22:45.680 or very tiny babies that are very premature, they can 0:22:45.760 --> 0:22:48.760 actually have such little reserve when it comes to their 0:22:48.840 --> 0:22:52.920 respiratory system that they can present a little bit differently. 0:22:53.560 --> 0:22:56.920 Sometimes they might just look kind of lethargic, like they 0:22:57.000 --> 0:22:59.480 just don't really look like themselves. They have no energy. 0:23:00.359 --> 0:23:03.680 Sometimes they might just have apnea, which is when they 0:23:03.760 --> 0:23:07.520 just stop breathing entirely for a spell, which is terrifying. 0:23:10.040 --> 0:23:14.000 Now in elderly adults over age sixty five, or in 0:23:14.119 --> 0:23:19.160 adults or children with underlying lung conditions like COPD or asthma, 0:23:19.320 --> 0:23:22.919 cystic fibrosis, things like that, you can also have a 0:23:23.000 --> 0:23:26.439 more severe infection that can lead to something like a pneumonia, 0:23:26.480 --> 0:23:28.879 a viral pneumonia, which we've talked a lot about on 0:23:28.920 --> 0:23:33.920 this podcast. So then the question you ask, the question 0:23:34.000 --> 0:23:37.360 of who does this happen to? And before I get 0:23:37.400 --> 0:23:39.320 to that, what I want to talk about is what 0:23:39.480 --> 0:23:43.200 is actually happening in our airways? And I think once 0:23:43.240 --> 0:23:46.320 we understand that, we can understand who is at highest 0:23:46.440 --> 0:23:52.840 risk for severe infection. Okay, so what actually happens when 0:23:52.880 --> 0:23:56.200 we get infected with this virus as a respiratory virus 0:23:57.080 --> 0:24:02.760 RSV is initially and primarily infecting the epithelial cells of 0:24:02.840 --> 0:24:05.320 our respiratory tract. I feel like we talk about these 0:24:05.320 --> 0:24:06.800 cells all the time. 0:24:06.960 --> 0:24:07.200 We do. 0:24:08.600 --> 0:24:09.639 Let's do it again. I love it. 0:24:09.720 --> 0:24:12.760 Yeah, let's these are the cells that are lining our nose, 0:24:12.840 --> 0:24:16.719 they're lining our throat, they're lining our airways. Part of 0:24:16.760 --> 0:24:19.879 what determines how severe of an infection you're going to 0:24:19.920 --> 0:24:23.000 have with RSV is going to be whether or not 0:24:23.200 --> 0:24:27.480 it establishes an infection in the lower respiratory tract, meaning 0:24:27.640 --> 0:24:31.920 down in our lungs. RSV seems to have an easier 0:24:32.000 --> 0:24:36.040 time doing this in either an initial infection so you've 0:24:36.119 --> 0:24:40.120 never been exposed before, you have no immunity whatsoever. That 0:24:40.200 --> 0:24:44.360