What Is RSV?
Respiratory syncytial virus (RSV) is very easy to catch. With it, you’ll get cold-like symptoms such as a runny nose and cough. Many people get over RSV within a week or two, usually without treatment. But for older adults and infants, RSV can lead to serious, sometimes life-threatening complications. This is especially true for people with respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma. It can also become very serious for people who have cardiovascular disease or another type of heart disease.
Because RSV symptoms are like those of the common cold or flu, you may think it’s OK to dismiss them as relatively harmless. But at the first sign that symptoms are getting worse, you should get medical attention to lower your risk of getting pneumonia or other serious health problems.
You can get RSV throughout the year. But it’s most common in the winter months through the spring (roughly November to April or May). It coincides with the peak of flu season.
Most babies have at least one RSV infection by the time they’re 2. You can get it again at any age. It’s unusual for it to cause a very serious illness in older kids and most adults. But by age 65, the health risks are greater.
Risks for RSV
The CDC estimates that 177,000 older adults in the U.S. are hospitalized with an RSV infection every year, and about 14,000 die. RSV is the second-leading cause of major respiratory tract illnesses among adults in the U.S., just behind the flu.
People with heart disease, lung problems, or other serious medical conditions that weaken their immune systems are at greater risk for serious RSV complications. And if you have asthma, COPD, or heart failure, RSV can make your condition worse.
For older adults and people with ongoing health conditions, RSV can lead to pneumonia, an infection of the lungs’ air sacs. It’s estimated that RSV causes 11% of hospitalizations related to pneumonia and COPD. Bronchiolitis – inflammation of the lungs’ small airways – is another common complication in older adults who get the virus.
RSV may even lead to respiratory failure, when your breathing becomes more difficult and less oxygen enters the bloodstream. It may also cause congestive heart failure, when the heart can’t pump blood and oxygen through the body.
In addition, people who already have congestive heart failure are much more likely to go to the hospital because of RSV than people who don’t have the heart condition. And about half of the older adults infected with RSV who end up in the hospital have cardiovascular disease.
RSV is also linked to a higher risk of hospitalization among people with acute coronary syndrome – the sudden reduction of blood flow to the heart – and heart rhythm disturbances (arrhythmias).
In addition to having weaker immune systems than younger adults, older adults are at greater risk of RSV complications because they also tend to have weaker respiratory muscles that support healthy lung function. They also have less protective mucus in their respiratory systems.
Signs of Trouble
To help prevent pneumonia or other serious conditions from happening, be on the lookout for signs that your RSV infection is getting worse, including:
- A bluish tint to your skin due to reduced oxygen in the blood
- Shortness of breath (Lying flat may make it harder to breathe.)
- Wheezing (a high-pitched whistling sound when exhaling)
- Worsening cough
If any of these symptoms come up, you should get medical attention right away. Shortness of breath can be a symptom of several serious medical problems, including a heart attack. If you have a hard time breathing – sometimes, that can be unusual fast breathing – call 911 and go to the emergency room.
Older adults should not just assume an RSV infection is a regular case of the flu. This can be tricky, because many older adults with RSV show signs of an acute respiratory infection that are like symptoms of the flu.
Healthy adults ages 65 and older may have a little more wheezing and less fever and shortness of breath with RSV than with the flu. But in older adults with high-risk conditions, there is even less of a difference in symptoms. One clue is that fever is more common in people with the flu than with RSV. Another clue is flu symptoms often come on faster with a higher fever. That makes many people go to their doctors sooner than people with RSV.
Symptoms of RSV and the flu are also very much like symptoms of COVID-19, so your doctor will likely have you test for those as well. An RSV infection can make you more prone to getting COVID, and you may even have both at the same time. That would make COVID more serious. Be sure to get your COVID vaccines as well as the flu shot.
Making sure that what you have is RSV usually requires a PCR (polymerase chain reaction) test. That involves getting a swab from inside the nose to see if the virus is there.
When RSV leads to serious respiratory problems, you may go to the hospital to get oxygen and other urgent care. Dehydration is common with RSV in older adults, so you may need intravenous fluids (in your vein) when you get there.
For people with COPD, asthma, or other respiratory conditions, corticosteroids or bronchodilators can help ease the breathing problems that RSV makes worse. Antibiotics are helpful only if you have a bacterial infection in addition to your RSV infection. Sometimes pneumonia can be the result of a bacterial infection.
The FDA is expected to approve two vaccines in 2023 to help prevent severe illness in older adults.
Even without major health complications, older adults may need more time than younger people to get over RSV. As with cold viruses, there is no specific medication or other treatment for RSV. The usual advice to rest and get plenty of fluids still applies. And an over-the-counter pain reliever and fever reducer can help.
But because RSV can lead to very bad health complications in older adults – especially for people with certain other health problems – be aware that your symptoms may be signs of a serious infection that needs medical attention right away.
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CDC: “RSV in Older Adults and Adults with Chronic Medical Conditions,” “Respiratory Syncytial Virus Infection (RSV),” “RSV in Infants and Young Children.”
Human Vaccines & Immunotherapeutics: “Estimating the burden of adult hospitalized RSV infection using local and state data methodology.”
Journal of the American College of Cardiology: “Respiratory Syncytial Virus and Associations with Cardiovascular Disease in Adults.”
National Foundation for Infectious Diseases: “Respiratory Syncytial Virus in Older Adults: A Hidden Annual Epidemic,” “Respiratory Syncytial Virus Infection (RSV).”
PLOS One: “Rates of respiratory syncytial virus (RSV)-associated hospitalization among adults with congestive heart failure – United States, 2015-2017.”
Journal of Chronic Obstructive Pulmonary Disease: “Risk Factors for Respiratory Syncytial Virus Illness Among Patients with Chronic Obstructive Pulmonary Disease, COPD.”
Mayo Clinic: “Respiratory syncytial virus (RSV).”
Pfizer: “Pfizer Announces Positive Top-Line Data from Phase 3 Trial of Older Adults for its Bivalent Respiratory Syncytial Virus (RSV) Vaccine Candidate.”