RSV threat: What older adults need to watch out for this respiratory season
Dr. Zain Chagla says taking steps to protect your health from respiratory viruses is important for individual well-being and to support the healthcare system during the season.
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Dr. Zain Chagla, head of infectious diseases service at St. Joseph’s Healthcare Hamilton in Hamilton, Ontario says hospitals are prepared for the “rollercoaster” of what is known as respiratory season – but he’s calling for people to be proactive about their health. The trifecta of influenza, COVID-19 and respiratory syncytial virus, or RSV, circulating most noticeably from November through to March, can be a serious threat.
“They’re not ideal for older adults,” he says of the viruses, adding there is a huge overlap of symptoms. Older seniors and those with underlying health conditions have a weakened immune response that makes it more challenging to fight the virus.
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“Patients who are immunocompromised have difficulty clearing the virus, which means the virus is attacking their lungs for longer and their recoveries are often much more prolonged. Then if they have other medical issues that flare up, they’re even more at risk of having that deterioration and even as they recover, not having a fulsome recovery back to their normal baseline.”
The situation can be worse for people with RSV, which is a common contagious respiratory virus that usually causes mild, cold-like symptoms like a cough, runny nose and fever. For those with weakened immunity, it can lead to respiratory tract infections such as pneumonia or bronchiolitis. Compounding the problem is that many people have not even heard of RSV, according to a recent GSK survey.
“RSV really can get to the lower airways and that can be a struggle for people with underlying lung disease or underlying other diseases. For example, older populations in Ontario make up over 80 per cent of the deaths from RSV,” Chagla explains.
While younger populations make up more of the hospitalizations – we hear the frightening stories of infants with RSV in intensive care – these populations usually recover.
What symptoms should people watch for? With RSV, you’ll tend to have more coughing, shortness of breath and tightness in the chest, he says.
When these symptoms are acute, people end up in hospital in isolation to protect the spread of infection. If they have COVID-19 or the flu, there are specific therapeutic treatments to help with recovery. But there are no dedicated therapies for RSV.
“Unfortunately, there’s not much we can offer people with RSV and so our hospital course for individuals with RSV is limited to just supporting them while they recover,” he says. “We’re waiting for their immune response to kick in. We’re hoping that the disease doesn’t make them sick enough to need more escalated care in an ICU bed.”
In the Journal of Clinical Virology in 2023, German researchers looked at the role and impact of RSV in the adult population, finding that “RSV infections in elderly are frequent and more severe than those with influenza A/B,” authors wrote, advising that more awareness “on the disastrous impact of RSV in this age group is urgently needed.”
Nancy Williams, a 70-year-old Markham, Ontario woman, says she wasn’t aware of RSV when she experienced symptoms a year ago that left her out of commission and in bed for two weeks, and then slowly feeling more like herself over the next several weeks.
“I get colds every year, but this was different. This was headaches and wheezing and shortness of breath, along with runny nose, like crazy, but mostly the respiratory symptoms were the worst,” she says. “Whenever you have shortness of breath, it’s very scary.” Williams lives alone and has adult children who are in the Greater Toronto Area, but she doesn’t like to impose.
She took multiple COVID-19 rapid tests, but all were negative. While never officially diagnosed with RSV, her pharmacists told her that’s likely what she had.
“It took me a long time to just feel normal again,” Williams says, adding she had pneumonia two years ago and was referred to a respirologist for monitoring. “I have to be careful, especially at this age. I don’t have diabetes or anything serious, but I do think my lungs make me more susceptible [to viruses].”
She’s already had her flu and COVID vaccines and plans to get the RSV vaccine as well.
Earlier this week, GSK’s AREXVY was approved by the regulator for adults 50 to 59 years of age who are at increased risk for RSV disease. The vaccine previously was approved for adults aged 60 and older and is strongly recommended by the National Advisory Committee on Immunization for all adults 75 years and older and those aged 60 and above in nursing homes and other chronic care facilities. The Committee also recommends that adults aged 60 to 74 years may consider RSV vaccination in consultation with a healthcare provider.
Chagla says taking steps to protect your health from respiratory viruses is important for individual well-being and to support the healthcare system during the season. He advises frequent handwashing, avoiding people who are sick and staying home to recover when you’re not feeling well, along with getting vaccinated and seeking out testing for COVID-19 to get the appropriate medication.
“The benefit of the last five years is that we now have vaccines for all three of these viruses going into the season, and good data suggesting that getting and staying up to date with vaccination reduces the risk of being hospitalized,” he says. “They work well, but they work only if people get them.”
