RSV in adults: symptoms, care and a video doctor visit

RSV (respiratory syncytial virus) infects the nose, throat and lungs. It spreads through droplets from coughs and sneezes, close contact, and touching your nose, eyes or mouth after touching contaminated surfaces, where the virus can live for hours. Symptoms appear 4 to 6 days after infection.

Almost every child has had it by age 2, and adults can catch it again. In a healthy adult it is usually mild. In other adults it can cause pneumonia or worsen asthma, COPD and heart failure.

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According to the CDC, symptoms usually appear in stages:

• Runny nose
• Congestion
• Cough
• Sneezing
• Fever
• Wheezing

In a healthy adult, RSV looks so much like a common cold that symptoms cannot tell them apart; only a test confirms it, and most of the time it does not change treatment. The flu usually starts suddenly, with high fever and body aches. For COVID-19, home tests are sold at pharmacies.

Treatment: the CDC does not routinely recommend an antiviral for RSV, and antibiotics do not work because it is a virus. It is treated with rest, plenty of fluids and acetaminophen or ibuprofen for fever and aches, as the label directs. Most infections clear on their own in a week or two.

Who should get seen early: people 75 and older; people 50 to 74 with heart or lung disease (asthma, COPD), a weakened immune system or other risk conditions; and anyone living in a long-term care facility.

To protect others: stay home, wear a mask around other people, wash your hands and do not share cups or utensils. You can go back to normal activities when, for at least 24 hours, you feel better and have had no fever without medicine; keep taking precautions for 5 more days.

The CDC recommends an RSV vaccine for all adults 75 and older and for adults 50 to 74 at increased risk of severe RSV. It is a single dose, not a yearly vaccine, and the best time to get it is late summer or early fall, though you can get it any time of year. To protect babies, there is a vaccine during pregnancy (weeks 32 to 36) or an antibody given to the baby after birth. Vaccines and antibodies are given in person: ask your pharmacy, your healthcare provider or a vaccination center. During your visit, the doctor helps you work out whether you should get it.

RSV is the most common cause of lung infections in babies and young children, and the younger the baby, the higher the risk. In young babies the only symptoms may be irritability, less activity, eating or drinking less, and pauses in breathing. According to the CDC, whooping cough can also cause pauses in breathing in babies, sometimes without a cough; the Tdap vaccine during pregnancy helps protect the baby in the first months of life.

Any breathing problem in a baby is an emergency: go to the emergency room or call [911](tel:911). Also go right away if, at any age, your child’s ribs or neck skin pull in with each breath, their nostrils flare, they grunt when breathing, their lips or face look blue, they stop breathing for moments, or they breathe more than 60 times a minute (count for a full minute while the child is calm). A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher also needs the ER, as does a baby who is eating or drinking much less than usual and wetting fewer diapers.

Get your child seen in person soon if a baby 6 to 12 months old breathes more than 50 times a minute, or a child 1 to 5 years old more than 40. For cough and cold in a child who is breathing comfortably, read cough in children. Patients under 21 need a parent or legal guardian on camera for the whole visit, with ID. Never give aspirin to a child.

For your safety, go to the emergency room or call 911 if you have any of these signs. See when to go to the ER.

• Shortness of breath or difficulty breathing
• Bluish or gray lips, face or skin
• Confusion or being hard to wake
• Chest pain or pressure that does not go away
• Asthma or COPD that does not improve with your inhaler
• A baby with any breathing difficulty