Over the last few years, the typical incidence patterns of respiratory syncytial virus (RSV) infection have been disrupted due to increased social distancing measures and other safety precautions to mitigate the spread of the SARS-CoV-2 virus. As a result, severe RSV cases have dramatically increased in the US over the last few months as herd immunity waned and these precautions were removed. The media has extensively covered this increase, as cases in young infants have led to a record number of RSV-related hospitalisations. However, less media coverage has been given to the threat this increase poses to older adults, especially those in nursing homes, who are also at high risk of severe RSV complications.

In the US, according to Centers for Disease Control and Prevention (CDC) surveillance data, the polymerase chain reaction (PCR) test positivity rate for RSV infection increased from 1.10%–3.27% throughout the summer to 18.86% on November 5. This rate is higher than it has been at any point over the previous two years and suggests substantial RSV transmission. As RSV incidence has historically been higher in the fall and winter seasons, current transmission levels may remain high over the next several months. While typically harmless, severe RSV infection can lead to life-threatening pneumonia, making these increases in transmission troubling among groups that are at high risk for severe RSV infection, such as very young infants (ages six months or younger) and elderly adults. In adults older than 65 years, the RSV-related hospitalisation rate this fall has been much lower than in very young infants so far. However, infectious diseases can rapidly spread through clusters of individuals living in shared spaces, so this situation could change quickly.

This possibility places millions of older adults who are living in nursing homes at an increased risk of severe disease. According to GlobalData’s Respiratory Syncytial Virus: Epidemiology Forecast to 2030 report, more than 1.32 million individuals in the US older than 65 years will be living in nursing homes in 2022. Given the size of the group and the relative lack of hospitalisations thus far, outbreaks of RSV may result in large numbers of hospitalisations and deaths. Therefore, while the Covid-19 pandemic will most likely overshadow news coverage of RSV this fall, the increased threat of RSV warrants attention from physicians, public health practitioners, and individuals working in nursing homes. Physicians may need to screen for RSV, Covid-19, and influenza, when patients present with respiratory symptoms since diagnosing the correct virus, will help contact tracing and prevention efforts for these viral infections. Likewise, individuals working in nursing homes will need to be aware of current RSV incidence to help prevent outbreaks within their residential community. These efforts could help mitigate the impact of RSV this winter and save lives.