Children’s hospitals in parts of the U.S. are seeing a surge in a common respiratory illness that can cause severe breathing problems for babies.

RSV cases fell dramatically two years ago as the pandemic shut down schools, day cares and businesses. With restrictions easing in the summer of 2021, doctors saw an alarming increase in what is normally a fall and winter virus.

Now, it’s back again. And doctors are bracing for the possibility that RSV, flu and COVID-19 could combine to stress hospitals.

“I’m calling it an emergency,” said Dr. Juan Salazar of Connecticut Children’s Hospital, where RSV has caused a shuffling of patients into playrooms and other spaces not normally used for beds. The institution explored using a National Guard field hospital, but has set aside that option for now.

A look at RSV and what the recent surge may mean:

WHAT IS RSV?

It stands for respiratory syncytial virus, a common cause of mild cold-like symptoms such as runny nose, cough and fever. Nearly all U.S. children normally catch an RSV infection by age 2.

People infected are usually contagious for three to eight days. Babies and people with weakened immune systems can spread RSV for up to four weeks. There is no vaccine for it, though several candidates are in testing.

WHO DOES IT AFFECT?

Everyone can get RSV. But it causes the most threat to infants, older adults and other vulnerable people, who can get serious airway and lung infections.

Among U.S. kids under age 5, RSV typically leads to 58,000 hospitalizations and up to 500 deaths in a year.

For adults 65 and older, RSV causes 177,000 hospitalizations and 14,000 deaths yearly.

For babies, the struggle to breathe can interfere with eating. “And that’s really when we start to worry,” said Dr. Melanie Kitagawa of Texas Children’s Hospital in Houston, where more than 40 children have RSV.

“They’re breathing fast, breathing deep. We see them using muscles in their chest to help them breathe,” Kitagawa said. “These are kids who are having difficulty taking a bottle because their breathing is being impacted and they can’t coordinate both at once.”

WHY IS THERE AN INCREASE NOW?

The virus is encountering a highly vulnerable population of babies and children who were sheltered from common bugs during the pandemic lockdowns.

Immune systems might not be as prepared to fight the virus after more than two years of masking, which offered protection, according to Dr. Elizabeth Mack of Medical University of South Carolina.

“South Carolina is drowning in RSV,” Mack said in a news release. The surge arrived earlier this year than normal, she said.

For babies, their mothers may not have been infected with RSV during pregnancy, which could have given the children some immunity.

U.S. health officials have noted a rise this month in national reports of respiratory illnesses, which they say is at least partly due to the early spread of flu in much of the South.

Last week, more than 7,000 tests came back positive for RSV, according to CDC figures. That’s more than in previous surges.

IS THERE A TREATMENT?

There’s no specific treatment, so it’s a matter of managing symptoms and letting the virus run its course. Doctors may prescribe oral steroids or an inhaler to make breathing easier.

In serious cases, patients in the hospital may get oxygen, a breathing tube or a ventilator.

WHAT DO DOCTORS RECOMMEND?

Prevent the spread of viruses by washing hands thoroughly and staying home when you’re sick.

During RSV season, an injection of an antibody-based medicine is sometimes prescribed to protect premature infants and other very vulnerable babies.

If you’re worried your child is having a severe breathing problem, “do not hesitate” to go to an emergency department or call 911, said Dr. Russell Migita of Seattle Children’s Hospital, where RSV is on the rise.

For less severe medical problems, Migita said, call your regular health care provider for advice, use telehealth or go to urgent care.

In Chicago on Saturday, Dr. Juanita Mora saw a family of five kids all with RSV, ranging from a 3-year-old to a teenager. Fearing what’s ahead this winter, she’s telling everyone to get a flu shot and a COVID-19 booster.

“We don’t want a triple whammy, a triple pandemic,” Mora said.

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Associated Press/Report for America reporter James Pollard contributed from Columbia, South Carolina. AP Medical Writer Mike Stobbe contributed.

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After preying heavily on the elderly in the spring, the coronavirus is increasingly infecting American children and teens in a trend authorities say appears fueled by school reopenings and the resumption of sports, playdates and other activities.

Children of all ages now make up 10% of all U.S cases, up from 2% in April, the American Academy of Pediatrics reported Tuesday. And the Centers for Disease Control and Prevention said Monday that the incidence of COVID-19 in school-age children began rising in early September as many youngsters returned to their classrooms.

About two times more teens were infected than younger children, the CDC report said. Most infected children have mild cases; hospitalizations and death rates are much lower than in adults.

Dr. Sally Goza, president of the American Academy of Pediatrics, said the rising numbers are a big concern and underscore the importance of masks, hand-washing, social distancing and other precautions.

“While children generally don’t get as sick with the coronavirus as adults, they are not immune and there is much to learn about how easily they can transmit it to others,’’ she said in a statement.

The CDC report did not indicate where or how the children became infected.

Public health experts say the uptick probably reflects increasing spread of the virus in the larger community. While many districts require masks and other precautions, some spread in schools is thought to be occurring, too. But experts also say many school-age children who are getting sick may not be getting infected in classrooms.

Just as cases in college students have been linked to partying and bars, school children may be contracting the virus at playdates, sleepovers, sports and other activities where precautions aren’t being taken, said Dr. Leana Wen, a public health specialist at George Washington University.

“Understandably, there is quarantine fatigue,’’ Wen said. Many people have a sense that if schools are reopening, then other activities can resume too, “but actually the opposite is true.”

Global school studies suggest in-person learning can be safe when transmission rates in the larger community are low, the CDC report said.

Mississippi is among states where several outbreaks among students and teachers have been reported since in-person classes resumed in July and August.

Kathy Willard said she had mixed feelings when her grandson’s fourth grade class in Oxford was sent home for two weeks after several teachers and one student tested positive for the virus. The family doesn’t have internet access at home, making remote learning a challenge.

“It was a hardship. There’s always a worry about him falling behind or not getting access to what he needs for school,” Willard said. “But at the same time, I’m glad the school is doing what they can to protect our kids.”

Students in her district are required to wear masks and receive temperature checks, and students and teachers who come into contact with the virus are quarantined.

In Alcorn County, Mississippi, where hundreds of community cases have been reported, including dozens among teachers, staff and students, parent Kimberly Kilpatrick-Kelley is keeping her 15- and 17-olds home for virtual learning.

The Corinth mother said the family always wears masks when they leave home and practice social distancing, and she worries about her kids getting sick and infecting her parents.

“I personally don’t want to take the risk” she said.

Dr. Yvonne Maldonado, head of the American Academy of Pediatrics’ infectious-diseases committee, said the big question is what will happen as schools that have started out with online learning go back to in-person classes.

“It really will depend on how well can you mask and distance in a school setting,” she said.

New York City, the nation’s largest school district, with over 1 million students, resumed classroom learning Tuesday for elementary school children. Higher grades will resume on Thursday.

The CDC report said more than 277,000 children ages 5 to 17 were confirmed infected between March and Sept. 19, with an increase in September after a peak and a decline over the summer.

The agency acknowledged that may be an underestimate, in part because testing is most often done on people with symptoms, and children with the coronavirus often have none.

The CDC reported 51 deaths in school-age kids, most in them ages 12 to 17. Less than 2% of infected children were hospitalized, and youngsters who are Black, Hispanic or have underlying conditions fared worse than white children.

The findings add to other data showing the pandemic is increasingly affecting younger age groups after initially hitting older Americans hard.

In a separate report Tuesday, the CDC said weekly COVID-19 cases among people ages 18 to 22 increased 55% nationally. The increases were greatest in the Northeast and Midwest and were not solely attributable to increased testing, the CDC said. About one-third of U.S. cases are in adults 50 and older, while one-quarter are in 18-to-29-year-olds.

The AAP research is based on reports from public health departments in 49 states, New York City, Washington, D.C., Puerto Rico and Guam. New York state doesn’t provide data by age. Most states count children’s cases up to age 19, though a few use different age ranges.

As of Sept. 24, the AAP counted nearly 625,000 youth cases, up to age 20, a 14% increase over the previous two weeks. Deaths totaled 109, well under 1% of all COVID-19 fatalities in the U.S.

As of Monday, the CDC counted over 435,000 cases in children from age zero through 17 and 93 deaths. The groups’ totals differ because they include different ages and time periods.

Overall, 7 million Americans have been confirmed infected and 205,000 have died.

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