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is it covid, flu or rsv? new survey reveals older canadians not aware of rsv despite health risks
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rsv is a common contagious respiratory virus that usually causes mild, cold-like symptoms like a runny nose, cough and fever. but it can also cause respiratory tract infections such as bronchiolitis and pneumonia.
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winter can be tough for the public and overwhelming for emergency departments as serious health threats like influenza, covid-19 and respiratory syncytial virus, or rsv, are on the increase in what is also known as respiratory season.
these illnesses go beyond a couple miserable days at home in bed. they can bring complications and be lethal for people with underlying health conditions that weaken their immune response.
despite the significant risk, a new survey has found there is widespread lack of awareness about rsv in older canadians who are among the most vulnerable populations. almost half had never heard of rsv, flagging the need for understanding and prevention.
rsv is a common contagious respiratory virus that usually causes mild, cold-like symptoms like a runny nose, cough and fever. but it can also cause respiratory tract infections such as bronchiolitis and pneumonia.
“the people who end up in the hospital with rsv look as sick or sicker than people who have influenza. they’re quite sick. it often tips off other illnesses and it often has a long recovery time,” says dr. zain chagla, co-medical director of infection control and head of infectious diseases service at st. joseph’s healthcare hamilton in hamilton, ont.
rsv targets the lungs and breathing passages. older adults are at high risk for severe disease in part because of age-related decline in immunity. underlying conditions can be aggravated, including chronic obstructive pulmonary disease, or copd, asthma, and congestive heart failure.
while the majority of those hospitalized for rsv are children, especially in their first year of life, most recover, he says. “if you actually look at who dies of rsv, kids, for example, they make up in ontario about 70 per cent of the hospitalizations for rsv, they make up less than five per cent of the deaths, thankfully, not many children die.”
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older adults make up 20 per cent of those hospitalized for rsv during a given year, but they make up 85 per cent of deaths, he explains. “if you look at ontario data, if you’re an over 65-year-old hospitalized with rsv, there’s a one in nine chance you don’t walk out of the hospital. it is quite profound.”
the online survey, commissioned by pharmaceutical company gsk, looked at the awareness and attitudes of 1,000 canadians aged 50-plus toward rsv and other respiratory illnesses, and how their lives were affected. almost half, 46 per cent, of had never heard of rsv, although a large majority, 65 per cent, said they’d had a respiratory illness in the previous 12 months.
awareness was also low among those at increased risk of becoming seriously ill from rsv because of an underlying medical condition; less than one in five, 18 per cent, reported they had some knowledge of rsv.
that said, four out of five respondents wanted more information about rsv, and nearly one in four were highly concerned about falling ill to the virus.
chagla isn’t surprised by lack of awareness in older people because prior to the pandemic, rsv wasn’t on the radar. in fact, it was difficult to diagnose because of limited labs that provided testing and long wait times for results. particularly in a lot of smaller centres, it would be referred to as an “influenza-like illness” and treated with supportive management like iv fluids for hydration and oxygen if needed, because there weren’t any specific anti-viral medications.
“prior to covid, it was one of the other respiratory flu-like illnesses and we would not diagnose it much in people living in the community or when people were hospitalized. testing for rsv was pretty minimal, and it took a long time to come around. i will say, it plays a burden in what we call the respiratory season in the hospital,” he says. “given that we didn’t diagnose it much, there was just a lack of awareness for everyone, for both patients and providers.”
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rsv testing is a simple nose swab, but prior to covid, laboratories that managed that testing were few, but the situation changed with the onset of the pandemic. “post-covid, i think we have a better sense of the burden given that this type of testing is now very routine and more centres have access to it. so we do know that probably a good third of what we deal with outside of covid in the respiratory season is rsv that causes that burden both in adults and young children.”
the survey also provided insights about the impact of respiratory viruses like rsv on daily activities. among the 65 per cent of respondents who said they’d contracted a respiratory infection like covid-19, flu, rsv in the last 12 months:
- 39 per cent said that it took them more than two weeks to recover. for those aged 60 and older, recovery took three or more weeks for 72 per cent of them
- 65 per cent reported the illness disrupted their daily activities
- 69 per cent said it disrupted their sleep
- 43 per cent said it had affected their social events
- 29 per cent said it affected their ability to attend work.
respondents also said they were worried infections could cause them to miss important family occasions, birthdays and holidays.
studies in the u.s. have shown that about one-third of older adults hospitalized with rsv experience acute functional decline and may never regain their pre-infection functioning.
“the virus itself causes a lot of inflammation in the lung. so you can imagine someone with a lung comorbidity, asthma, copd or other lung disease is obviously going to have challenges if their baseline lung status isn’t great. we also see rsv not only cause that acute lung inflammation and the respiratory syndrome, but just being ill with that lung syndrome can often tip off other diseases. so, we do know, for example, that people who get rsv have an increased risk of having a heart attack within the first week of having rsv,” chagla says.
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even people who are frail and less functional who suffer with rsv are out of commission for a few days, coughing and not eating or sleeping well, he adds. “that in someone who is already frail may lead to even more frailty, may lead to less independence, may lead to a fall. this is where that comorbid concept is not just the lung that’s the issue. it’s the fact that people are so sick that their underlying disease states can get worse, or again, their frailty can get worse. we never want to see people losing their independence.”
on the upside, chagla notes that awareness about rsv among healthcare providers has changed dramatically – especially with new rsv vaccines for adults 60 years and older approved in 2023. “we actually have a preventative tool to help protect people from rsv. so that is the big message out there.”
getting vaccinated can help you avoid serious illness, along with daily vigilance like frequent handwashing and avoiding people who are sick. and this july, the national advisory committee on immunization released updated guidance on the prevention of rsv in older adults, stating that concurrent administration of an rsv vaccine with other seasonal adult vaccines is acceptable and supported. you can get your flu, covid-19 and rsv shots in the same visit.
“people are definitely worried about rsv when they hear about it,” chagla says. “it’s important going into the respiratory season to talk to your healthcare provider and say, ‘am i up to date? what do i need to do as an older or vulnerable adult to really get as much prevention as possible going into the season?’”
still, he expects that hospitals will feel the stress on services during the winter.
“there is a surge in patients we deal with and so it’s a challenging time in healthcare. covid is just as bad as influenza. even if we have a normal influenza season, we have covid, we have an rsv season, that’s still a decent amount of pressure on the system. that’s not going to be comfortable. surges may need centres to staff differently, may have longer emergency room stays, may need to cancel some non-emergency surgeries,” he says.
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“the health system is resilient and will do its work, but at the same time, preventing people from coming to hospital is a huge benefit for the system as a whole.”
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