School children in the Midwest are being hit by a viral infection that is sending hundreds to the hospital.
No, it is not Ebola, though the throb of coverage would have it seem so. Rather it is the bookish-sounding enterovirus 68 (EV-68). A harsh and unexpected member of a veteran crowd of viruses, the enteroviruses gets its name “entero” for their original place of preference—the intestinal tract. Other famous enteroviruses include the causes of polio, the common cold, and SARS, as well as mild meningitis and host of other, usually annoying but tolerable, summertime complaints.
This year’s version is a doozie. According to a press conference conducted Monday by Dr. Anne Schuchat, Assistant US Surgeon General, and Director, National Center for Immunization and Respiratory Diseases, severe cases from Chicago and Kansas City a few weeks ago led the CDC to test for virus. Many cases were kindergarten age, and EV-68 accounted for more than 80 percent of cases. Thus far, at least 12 states appear to be involved though complete viral testing has not been completed for all cases.
The impact, even among cities with unconfirmed cases, is substantial. In Denver, Dr. Ann-Christine Nyquist, a professor of pediatrics and director of the infection control program at Children’s Hospital Colorado, more than 900 children had been seen in the emergency room and 100 have been hospitalized in the last three weeks. This volume of activity, according to Dr. Nyquist, is something “we usually see [only] in the winter.”
Thankfully, no one has died of the infection. This year’s illness is different than the typical few days of sniffles and aches, because some kids have progressed to a severe asthma attack requiring ICU care. The provocation of a severe asthma attack after a cold is a well-known and well-traveled path to serious illness. For many people with asthma, and even some without a history, a respiratory infection can trigger intense inflammation, which in turn can narrow airways, making it hard to breath and requiring emergency medical attention.
This strain of enterovirus seems unusually provocative in irritating lower airways, thereby causing airway narrowing. This has resulted in the large uptick in asthma and ER visits made by frighteningly sick kids and their even more frightened parents. It is the extreme version of what happens every Labor Day: armies of kids trudge back to school and try to stay awake, then at lunch and at recess, wrestle and eat each other’s French fries, and carry on with the kid energy that has been unsuccessfully re-bottled after three glorious summer months. Usually they trade sniffles and exaggerated stories of late night derring-do; now they are exchanging enterovirus EV-68.
This sort of eccentric behavior by a virus is nothing new. We saw an enterovirus go rogue earlier this year when one apparently was found to be associated with a polio-like illness in California. One story even suggested the EV-68 strain was the cause—though no additional studies have appeared to clarify this, and there is no evidence of neurologic disease in the current respiratory outbreak. That outbreak, too, flashed brilliantly across the headlines and created a similar legion of terrified parents who called worn-down pediatricians for support. Now, months later, few even recall that winter panic demonstrating both the voracity and the concurrent amnesia for these sorts of pop-up public health panics.
This one, too, will go the way of all respiratory infections and sooner probably than later. There are no reports of adults developing the illness, demonstrating that immunity is effective and durable and probably crosses different enterovirus strains. But once EV-68 fizzles out, surely something new will fill its place in the rabid 24-hour all-crisis-all-the-time news cycle.
The upbeat fact about EV-68, at least for now, is that although it has overwhelmed families and over-worked doctors and nurses, we have been up to the task and no one has died—a reminder of just what it means to have an effective healthcare infrastructure.