Hospitals across Scotland are dealing with a highly unusual surge in illness among pre-school children, with thousands more under-fives than normal attending to A&E departments.
It is unclear exactly what is driving the trend among very young children compared to older age groups.
However, the influx of toddlers and pre-schoolers requiring medical attention has coincided with an unseasonal surge in respiratory syncytial virus (RSV), particularly since the beginning of August.
RSV, a common virus which normally occurs in winter, causes mild cold-like symptoms in most people.
However, in young children and infants it can lead to bronchiolitis – inflammation of the lungs – which makes it difficult to breathe and is potentially life-threatening.
A respiratory surveillance report by PHS, published on Wednesday, notes that rates of RSV were ‘high’, with 305 cases confirmed by laboratory testing during the week beginning September 27.
It added: “The large majority of RSV detections thus far have been in those aged under five years. The typical RSV season usually peaks between week 49 and week 52.
“However, in 2020/21, week on week increases in laboratory-confirmed diagnoses for RSV have been reported since week 23 [beginning June 7] 2021.”
PHS also noted that recent weeks had seen increases in laboratory-confirmed diagnoses of other non-influenza and non-Covid respiratory pathogens, including rhinovirus, which is one of the viruses known to cause the common cold.
Flu remains at “baseline” levels.
Modelling by Public Health England earlier this year predicted that there would be a sharp rise in RSV across the UK during autumn and winter, particularly among children under-three, as Covid restrictions were lifted.
The projections anticipated that between 20 to 50% more cases than normal would require hospitalisation and that such a surge would require, at least, a doubling of paediatric intensive care beds.
Symptoms of RSV infection include a high temperature of 37.8°C or above, a dry and persistent cough, difficulty feeding, and rapid or noisy breathing.
The current spike in RSV in Scotland mirrors patterns already seen in the southern hemisphere earlier this year, where hospitals in New Zealand were forced to delay surgeries and convert playrooms into makeshift wards amid demand for paediatric beds.
Most children naturally acquire RSV before the age of two, but successive lockdowns and social distancing have eroded immunity and created the perfect conditions for the virus to rebound – with fears that a similar pattern could occur with flu.
It comes as Health Secretary Humza Yousaf said the NHS in Scotland faces an “incredibly, incredibly difficult winter” despite a £300 million funding boost.
Mr Yousaf told Holyrood’s Covid Recovery Committee that low immunity levels to flu, in addition to potential Covid pressures, could cause severe pressure.
Scottish Labour MSP Alex Rowley raised concerns from trade unions that the nurse-patient ratio in hospitals is sometimes “way beyond what is acceptable”.
Mr Yousaf said staffing levels, by headcount, are at a record high.
He added: “We’ll continue to recruit, of course. My [winter plan] made significant ambitions and recruitment, not just for nurses but also band twos to fours as well.
“But I have to be upfront with the member, and with the public.
“These measures will help to mitigate some of the challenges, but we’re still in for an incredibly, incredibly difficult winter.
“Clinicians tell me that their real concern is not just the Covid pressures – but we hope to make a significant dent into those as we’re controlling transmission – but the flu and other respiratory viruses because our immunity we suspect is quite low.
“Last year, of course, the flu wasn’t circulating as much due to the lockdown and restrictive measures we were under.”