After Dr. Laura Romano’s 4-year-old daughter began showing symptoms of a respiratory illness on Halloween, the pediatric hospitalist at Cook Children’s Medical Center knew the likely culprit: RSV, or respiratory syncytial virus. By then, she and her colleagues had been treating the virus for more than a month.

For children, the diagnosis is not uncommon; most will contract RSV before their second birthday. But the timing was unusual. “We normally think of (RSV) as being a very wintertime virus,” Romano said. In a typical season, cases peak mid-December. 

Dr. Laura Romano pronounces ‘respiratory syncytial virus.’

But this fall, after a two-year reprieve Romano credits to COVID-19 safety protocols, more and more children are contracting the virus early, creating a glut of patients across pediatric offices, urgent cares and emergency rooms in Tarrant County and nationwide. At Cook Children’s, the crush has been so severe that the medical center issued an internal ‘disaster code’ the first week of November, hospital officials said during a Nov. 3 press conference.

In winter 2019, Cook Children’s treated more than 2,500 children with RSV. A year later, in the throes of the pandemic, that number fell by almost one-third. As of Nov. 10, this season’s throngs have already surpassed 2,000. The cases come amid upticks in flu and COVID-19

“The sheer volume has made finding a bed for our patients a daily logistical puzzle,” said Wini King, chief of communications, diversity, equity and inclusion at Cook Children’s, during the press conference.

The timing and strength of the outbreak is likely a consequence of public health strategies like masking and social distancing during the pandemic, Romano said. A generation of children who, in other seasons, might’ve contracted RSV, didn’t. Now, as few COVID-19 protocols remain in place, they’re being exposed for the first time and with little immunity for protection. 

“This is, unfortunately, a natural thing that our kids go through,” Romano said. “We’re just seeing it all coalesce together at once.”

For most people, like Romano’s daughter, RSV causes mild, cold-like symptoms — coughing, sneezing, a runny nose — and resolves within a week or two. 

The virus is more likely to threaten older adults and babies, whose immune systems may be weakened or their lungs underdeveloped. RSV causes bronchiolitis, inflammation of the smallest airways in the lungs. In severe cases, bronchiolitis can lead to difficulty breathing, dehydration or pneumonia. 

The sickest people may require oxygen, IV fluids and breathing support from a ventilator. 

During the Nov. 3 press conference, King and three physicians gathered via Zoom to urge people to reserve the emergency room for emergencies. Families showing up with children experiencing mild symptoms cause bottlenecks, Romano told the Report in a separate interview.

For a respiratory illness like RSV, mild symptoms could look like cough and congestion. If a child is otherwise well, the physicians recommend the family seek, first, the child’s pediatrician and, if necessary, an urgent care. An urgent care is a walk-in clinic that offers expanded services like X-rays and stitches, usually with expanded hours. 

A child who is dehydrated or struggling to breathe should come to the emergency room, Dr. Daniel Guzman, a pediatric emergency medicine physician at Cook Children’s, said during the press conference. 

In a baby, dehydration could look like fewer wet diapers or no tears when crying, Romano said. A baby struggling to breathe may breathe faster than usual. “Like their belly going in and out with every single breath,” she said. “The skin between the ribs being sucked in or the skin around their collarbone being sucked in with every single breath.”

Guzman noted that he and his colleagues will prioritize the sickest children, so wait times for others will be longer than normal. He asked for kindness. 

“We understand how frustrating it can be and how important that each child’s care is. We don’t take that for granted,” he said. “We want you to know that we are here for you.”

“We understand how frustrating it can be and how important that each child’s care is. We don’t take that for granted.”

Dr. Daniel Guzman, Cook Children’s

Romano encourages families to pursue preventive measures, like covering coughs and avid hand-washing. RSV spreads through droplets — from a cough or sneeze, or on surfaces like doorknobs and toys. 

She’s also encouraging families to vaccinate their children for flu and COVID-19. “I know that there is a lot of hesitancy with both of them, but it’s going to be a bad winter if we do not,” she said. An RSV vaccine isn’t yet available

She and her colleagues have already seen children with dual infections: RSV and flu, RSV and COVID-19. “I’m just waiting to get one where we have all three.”

Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her at or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

Creative Commons License

Republish our articles for free, online or in print, under a Creative Commons license.

Avatar photo

Alexis Allison

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....