What Happened to the Seasons of Pediatrics?

One of the things people love about living in Richmond is experiencing all 4 seasons. We can almost always count on one or two good sledding opportunities each winter, cherry blossoms and spring blooms, summers at the pool, and beautiful fall foliage.

Traditionally, pediatric healthcare in the greater Richmond area has also had a seasonality. Around here, summer season for pediatricians is filled with check-ups; ear infections (both middle ear infections in infants and toddlers, and swimmer’s ear in older children and adolescents); summer colds caused by viruses like adenovirus; and enterovirus infections, which cause everything from colds to belly symptoms, and hand, foot and mouth. Late summer ushers in ragweed and the fall allergy season, as well as a rise in strep throat and cold viruses as children return to school. Around the time of the state fair (early October) children with asthma or wheezing issues start to have more struggles. Late fall brings a rise in RSV, and the arrival of “cold and flu season.” These germs circulate heavily through March in Richmond, by which time the spring allergens of tree and grass pollens are in full effect. May brings a relative respite from illnesses, and then the cycle starts all over again with summer check-ups.

Since the Spring of 2020, the rhythm of pediatric infections has been anything but seasonal or predictable. We saw little-to-no colds (or their resultant ear infections), strep, RSV or Flu from Spring 2020 to Spring 2021. In fact, pediatric healthcare professionals were sadly noting that it felt like we were writing more prescriptions for mental health medications than for antibiotics during that time. We did see an uncharacteristic summer wave of RSV in 2021 (typically a November – April germ in RVA). Then the Delta variant hit in late summer 2021, bled right into the Omicron wave, and was joined by many of the usual offenders that we see circulating through the winter – RSV, influenza, rhinovirus, parainfluenza virus, and human metapneumovirus. When the original Omicron variant slowed somewhat abruptly in mid-February 2022, all the other respiratory germs kept circulating.

I can’t begin to express how many sick visit encounters I’ve had in 2022 where the parent indicated it seemed like their child had been continually sick “since the masks came off” in late February. Frankly, it seems that way because it has been that way. We saw anywhere from 7 to 12 cases of influenza per month from December 2021 through May 2022 and have continued to see 1-4 cases/month since then. As it did in summer 2021, RSV seemed to have another strong showing in summer 2022 – again a very unusual time for us to see a lot of RSV in Richmond. Add to that spring allergies, continued circulation of winter viruses in the spring and summer, return of summer viruses, an increase in strep cases, and all the summer swimmer’s ear and middle ear infections, and yes, a lot of children have been unwell a lot of this year. Not to mention the ebb and flow of the different Omicron variants. It’s the reason our sick visit appointment slots fill so quickly most days. The wave of germs has been unrelenting.

But there’s hope ahead. First, we are so proud of how proactive PAR families are about their routine and seasonal vaccines. As Pediatricians, arguably the most impactful effect we have on our patients is protecting them from vaccine-preventable diseases. It’s why we emphasize it so much at check-ups, and why we continue to strongly recommend flu and COVID-19 vaccines in addition to the other vaccines that protect against infections such as tetanus, whooping cough, meningitis, polio, measles and HPV. PAR families also do a great job at staying healthy through regular exercise, good sleep, staying hydrated, and eating healthily. These lifestyle choices not only support growth and development for your children, but also help their bodies stay primed to fight off infections. With these healthy choices, vaccinations, good hand hygiene, and staying home when you or your child is not feeling well, our bodies will be as ready as possible to fight the germs that come our way. Whether the seasonality of pediatric infectious diseases returns in the near future or not, we have the playbook for prevention and fighting them off. It’s up to us individually and collectively to trust and implement it. On behalf of all the staff at PAR, thanks for doing your part and partnering with us to keep your children and our community as healthy as possible.

– Dr. Grabill