Respiratory infections are surging early in Seattle and Washington this year, crowding pediatric emergency departments and leaving doctors concerned about the severity of fall and winter outbreaks.

After enduring two winters of widespread masking, distancing and remote school and work, it’s likely our immune systems will be caught off guard by the flurry of seasonal infections this year, public health and hospital leaders say. Now, outbreaks are hitting earlier and potentially harder than the region has seen since before the pandemic began.

One particular virus called RSV, or respiratory syncytial virus, has been responsible for the bulk of concern in many hospitals, especially children’s ones — leading to a sharp increase in admissions and four- to five-hour emergency room wait times.

While RSV is an often mild respiratory virus that causes the common cold in adults and lasts a week or two, it can be more serious in kids, infants and older adults, according to the Centers for Disease Control and Prevention. The worst infections can sometimes lead to bronchiolitis, an inflammation of the smallest airways in the lungs, or pneumonia.

In the past month, Washington jumped from at least 160 infections per week to more than 220 per week, according to the state’s weekly influenza update, which also includes data about other respiratory viruses. The numbers, however, are not a representative sample of lab testing for RSV across the state because lab reporting is voluntary.

Still, sharp increases have also been noticed in King County, which reported a rise from 25 infections in early September to more than 200 this month, with about 18% of laboratory tests coming back positive.

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UW Medicine virologists are also detecting 150% to 200% more RSV in the community compared to last year at this time, hospital spokesperson Susan Gregg said.

Cases of rhinovirus, another common virus that can cause mild cold symptoms, are also up in King County, with about 19.5% tests returning positive.

Flu season has been fairly mild so far in King County and Washington, though two people have died from influenza infections this month.

At Seattle Children’s, health care teams are seeing double the number of patients it usually does for October, pushing emergency department levels to 200% its capacity on any given day, said Dr. Russell Migita, attending physician and a clinical leader of emergency services.

As of this week, over half of Children’s emergency department patients have respiratory virus symptoms, he said. Staffers are treating about 20 to 30 RSV infections per day.

“In typical years, children get many viral infections spread out over their first two years of life,” Migita said. “Because of the success of masking and social distancing, those viral infections are all being clustered at the same time. Having more than one infection at the same time can cause more severe illness. The fact that so many children are getting their first RSV infection now is driving the volumes.”

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This month, 30% of respiratory viral tests from Children’s emergency department came back positive for RSV. Usually, the hospital considers its RSV season to be at its peak when tests are 30% to 40% positive.

In addition to being early, this year’s respiratory virus season is likely to be severe, Migita said.

At Mary Bridge Children’s Hospital in Tacoma, emergency room patients are waiting up to five hours for a hospital bed. On average, about six to eight kids are waiting for a bed at any given time, said hospital spokesperson Kalyn Kinomoto.

While flu season has stayed considerably mild the past few years, a significant wave of RSV infections hit King County last year. At its height in mid-December, the county recorded nearly 200 cases per week, according to county data.

Statewide, Washington labs reported seeing more than 250 RSV infections per week in late November, though numbers were much lower during fall and winter 2020.

This year, higher respiratory infection levels will likely worsen the burden on the state’s already strained hospitals and clinics.

“Our hospital is chronically full and the fact that inpatient rooms are always full has meant that patients sit in the ED, waiting for inpatient beds,” Migita said. “However, we are … increasing staffing and ancillary care space.”