Respiratory Syncytial Virus (RSV): Doctor’s guide

Summary: RSV (Respiratory Syncytial Virus) is a common yet potentially serious respiratory infection, especially for infants, older adults, and immunocompromised individuals. While it often mimics a cold, it can quickly escalate to severe breathing issues in high-risk groups. Prevention through handwashing, avoiding crowds, and new options like monoclonal antibodies has improved care.

It typically begins innocuously. A bit of nasal congestion, perhaps a slight cough. Maybe your infant seems more irritable than usual. You dismiss it—until the wheezing begins or the temperature rises. Suddenly, that simple sniffle has a diagnosis: Respiratory Syncytial Virus, or RSV.  

For new parents, grandparents, or anyone trying to avoid the seasonal onslaught of winter illnesses, comprehending RSV is essential. It's one of those stealthy viruses most people contract eventually—but for certain groups, particularly infants and seniors, it can be significantly more than an inconvenience.  

Here's a comprehensive overview of what you should know, from a medical perspective—without drowning you in technical terminology.

What is RSV?

RSV, or Respiratory Syncytial Virus, is a widespread respiratory infection that targets the lungs and breathing pathways. For most adults and older children with healthy immune systems, symptoms mimic a standard cold. However, for babies, elderly individuals, and immunocompromised people, RSV can be considerably more dangerous, potentially progressing to pneumonia or bronchiolitis (swelling of the small lung airways).

Consider this fact: Almost every child will have contracted RSV before reaching their second birthday. That's how prevalent it is. But prevalence doesn't equate to harmlessness.

Who's most at risk for RSV?

While RSV can infect anyone, certain populations face greater risks when infected. The most vulnerable include:

• Newborns and infants, particularly those born prematurely or with existing cardiac or pulmonary conditions
• People over 65 years old
• Individuals managing chronic health conditions (such as asthma, COPD, or heart disease)
• Those with compromised immune function, including cancer patients or organ transplant recipients

Though most RSV infections remain mild, these high-risk demographics may require hospitalisation and, in uncommon instances, face life-threatening complications.

How does RSV spread and what causes it?

Similar to other respiratory infections, RSV transmits through droplets expelled during coughs or sneezes. It also adheres to surfaces—doorknobs, children's toys, mobile phones—surviving for hours. Touching your face after contacting these surfaces creates a direct pathway to infection.  

Childcare centers, educational institutions, and crowded homes become transmission hotspots. Since individuals can spread the virus before symptoms appear, complete avoidance proves challenging.

RSV symptoms: What RSV looks like

The complicating factor? RSV initially presents much like an ordinary cold. Watch for these indicators:

• Nasal discharge
• Persistent cough or sneezing
• Reduced hunger
• Mild to moderate fever
• Wheezing or laboured breathing (a concerning sign)

In babies, symptoms may manifest more subtly—increased fussiness, unusual lethargy, or feeding difficulties. If an infant suddenly refuses feeds or exhibits rapid breathing (especially with visible abdominal movement), medical consultation becomes necessary.

Also read: Types of dry cough and their potential causes

How is RSV diagnosed?

Medical assessment typically begins with physical examination and symptom evaluation. When RSV seems likely—especially among high-risk patients—doctors may recommend nasal swab testing for confirmation.

More severe cases might warrant chest radiography or oxygen saturation monitoring to exclude complications such as pneumonia.

RSV treatment: What can you do?

The unvarnished reality: no specific medication exists for RSV. Most infections resolve independently with supportive measures—maintaining hydration, getting adequate rest, and perhaps using humidification to relieve congestion.

For more acute cases, particularly involving infants or elderly patients, hospitalisation might become necessary. This could include oxygen supplementation, intravenous fluids, or rarely, ventilator support in extreme situations.

Recent preventative therapies, including monoclonal antibodies (detailed below), are transforming treatment approaches—especially for infants.

Also read: Coughing and wheezing at night in kids: What to do? 

RSV prevention: What actually works?

While complete avoidance isn't realistic, practical precautions can minimise exposure risk:

• Regular and thorough handwashing (crucially important)
• Limiting proximity to sick individuals
• Regular disinfection of shared surfaces
• Not sharing eating utensils, drinking vessels, or infant pacifiers
• Keeping babies away from crowds during peak RSV season (typically autumn through early spring)

RSV prevention for babies: What's new?

This area has seen remarkable advancement. Recent scientific developments have introduced game-changing preventative options:

• Nirsevimab (Beyfortus): A single-dose monoclonal antibody administered before RSV season. It helps prevent severe disease and is particularly recommended for newborns and vulnerable infants.
• Palivizumab (Synagis): An established option for high-risk babies (such as premature infants or those with congental heart disease), requiring sequential monthly injections throughout RSV season.
• Maternal RSV vaccination: Administered during the third pregnancy trimester, providing passive protection for newborns during their initial vulnerable months.

Consult your paediatrician about which approaches suit your child's specific needs. These innovations herald a new chapter in RSV prevention.

When should you call the doctor?

While mild RSV can be managed at home, certain circumstances warrant immediate medical attention:

• Breathing becomes difficult or audibly strained (wheezing, grunting, using stomach muscles)
• Infant shows poor feeding or unusual drowsiness
• Fever remains high or persistent
• Lips or fingernails develop bluish discoloration (indicating oxygen deficiency)

When uncertain, trust your instincts. Seeking medical advice is always appropriate.

How can telehealth help?

Sometimes, a brief video consultation with your paediatrician or primary care physician provides crucial guidance. Telehealth particularly benefits those:

• Evaluating early or mild symptoms
• Determining whether in-person assessment is necessary
• Receiving immediate advice for home symptom management

This approach proves especially valuable during RSV season to minimise exposure in clinic waiting areas. When debating between urgent care visits or continued home care, virtual consultation saves time, reduces anxiety, and potentially prevents unnecessary travel.

How can Hola Health help with RSV?

Hola Health offers 24/7 online GP consultations, giving parents fast access to medical advice without leaving home which is crucial during RSV season. Through video calls or instant online appointments, AHPRA-registered online doctors can assess your child’s symptoms, recommend at-home care strategies, issue valid medical certificates, give 24/7 instant scripts and advise if further in-person treatment is needed. If required, they can provide referrals to paediatricians and offer guidance on RSV prevention options. Hola Health helps families get trusted medical support quickly, reducing clinic visits and exposure during busy winter months.

Final thoughts: What you shouldn't ignore about RSV

Though RSV remains common, its commonality doesn't diminish potential seriousness. For most people, it manifests as an uncomfortable period of coughing and nasal congestion. But for our youngest and oldest family members, conditions can deteriorate rapidly.

Encouragingly, preventative and management resources have never been more advanced. Between improved preventative options, telehealth accessibility, and heightened awareness, today's families have unprecedented tools to navigate RSV season intelligently and safely.

So if you're reading this while comforting a congested baby or researching symptoms during early morning hours—take a deep breath. Remember you're not alone. Ask questions, trust your parental intuition, and utilise your healthcare providers.