Nationwide Children's, Ohio State doctors urge vaccination against COVID-19, discuss RSV

Doctors stress importance of vaccines as the powerful delta variant surges.

Laura Newpoff
For Columbus CEO
Dr. Octavio Ramilo, chief of infection diseases, Nationwide Children's Hospital

Respiratory syncytial virus, or RSV, is a common virus that causes cold-like symptoms for most people but can lead to bronchiolitis and pneumonia in babies. Dr. Octavio Ramilo has been researching RSV for 26 years and says it’s not uncommon for pediatric hospitals to treat about four or five children afflicted with RSV over any given summer month.

This July, Nationwide Children’s Hospital saw 320 cases.

Ramilo, the chief of infectious diseases at the hospital, expects the measures people took to ward off COVID-19, including social distancing and mask wearing, suppressed the circulation of certain viruses like RSV and influenza. That changed when Americans began to gather again in late spring and early summer as people began getting vaccines and mask mandates were lifted.

The unexpected rise in RSV added more pain to an already strained American healthcare system that caught barely any break from the alpha version of COVID-19 before the delta variant became the predominant strain over the summer. Nationwide Children’s has seen its fair share of COVID patients, and some have been as young as two days old.

The rise in RSV and a surge of children in hospital beds because of the delta variant is symbolic of the topsy-turvy nature of the pandemic and the unprecedented situations doctors have faced over the past 18 months. Ramilo, like his peers at other local health systems, says there’s only one way out of the crisis. “We need to vaccinate, we need to vaccinate, we need to vaccinate,” he says.

What is the delta variant?

Viruses evolve as they spread and replicate. Flu viruses, for example, constantly change and that’s why its vaccine is updated every year.

Delta is the predominant strain of the COVID-19 virus in the U.S. In late June, the seven-day moving average of reported cases was about 12,000, according to the Centers for Disease Control and Prevention. By the end of July that number rose to more than 60,000.

Dr. Andrew Thomas, chief clinical officer at Ohio State University Wexner Medical Center, says delta is far more contagious than the original Alpha variant with viral loads in a person’s nose that can be 1,000 times higher. Fully vaccinated people with delta breakthrough cases also can spread the virus to others, according to the CDC.

Those factors prompted the CDC to issue new guidance in July that recommended fully vaccinated people wear masks indoors in areas of substantial or high transmission, which includes Franklin County and most of Ohio.

“Delta was a game changer because of its contagiousness,” Thomas says. “Compared to the alpha variant, a smaller amount of droplets need to go from the mouth or nose of an infected person to an exposed person for that person to become infected because of the higher concentration of the virus. Masks are important because people who are vaccinated may not know they have it and now we know they can transmit it.”

Doctors emphasize education to battle vaccine hesitancy

While vaccinated people can get the delta variant, the jab has proven effective in terms of hospital stays and death. With nearly 60 percent of our state’s adult population fully vaccinated, most hospitals, Thomas says, are reporting that 85 percent to 90 percent or more of their COVID admissions are patients who are not fully vaccinated. That’s why in addition to his administrative duties and treating patients, Thomas spends countless hours educating others about the vaccine, including visits with businesses, media, school districts and other healthcare professionals and public policy makers. Key to fighting vaccine hesitancy, he says, is dispelling the wave of disinformation that’s pumped out to the public by some news outlets and social media channels.

Dr. Joseph Gastaldo, who specializes in infectious diseases at OhioHealth, thinks so, too. He has produced hundreds of hours of education about the pandemic and continues to host Facebook live events and podcasts, authors provider communications and conducts media interviews anytime he’s asked. Now that the vaccine is available, he talks with businesses, schools and universities and sports teams about the importance of the shot.

“When I hear people are not vaccinated, the first thing I ask them is, ‘Hey, this is what I do for a living, tell me what you have heard. Teach me something that I don’t know,’” he says. He has been able to convince some who were among the hesitant, including family members from Tuscarawas County, to get the shot. In mid-July he says there were only two COVID patients at Riverside Methodist Hospital. By mid-August there were 33, and 18 were in the intensive care unit. The vast majority were unvaccinated.

The U.S. Food and Drug Administration gave full approval to the Pfizer vaccine on Aug. 23.

Unfortunately for children under the age of 12, vaccines aren’t an option right now, and Ramilo says they can get very sick from the disease.

“Children do get infected. They can have a huge amount of the virus and they can transmit it to others,” he says. For children who are eligible, the hospital’s role is to educate families and “to vaccinate every single opportunity we can.”

In addition to vaccines, there are treatments:

A nasal cannula device can deliver high-flow supplemental oxygen to a patient or increase airflow to a person who needs respiratory help. This has allowed Wexner Medical Center, for example, to place fewer people on a ventilator, which reduces the risk of infection and injury and allows it to free up intensive care unit beds.

Remdesivir has been approved by the Food and Drug Administration for the treatment of COVID-19 requiring hospitalization. In a class of medications called antivirals, it stops the virus from spreading in the body.

Monoclonal antibody treatments have FDA emergency use authorization to be used for patients who are at high-risk for severe disease and hospitalization. If these infusions are given early during a patient’s illness, it can reduce the risk of admission to the hospital by 70 percent.

And several drug makers are racing to produce a pill akin to Tamiflu that people could take at the early stage of the illness.

“A year and a half into this we have practice guidelines along with treatments and vaccines,” Gastaldo says. “That novel anxiety is gone, and we know how to take care of patients now. Still, people need to understand the way to get on with your life is to get the shot. COVID is not going away, so we need to learn how to live safely with this virus.”

Laura Newpoff is a freelance writer.