Enterovirus: How frontline U.S. doctors first encountered EV-D68

WATCH ABOVE: Dr. Samir Gupta explains what you should know about enterovirus D68.

TORONTO – The kids poured into hospital coughing, wheezing, unable to even say a sentence without gasping for air.

Dr. Mary Anne Jackson knew that the Children’s Mercy Hospital in Kansas City had an unusual disease on its hands.

“I’ve certainly seen outbreaks in our community and tracked a variety of outbreaks, but what caught or attention from the beginning was the severity of illness,” Jackson, the hospital’s director of infectious diseases, said.

There have been outbreaks of measles, whooping cough, and the seasonal flu. Doctors knew how to prepare for them, when to brace for them and what to expect. The past few weeks weren’t as predictable.

READ MORE: Everything parents need to know about EV-D68 symptoms and treatment

“Most of the kids were school-aged and they were so short of breath, with rapid breathing using muscles from in between the ribs and neck to help. They couldn’t even speak a sentence,” Jackson recalled.

There wasn’t a day during the August outbreak that the hospital didn’t have at least one child admitted to the ICU with a suspected case of EV-D68. The rare disease is now in at least 12 U.S. states, with confirmed cases in two Canadian provinces while other illnesses are being lab-tasted.

What are enteroviruses?

Enteroviruses are a group of viruses comprised of more than 100 different types of strains. Only some affect humans and enterovirus D68 happens to be one of them.

“Parents are obviously very scared and very nervous. We’ve been trying to impress upon them how important handwashing and other hygiene habits are to prevent spread,” Dr. B. Louise Giles told Global News.

READ MORE: Is enterovirus D68 on Canadian health officials’ radar?

She’s a Canadian doctor and pediatrician at the University of Chicago’s Comer Children’s Hospital. Since mid-August, Giles has been treating kids with the rare virus.

“It was really profound because we normally expect to see increases when school starts but this came very, very early,” she said.

At the onset, and at its peak in the Midwest

The first positive at Children’s Mercy Hospital was on Aug. 4, and the virus quickly spread. By Aug. 15 it peaked, testing the resources and preparedness of U.S. hospitals for the following weeks.

At its height, more than 120 children were in the emergency room, 20 per cent of which were then rushed to pediatric intensive care units.

READ MORE: Where is enterovirus D68 in Canada?

The Kansas hospital is the one often referred to in media reports as the Missouri facility that saw more than 30 kids a day.

Jackson estimates that 70 per cent of the time, the cases were enterovirus but officials are still working through testing to confirm.

In Giles’ case in Chicago, patients were young – primarily between two and eight years old. The Comer hospital is the second largest children’s hospital in Chicago, yet its wards were at full capacity.

Ultimately, the doctors ditched testing to focus on treatment.

How enterovirus behaves

EV-D68 presents more or less the same way as the common cold. Kids have the exact same symptoms: a runny nose, watery eyes and a cough. Some even have a fever.

What’s key is how the illness progresses, so parents should pay close attention to their child’s symptoms and if they worsen.

“Parents might say my child’s really struggling to breathe or the asthma action plan I’m told to follow isn’t working,” Giles explained.

READ MORE: Alberta Health Services confirms 18 cases of enterovirus D68

If your child falls sick with what appears to be a cold, within 12 to 24 hours you could be in hospital if he or she is responding poorly to enterovirus.

“By morning they’re in the ER. They’re sick that fast,” she said. The kids could have lungs that fail, in which oxygen is fed through a tube into the airways or they’re put on a breathing machine.

Unfortunately there are no vaccines or medications for enterovirus; eventually people recover on their own.

It’s all about relieving the symptoms. If kids are wheezing or struggling to breathe, they’re given medication to help the airways relax. In some cases, they’re given oxygen.

READ MORE: How do you treat the common cold? Here’s what works and what doesn’t

Bed rest, staying hydrated and monitoring patients’ health is also important. Within a few days, the kids’ immune system should take over.

Lessons from the Midwest

Giles suggests that Canadian health officials have an advantage: a heads up. Jackson says that it’s up to hospitals to ensure they’re prepared.

“You need to be about to mobilize on the fly in case you need more beds, more nurses, more respiratory therapists. In a very, very short period of time, our beds were at maximum capacity,” she said.

That’s almost 300 beds at the pediatric hospital that was already juggling day-to-day hospital operations, such as other ailments, surgeries and recovery.

While Alberta and B.C. each have confirmed cases, clusters of mild and severe illnesses are popping up in other provinces.

READ MORE: Sask. health officials closely monitor enterovirus D68 situation

“The cause of the respiratory illnesses in these additional clusters has not yet been identified. The agency’s National Microbiology Laboratory is providing guidance and assisting these provinces with additional testing of samples of the EV-D68 subtype,” the federal agency’s spokesman Robert Cyrenne said.

He said PHAC is closely monitoring the situation and is in touch with provinces and territories, along with U.S. public health officials.

The government has even issued a public health alert to more than 4,000 health professionals across the country to keep vigilant for potential cases.

How do you prevent it?

EV-D68 spreads just like the flu – through coughing, sneezing or close contact with infected patients.

Because the virus is affecting North America during the back-to-school period, health officials and school boards are sending kids home with a warning of the epidemic in the U.S. and advice to parents.

The Public Health Agency of Canada (PHAC) says the most effective measures you can take to protect yourself and children against enteroviruses such as EV-D68 are:

• Wash your hands with soap and warm water for at least 20 seconds
• If soap and water are not available, use a hand sanitizer
• Wash your hands: before and after eating, after you have been in a public place, after using the washroom, after coughing and sneezing, after touching common surfaces
• Cough and sneeze into your arm, not your hand
• Keep your hands away from your face
• Keep common surface areas clean and disinfected
• If you get sick, stay home
• Ensure your immunizations are up to date

carmen.chai@globalnews.ca
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