Unexpected peak of bronchiolitis requiring oxygen therapy in February
2020: Could an undetected SARS-CoV2-RSV co-infection be the cause?
Abstract
Respiratory syncytial virus (RSV) infection is the leading cause of
bronchiolitis among infants <12 months old. It is widely known
that coinfections between RSV and other viruses can worsen the clinical
picture of affected patients. To evaluate the severity of clinical
pictures of bronchiolitis in the 2019-2020 winter season, we performed a
retrospective study of our third-level Pediatric Emergency Department
(ED) admission charts. From February 2 to March 9, 2020 (start date of
the Italian lockdown), we observed a peak of patients with a clinical
picture of bronchiolitis requiring oxygen therapy of 55.1%, compared
with 18% and 14.5% during the same period in 2017-2018 and 2018-2019,
respectively (p<0.0001), without other clinically significant
differences between the groups. Several authors hypothesized that
SARS-CoV2 was present in northern Italy some weeks be-fore the first
confirmed case. We suggest that one of the causes of this unexpected
severe bronchiolitis peak may be a SARS-CoV2 - RSV coinfection in a
period when SARS-CoV2 was already circulating in north-ern Italy. Given
the lack of real-time polymerase chain reaction (RT-PCR) tests for
SARS-CoV2 at that time, our suggestion remains a hypothesis.