When Viruses Go Viral: What’s the Deal With Enterovirus D68?

With all the recent news coverage surrounding Enterovirus D68 (EV-D68), we seem to be on the verge of mass panic. It sounds scary (I mean, it has a number…), and there are new affected states added to the map every day. So what is this thing, where did it come from, and how scared do we need to be?

Let’s start basic. It’s a virus. I’m sure you’ve all been told at some point that your illness was “just a virus,” and that it would go away on its own. That’s usually true, but viruses can play dirty, too. There are viruses cause HIV/AIDS, cervical cancer, and liver failure. They’re probably involved in some way with triggering various autoimmune diseases. So where on the spectrum does EV-D68 fall? Roughly somewhere between a common cold and influenza—in the big picture, not that bad.

Viruses are classified based on their structure and genetic composition. The enterovirus family is a group of over 100 viruses that share a large part of their genetic code. Like other viruses, they are constantly mutating, and new strains emerge all the time (just like the influenza virus…which is why you have to get another flu shot every year). They can cause a wide range of symptoms, based on the particular strain and how your body responds to it. They can cause runny noses and congestion, rashes (like hand, foot, and mouth disease), meningitis, and even polio (which has been nearly completely eradicated by immunization efforts). The EV-D68 strain is just another one of these viruses—a bit nastier than most. It typically causes cold symptoms, but seems to have an affinity for the lower respiratory tract; because of this, it can trigger some more serious respiratory problems—most notably in children that have asthma or a tendency to wheeze with viral illnesses.

So how do you know if your child has it? Well, you probably won’t, and it doesn’t really matter. Your child will most likely look like any other kid with a cold—runny nose, congestion, cough…you’ve been there. And if he’s unfortunate enough to be one of the ones that gets hit harder, he may need some extra help to get over the hump. But that’s nothing new. Every year around this time, there’s an increase in hospital admissions for respiratory illnesses and asthma exacerbations. It’s partially due to seasonal variations in viral activity, and partially due to all the kids going back to school or daycare. (Kids are gross—if you don’t believe me, go observe a kindergarten class for half an hour.) Granted, this virus seems to be more aggressive than average, and some kids have gotten really sick…but it’s not as bad as the nightly news makes it seem.

One of the most important lessons learned in medical training is to treat the patient, not the chart. If your child has a runny nose but tests positive for EV-D68, a box of tissues will get her through; if she is working harder to breathe and needs extra oxygen, but tests negative, she still probably needs to spend a night or two in the hospital. There’s no specific treatment for this virus, so the medical management is what we like to call “supportive”—meaning that we manage the symptoms until the patient just gets better (as Voltaire said, “The art of medicine consists in amusing the patient while nature cures the disease.”). Also, consider that the testing is expensive and not routinely available, and the results come back about a week after the illness is over…it’s really not worth checking. Well, that’s not entirely true—one reason to check is that epidemiologists (people that study the spread of diseases) eat this stuff up; without them, our understanding of diseases and how to prevent them would be limited, and we would have no warning about an upcoming zombie apocalypse flu pandemic. Another reason to check is that it gives the news anchors something to talk about.

What’s this all mean for you? Should you keep your kids out of school for the next 2 months or seal your windows with duct tape? I wouldn’t bother. Go about your life, don’t watch the news, and practice good hygiene. EV-D68 (along with thousands of other viruses) is spread by respiratory particles (i.e., spit and snot). Don’t share drinks or kiss sick people. Cover your mouth when you cough or sneeze. Wash your hands with soap and warm water frequently and make sure your kids wash theirs—EV-D68 isn’t destroyed by alcohol-based hand sanitizer, and who wants dead germs on their hands anyway? And finally, if you notice that your child is having difficulty breathing or you have other concerns, call your doctor.

For more information about EV-D68, as well as a current map of states with confirmed cases, see the CDC website.

As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

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