Impact of COVID-19 on the Changing Patterns of Respiratory Syncytial Virus Infections
Round 1
Reviewer 1 Report
This comprehensive well–written review well complements the previously published reviews on this topic. The review describes the unique properties of one of the most common respiratory viruses. For the future, we can recommend the authors to write a large full–length review on this topic, since the topic they touched on is very important both from the point of view of virology and from the point of view of epidemiology. The reviewer has mostly minor comments.
Point 1: In addition to RS–viruses, there is another group of viruses that is equally unique in terms of distribution – rhinoviruses (doi: 10.1016/j.ijid.2020.09.1473). Please mention it in the review that despite some delay, RS–viruses continued to circulate during the COVID–19 pandemic, as rhinoviruses did.
Point 2: The reviewer fully agrees with the statement that “Public health interventions for countering the spread of the COVID–19 pandemic significantly impacted the transmission of other respiratory viruses, including RSV.” However, these measures have had a much smaller impact on the spread of RS–virus and rhinovirus compared to other respiratory pathogens. Preventive measures (including mask–wearing) did not dramatically decrease transmission of rhinoviruses.
Point 3: Line 51. Please, put dot after “RSV outbreaks”
Point 4: Line 60–61. Can the authors argue that the mechanism of high transmissibility of rhinoviruses, which are not enveloped, is different??? I believe that this statement, which can be understood as “enveloped viruses like SARS–CoV–2 are transmitted through similar mechanisms,” should be written more carefully.
Point 5: Line 101, 125. Should it be in bold or italicized?
Point 6: Please, express your point of view (even if it is speculative) why a number of authors indicate that during the COVID–19 pandemic in various countries, RS viruses and rhinoviruses continued to circulate, while other respiratory viruses were suppressed by SARS–CoV–2.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
1. Content of Section 2 doesn't say anything around the section header. A scientific review article should be more contained with significant evidences and scientific statements. I would recommend a rigorous literature search and complete rewrite with information on:
(a) the pre-pandemic nature of the circulation of RSV,
(b) how much that been affected by COVID-19 pandemic (improves or worsens),
(c) how the pandemic restrictions (social distancing, face masks, lockdown, etc.) shape that circulation.
(d) make briefs from each of the cited articles.
2. In lines 77-78, 10 articles has been cited at the same place. I doubt all of these articles reported along the same storyline, but they must have some significant explorable insights. A review article should be a careful thorough readout of those cited articles for the readers, specially, for a novice/layman of any scientific area start exploring the field through review articles as guidelines. Moreover, it is a sign of poor scientific conduct to club a chunk of articles in reference without any justification or assertion. Please follow 1.(d) here as well.
3. Before starting line 81, provide background seasonality information with reference.
4. Missing reference in line 87.
5. Do not understand lines 92-93. How the reference 30 justify the scope of this article? Secondly, covariates are always there, a study should carefully extract them out or take care of them. There are quantitative methods for them and I am sure there are reported articles on them. I would consult few of those articles and elaborate.
6. I appreciate the lines 94-100. This is very useful information. I am curious, if the authors are able to comment why the three season onset timings are different. That would be very informative.
7. It would be great if the authors can provide a schematic of the seasonality shifts/delays using the reported data.
8. The 'immunity debt' should be elaborated following the cited articles. It is not that simplified but multi-layered immunological phenomenon, as much I understand. The time-scales and events in human immune response system has cross-talks with a spectrum of infection, organ-tissue architectures and external interventions.
9. Co-infection has been mentioned in the Section 5 with case reports. That is good, but the authors did not make any commendation or inferred anything from that. It is needed little more focus.
10. The future directions also lac similar as in the previous comment.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
This review of the effect of SARS-CoV-2 prophylaxis on seasonal RSV infections in young children is well written and informative.
Minor grammar and spelling suggestions are noted on the attached file.
Comments for author File: Comments.pdf
Author Response
Response- We thank the reviewer for their comments. We have corrected the grammar/spelling errors borne out by the reviewer.
Reviewer 4 Report
Below are comments to the work titled: Impact of COVID-19 on the changing patterns of Respiratory Syncytial Virus infections.
1. Line 60.
“Viruses that can cause bronchiolitis, including RSV and Influenza (enveloped viruses like SARS-CoV-2)”
Authors mentioned that RSV and Influenza virus are enveloped viruses like SARS-CoV-2. Does having an envelope have any special importance in the context of this study? The Authors appear to have mentioned one random feature common to these viruses.
2. Line 65
“Similar preventive measures (including mask-wearing) implemented during the severe acute respiratory syndrome coronavirus (SARS) 2003 pandemic coincided with a decrease in influenza rates.”
Are there any data that support this statement? What was the scale of the reduction in influenza cases? Is it possible to provide any figures from different countries?
3. Line 78
“Understanding RSV seasonality and year-round surveillance are crucial for
health service planning and the timing of RSV passive prophylaxis (monoclonal antibodies or maternal immunization).”
Please explain how it should be understood “maternal immunization”
4. Line 83 and 133
“Various studies from the southern hemisphere noted a drastic reduction in new RSV cases [29] compared to previous seasons”
and
“Some authors have suggested a combination of increased exposure following re-
opening of schools, nurseries, and kindergartens, easing off travel restrictions, and cessation of mandatory facemask-wearing (non-pharmaceutical interventions) following COVID-19 vaccination, the future RSV outbreak might be more severe compared to previous seasons [56]”
When the sentence starts with “some” or “various” it can be expected that the opinions/results of various researchers will be given, but there is only one citation for each statement (one from Australia, the second from New Zealand).
In this manuscript the authors presented a trend, which correct of course. Thesis is not supported by the results of studies carried out by various researchers from different centers/countries. The evidence supporting the thesis presented in the title should be described by the authors. This would let us know exactly the impact of COVID-19 on the changing patterns of Respiratory Syncytial Virus infections.
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
The authors have done a significant revision of the manuscript and that has definitely improved the review article. Few concerns still are unaddressed in the present revision; the authors might have missed, unfortunately. I would strongly recommend to address to points once again.
1. Comment 1 from my previous review has not been properly addressed.
2. Comment 9 about the coinfection has not been addressed. I am afraid the authors have not understand the question clearly. Their revision includes only few redundant and unnecessary information.
3. Similar attempt has been taken for section 6. It doesn't say anything about the authors opinion or inference.
4. There are still some English and typo errors and order of the revised references.
Author Response
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Author Response File: Author Response.pdf
Reviewer 4 Report
I have some additional questions and comments to the 2nd version of the manuscript titled:
1Line 109
,,This pattern of RSV seasonality by geography was also borne out in a systematic review by Stensballe et al examining global trends [26]”.
What kind of conclusions and observations can be drawn from this review
2Line 117
“… drastic reduction in new RSV cases…”
The authors mention the situation in Australia and Asia. What is the situation e.g. in Europe? Are there any observations available?
3 Line 134
,, For instance, meteorological factors, diurnal temperature range, precipitationand relative humidity were noted to be associated with increased RSV transmissibility and higher maximum wind speed was associated with decreased RSV transmissibility[34]”.
The authors should try to explain the relationship of RSV-related morbidity to the factors given above.
4Line 205
,,Impact of COVID-19 on RSV severity,,
The authors noted well that the isolation of humans, because od Covid-19 epidemy, increased the pool of people susceptible to RSV infection, but did not provide evidence on Impact of COVID-19 on RSV severity.
Line 177
,,Decreased protective immunity in the general population to respiratory pathogens, including RSV”
This is not entirely true. The increase in the pool of people susceptible to infection due to lockdown caused a compensatory epidemic.
Author Response
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Author Response File: Author Response.pdf
