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Children’s hospitals are under strain in the United States as they care for an unusually high number of children infected with RSV and other respiratory viruses.
It’s the latest example of how the pandemic has changed the usual seasonal patterns of respiratory illnesses, denying health professionals a respite ahead of a potentially hectic winter as the coronavirus, flu and other viruses collide.
Respiratory syncytial virus, a common cause of a cold-like illness in young children known as RSV, began to increase in late summer, months before its typical November to early spring season. This month, the U.S. has seen about 5,000 cases a week, according to federal data, which is the same as last year but far higher than October 2020, when there were more coronavirus restrictions and very few people had RSV .
Hospitals are worried about childhood RSV this year. Here’s what you need to know.
“It’s very difficult to find a bed in a children’s hospital, specifically an intensive care unit bed for a child with pneumonia or bad RSV because they are so full.” said Jesse Hackell, a physician who chairs the American Academy of Pediatrics’ committee on ambulatory practice and medicine.
Nearly three-quarters of pediatric hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia and Delaware report that more than 94 percent of pediatric beds are occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. Data is limited to facilities that report the information.
Several children’s hospitals in the DC area have been at capacity for weeks; 18 children were waiting a room in the ICU on Tuesday at the National Children’s Center of the District.
D.C. real estate agent Kate Foster-Bankey was more attuned to RSV after she began hearing from clients whose children were affected by the virus in recent weeks, including one whose child was admitted to Children’s National.
Then her 3-year-old daughter Isabelle became ill, became lethargic, complained of a fast heartbeat and wasn’t eating. They waited two hours in the packed waiting room at a pediatric emergency center where Foster-Bankey, a mother of four, was used to seeing only a handful of patients.
During a follow-up visit on Tuesday, Isabelle was transported by ambulance to a children’s hospital emergency room, where she tested positive for RSV and had to wait until the next morning to find a bed.
“It seems that in covid, we destroyed our pediatric care,” Foster-Bankey, 41, said. “Kids shouldn’t have to wait in a waiting room with a bunch of other sick kids for hours.”
At Connecticut Children’s Hospital, the emergency room is so full that patients are being picked up in the hallways. Adolescents with broken bones and appendicitis are being diverted or transferred to adult care facilities to create additional space for respiratory patients. Hospital officials are studying the possibility of enlisting the help of the National Guard to set up tents and attend to the influx of patients.
Over the past nine days, 110 children with RSV have arrived in the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, chief medical officer at Connecticut Children’s. He said that for the first time in his career he has had to entrust doctors from other specialties such as endocrinology and rheumatology with working with RSV patients, a situation reminiscent of the “all hands on deck” approach that many adult hospitals adopted in March 2020, when the coronavirus began to sweep across the United States.
“In my tenure here I have not seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.
For decades, fear and failure in the search for a vaccine against RSV. Now, success.
Salazar and other doctors said one possible reason for the rise in RSV cases is that “pandemic babies” born in the past three years had been protected from respiratory pathogens by social distancing and masking.
Salazar said another theory suggests that children exposed to covid-19 have weakened immune systems, even if they had asymptomatic or mild cases. Even if the babies had asymptomatic or mild cases, he said, it’s possible that the percentage of infection-fighting B cells may have dropped, creating “a certain level of immunosuppression” just when they get an infection. viral
“So the virus has found a very susceptible population and spread very quickly,” Salazar said.
Texas Children’s Hospital, the nation’s largest pediatric medical center, had more than 40 patients hospitalized for RSV Friday, with several children in intensive care.
James Versalovic, chief pathologist at Texas Children’s, said the rise in RSV outside the typical season could be attributed to how different respiratory viruses interact with each other and how the pandemic changed children born in recent years.
“Their immune systems and their immunity may have been altered in ways that we are just beginning to appreciate,” he said, adding that the pandemic has changed humanity’s “susceptibility pattern to respiratory viruses.”
Covid is causing flu and other viruses to act in unknown ways
Hackell, of the American Academy of Pediatrics, said that masking during the pandemic simply delayed the normal infection pattern of respiratory pathogens. “We’re seeing a lot more cases at once where they used to be distributed,” he said.
RSV, which mostly infected infants and young children before the pandemic, has now been seen in children older than age 3, said Andrew Pavia, an infectious disease expert at University of Utah Health and Primary Hospital Intermountain Children’s.
Most cases of RSV and other respiratory illnesses will not require hospitalization. But when so many children get sick at once, even a small percentage requiring hospital care can deplete beds.
Elizabeth Murray, a pediatric emergency medicine physician at the University of Rochester-Golisano Children’s Hospital, said her hospital sees 20 to 30 more patients a day because of the crush of respiratory illnesses. About one fifth of patients have RSV. Some are staying in the emergency room or post-surgical areas instead of getting a traditional room because the hospital is filling up.
“We need to use the spaces a little more creatively,” Murray said.
Marc Lashley, a pediatrician at the Allied Physicians Group in New York, one of the nation’s largest pediatric organizations, said his pediatric practice is experiencing a steeper decline because of the increase in RSV cases.
“It’s pretty labor-intensive to keep them out of the hospital,” Lashley said, recommending parents keep sick children at home to reduce the spread of disease and strain on the health care system. “We don’t want kids to live in a bubble, but we want parents to be cautious if a child has cold symptoms, which is how RSV can start.”
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Experts have also been concerned about very low vaccination and booster rates of the coronavirus in children, as authorities prepare for a winter influx fueled by variants fit to infect people despite previous infections and infections.
Although children tend to have milder cases of covid-19, hospitals can still be overwhelmed by pediatric cases during waves of mass infection when the small percentage of children who become seriously ill rises into the thousands.
Staff at Intermountain Primary Children’s Hospital, which was at 92% capacity on Friday, are bracing for a confluence of RSV, flu and covid-19 surges.
“The ingredients are in place for all three overlapping waves,” Pavia said.
When the coronavirus receded last year, other viruses roared back
That’s why medical experts are expanding their pleas for people to get flu and coronavirus shots, and to take care of multiple viruses that affect at the same time.
“If you’re not vaccinated and you get infected, you’re going to have a much more serious infection,” said Angela Myers, director of the division of infectious diseases at Children’s Mercy Kansas City, who is also experiencing an increase in RSV cases.
For Foster-Bankey, whose 3-year-old daughter was hospitalized with RSV this week, the virus proved unpredictable.
Doctors had prepared to discharge Isabelle on Thursday, but her oxygen levels dropped dramatically and she nearly passed out. She was put on oxygen overnight and began to recover on Friday, perking up after playing with an Elsa doll.
After three nights in hospital, Isabelle was able to return home in time for dinner on Friday. Her older sisters greeted her with a new pumpkin headband.
Jenna Portnoy contributed to this report.