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Children’s hospitals are under pressure 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 upended the usual seasonal patterns of respiratory illness, denying healthcare professionals a respite ahead of a possible hectic winter when coronavirus, influenza and other viruses collide.
Respiratory syncytial virus, a common cause of cold-like illness in young children known as RSV, began to rise in late summer, months before its typical November to early spring season. The United States has been seeing about 5,000 cases a week this month, according to federal data, which is on par with last year but far more than in October 2020, when more coronavirus restrictions were in place and very few people contracted it. RSV.
“It is very difficult to find a bed in a children’s hospital, specifically an intensive care unit bed for a child with severe pneumonia or severe RSV because they are so full.” said Jesse Hackell, a physician who chairs the American Academy of Pediatrics committee on ambulatory medicine and practice.
Nearly three-quarters of children’s hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia, and Delaware report more than 94 percent of occupied pediatric beds. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported 85 to 90 percent of beds occupied. The data is limited to the facilities that report the information.
Several children’s hospitals in the DC area have been full for weeks; 18 children were waiting a room in the ICU on Tuesday at the Children’s National District.
DC real estate agent Kate Foster-Bankey was more in tune with RSV after she began hearing from clients whose children were affected by the virus in recent weeks, including one whose son was admitted to Children’s National.
Then her 3-year-old daughter Isabelle became ill and lethargic, complaining of a fast heartbeat and not eating. They waited two hours in the packed waiting room of a pediatric urgent care 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 get a bed.
“It seems that in covid, we destroyed our pediatric care,” said Foster-Bankey, 41. “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 crowded that patients are sorted in the hallways. Teenagers with bone fractures and appendicitis are being diverted or transferred to adult care facilities to create additional space for respiratory patients. Hospital officials are considering enlisting the National Guard to pitch tents and handle the influx of patients.
Over the past nine days, 110 children with RSV have come to the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, chief physician at Connecticut Children’s. He said that, for the first time in his career, he has had to commission doctors from other specialties, such as endocrinology and rheumatology, to work with RSV patients, a situation reminiscent of the “all hands on deck” approach taken by many hospitals for adults in March 2020, when the coronavirus began sweeping the United States.
“During my tenure here I haven’t seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.
Salazar and other doctors said one possible reason for the rise in RSV cases is that “pandemic babies” born in the last three years had been protected from respiratory pathogens due to social distancing and the use of masks.
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 mild or asymptomatic cases, he said it’s possible that the percentage of infection-fighting B cells has decreased, creating “a certain level of immunosuppression” just as they’re being attacked by a viral infection.
“So the virus has found a very susceptible population and has spread very rapidly,” Salazar said.
Texas Children’s Hospital in Houston, the nation’s largest pediatric medical center, had more than 40 patients hospitalized for RSV as of Friday, with several children in intensive care.
James Versalovic, chief pathologist at Texas Children’s, said the increase in RSV outside of the typical season could be attributed to how different respiratory viruses interact with each other and how the pandemic has changed children born in recent years.
“Their immune systems and immunity may have been altered in ways that we are only beginning to appreciate,” he said, adding that the pandemic has changed humanity’s “pattern of susceptibility to respiratory viruses.”
Hackell, of the American Academy of Pediatrics, said the masking during the pandemic simply delayed the normal infection pattern of respiratory pathogens. “We’re seeing a lot more cases at a time when they used to be scattered,” he said.
RSV, which primarily infected infants and young children before the pandemic, has now been seen in children older than 3 years, said Andrew Pavia, an infectious disease expert at the University of Utah Health and Intermountain Primary Children’s Hospital.
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 fill up beds.
Elizabeth Murray, a pediatric emergency physician at the University of Rochester-Golisano Children’s Hospital, said her hospital is seeing 20 to 30 more patients a day due to the onslaught of respiratory illnesses. About a fifth of patients have RSV. Some are staying in the emergency department or postsurgical areas instead of getting a traditional room because the hospital is filling up.
“We have to use the spaces a little more creatively,” Murray said.
Marc Lashley, a pediatrician with the Allied Physicians Group of New York, one of the largest pediatric organizations in the country, said his pediatric practice is experiencing a more active decline due to the rise in RSV cases.
“It’s quite laborious to keep them out of the hospital,” Lashley said, advising parents to keep sick children home to reduce the spread of disease and strain on the health care system. “We don’t want children to live in a bubble, but we do want parents to be cautious if a child has cold symptoms, which is how RSV can start.”
Experts are also concerned about stubbornly low coronavirus vaccination and booster rates in children, as authorities brace for a winter influx fueled by variants apt to infect people despite prior vaccinations and infections.
While 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 number in the thousands.
Staff at Intermountain Primary Children’s Hospital, which was at 92 percent capacity as of Friday, are bracing for a confluence of surges in RSV, flu and Covid-19.
“The ingredients are in place for all three waves to overlap,” Pavia said.
That’s why medical experts are amplifying their pleas for people to get vaccinated against influenza and coronavirus, and to be careful. of multiple viruses hitting at once.
“If you’re not immunized 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 uptick in RSV cases.
For Foster-Bankey, the virus proved unpredictable.
Doctors had prepared to release Isabelle on Thursday, but her oxygen levels dropped dramatically and she nearly passed out. She was put on oxygen support overnight and she began to recover on Friday, perking up after playing with an Elsa doll.
After three nights in the hospital, Isabelle was able to return home in time for dinner on Friday. Her older sisters welcomed her with a new pumpkin headband.
Jenna Portnoy contributed to this report.
Source: news.google.com