Health

Children’s hospitals in the US are overwhelmed with RSV

Children’s hospitals in the US are overwhelmed with RSV

A pediatrician in Mount Zion, Ill., sent a video of a 6-month-old named Natalie to a colleague for advice: The baby’s stomach was bloated and retracted with each pant as she tried to breathe, her nostrils flared and her lips bubbled.

Like dozens of patients of Dr. Caitlyn Berg In recent weeks, Natalie had contracted the respiratory syncytial virus, known as RSV, but the nearest hospital didn’t have a pediatric intensive care unit, and the one in Springfield — nearly an hour west — was full.

For Dr. Berg, this case was personal: Natalie is her daughter.

“I’m trying to separate the doctor’s brain from my mother’s brain,” she said. “But watching her breathe, I was terrified.”

A drastic and unusually early rise in RSV, a respiratory infection that obstructs the airwaysis flooding pediatric units across the United States, bringing long waits for treatment and prompting hospital systems to realign staff and resources to meet demand.

“Every children’s hospital that I know of is absolutely overwhelmed,” he said dr. Coleen Cunninghamchief pediatrician at Children’s Hospital of Orange County, a 334-bed facility in Southern California that is so full that children are being treated in the emergency room while waiting for hospital beds — sometimes more than 24 hours.

RSV is a common seasonal infection, and the vast majority of cases are very mild. But this year, the number of sick children – and seriously sick ones – is significantly higher than usual. Doctors suspect that those who would otherwise have been exposed to RSV in recent years have been isolated from it by social distancing measures and are now increasing in numbers.

“The immune system works on recognition and repetition,” he said Ph.D. Sarah Combs, an emergency medicine physician at Children’s National Hospital in Washington, DC, where over 1,000 children tested positive for RSV from July to early October of this year. “And when you take a break, as we did during the pandemic — and for good reason — we now have a generation of immune-naive kids.”

The surge in cases coincides with seasonal outbreaks of other respiratory viruses such as rhinoviruses and influenza, plus the ongoing burden of Covid. That’s especially challenging in regions where pediatric units have shrunk or even closed in recent years, creating bottlenecks in emergency rooms and shifting the burden to children’s hospitals that focus on specialty services like cancer treatment or heart surgery.

Doctors and public health experts are encouraging parents to do what they can to protect their children’s health in other ways (such as flu and Covid booster shots) because there is no widely available vaccine for RSV

According to preliminary estimates from the Centers for Disease Control and Prevention, nearly one in 500 babies 6 months and younger have been hospitalized with RSV since the beginning of October. The agency said the true numbers are likely higher because many people infected with the virus — even those who are hospitalized — never get tested.

Johns Hopkins Children’s Center in Baltimore, which has also reached capacity, is deploying nurses to its pediatric emergency department and will soon have children treated by doctors who normally care for adults — a reversal from two years ago, when pediatric staff assisted in the treatment of adult Covid patients.

“It all has a Covid-esque feel to it,” he said dr. Meghan Bernier, medical director of pediatric intensive care at the Children’s Center. “This is pediatrics’ Covid. This is our March 2020.”

RSV mainly affects the small airways, called bronchioles, that branch off from the bronchi in the lungs. Those tiny, straw-like tubules can become clogged with even small amounts of mucus, especially in infants and young children.

“The smaller you are, the smaller your airway is – it’s just physics,” said Dr. Combs.

High-risk babies sometimes receive a monoclonal antibody that can prevent infection, called Synagis. But the drug is so expensive that it is rarely offered – an approach that some doctors believe should change during such an extreme virus season.

Older adults and the immunocompromised are also at increased risk of severe illness from RSV, which kills about 14,000 adults 65 and older and up to 300 children younger than 5 in even a typical year.

The infection can be “a bit unpredictable,” said Dr. Meredith Volle, a pediatrician in Springfield, Ill., with whom Dr. Berg consulted, because what seems like a few days of a bad cold for some patients “very quickly leads to respiratory failure” in others.

Disease experts say there is no evidence that a more severe strain of RSV has emerged. Instead, the number of hospitalizations is increasing because in most regions more children are infected, and “a small percentage of a large number is still a high number,” said Dr. Buddy Creech, a professor of pediatric infectious diseases at Vanderbilt University Medical Center.

Virtual learning during the Covid pandemic stopped the spread of many respiratory viruses that bring children to hospitals. RSV has become so rare that some sophomores at Vanderbilt who joined the staff during the pandemic are just now seeing their first pediatric cases of RSV, said Dr. Creech.

As a result, older children are admitted with RSV longer and with more severe disease than usual. Many of them had never been infected with the virus before or were protected from re-exposure because their immunity was weakening, doctors said.

“When I first saw a 7-year-old without asthma in August who needed breathing support, I thought, what’s going on?” dr. Combs said.

Now, as virus-prone children return to classrooms and activities, the demand for pediatric beds falls largely on children’s hospitals receiving transfers from increasingly distant emergency rooms.

Boston Children’s Hospital has postponed some elective surgeries to make room for more respiratory patients, according to Dr. Daniel Rauch, a hospitalist there.

Doctors in Illinois received a list from the state Department of Public Health of 36 pediatric intensive care units in eight other states that doctors should call with requests to transfer patients. The document, reviewed by The Times, lists facilities spanning 1,000 miles, from Minneapolis to Chattanooga, Tenn.

Johns Hopkins Children’s Center received transfer requests from upstate New York, hundreds of miles away, and West Virginia, among other places. But it – like other pediatric specialty hospitals in Orange County, California; Seattle; and Lubbock, Texas – is already booked. It transfers its own patient transfusions to places like Richmond, Virginia, and Philadelphia.

Bringing doctors who treat adults to pediatric wards to help with the growth there will be complicated, according to Dr. Bernier, given the expertise required for high-quality child care. Redeployment can also be stressful.

“Watching a baby breathing 90 or 100 times a minute and struggling – that can be very distressing,” she said.

About 2,800 miles away from Johns Hopkins, at Children’s Hospital in Seattle, several patients are now housed together in single-patient rooms, and areas normally used for procedures have been converted into beds, according to Ph.D. Surabhi Bhargava Vora, infectious disease specialist. Doctors are being encouraged to rush tests and discharge patients as soon as possible to free up space, she said, in a season “worse than any RSV season I’ve ever seen.”

dr. Berg, a pediatrician in Mount Zion, Ill., ended up driving 6-month-old Natalie nearly an hour to Springfield, where a wait-only line formed at HSHS St. John’s Children’s Hospital. After spending eight hours in the emergency room, a pediatric bed opened up, and by evening Natalie was transferred to the intensive care unit, where she stayed for four nights. She is now back home and has mostly recovered, although she still has congestion and the occasional cough.

One side effect of the rise in respiratory infections, doctors and hospital officials said, is that children visiting the emergency room for non-life-threatening conditions, such as broken legs or dog bites, will have longer wait times because they rank lower on the triage scale. Parents should, for both their children’s sake and the hospitals’ sake, do everything they can to help flatten the curve, they said.

For Covid and flu — unlike RSV — that means getting available vaccines. (No RSV vaccine has been approved in the United States, but candidates made by Pfizer and GSK have completed late-stage clinical trials. dr. Cunningham, who also chairman of the department of pediatrics at the University of California, Irvine, is leader of the second trial for the vaccine in the form of nasal drops for children under 2 years of age.)

“I don’t want to say to parents, ‘Be scared’ or ‘Hide,’ because RSV is not new, and I think fueling that pandemic-era anxiety is harmful,” said Dr. Combs. “But get your picture taken, and if your child ride a bike, put a helmet on it. This is no time to run amok at the trampoline park.”



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