Respiratory syncytial virus and other viruses keep several children’s hospitals at capacity


Children’s hospitals in the United States are under pressure 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 can upend the usual seasonal patterns of respiratory illnesses, leaving healthcare professionals with little respite before a potentially busy winter when coronavirus, flu and other viruses collide.

Respiratory syncytial virus, a common cause of cold-like illness in young children called RSV, begins to surge in late summer, months before the typical November to early spring season. The U.S. recorded about 5,000 weekly cases this month, according to federal data, unchanged from last year but much higher than in October 2020, when more coronavirus restrictions were imposed and few people contracted RSV.

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“It’s hard to find a bed in a children’s hospital — especially an ICU bed for a kid with severe pneumonia or severe RSV because they’re full,” he said. said Jesse Hackell, chair of the American Academy of Pediatrics Committee on Practice and Outpatient 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 85% to 90% of their beds were occupied. Data is limited to facilities reporting information.

Several children’s hospitals in Washington, D.C. have been at full capacity for weeks; 18 children waiting One In the intensive care unit of the National Children’s Hospital in the district on Tuesday.

DC real estate agent Kate Foster-Bankey has become more comfortable with RSV after she began hearing in recent weeks that clients’ children had contracted the virus, including one who was taken by Children’s National Hospital. admitted clients.

Then her 3-year-old daughter Isabel fell ill and became lethargic, complaining of a fast heartbeat and not eating. They waited for two hours in a crowded waiting room at a pediatric urgent care center, where Foster-Bankey, a mother of four, is used to seeing only a handful of patients.

During a follow-up visit on Tuesday, Isabel was taken by ambulance to the emergency room of a children’s hospital, where she tested positive for RSV and had to wait until the next morning to get a bed.

Foster-Bankey, 41, said: “It sounds like our paediatric care has been completely disrupted in the midst of the Covid-19 pandemic. Kids shouldn’t be in a waiting room with a bunch of other sick kids. Wait a few hours.”

At Connecticut Children’s Hospital, emergency rooms were overwhelmed and patients were being triaged in hallways. Teens with fractures and appendicitis are transferred or transferred to adult care centers to create more space for respiratory patients. Hospital officials are considering the possibility of enlisting the National Guard to help set up tents and care for the influx of patients.

Juan Salazar, an attending physician at Connecticut Children’s Hospital, said 110 children with RSV have been admitted to the emergency room in the past nine days, and at times as many as 25 children with RSV are waiting for hospital beds. For the first time in his career, he said, he had to authorize physicians in other specialties, such as endocrinology and rheumatology, to work with RSV patients — a situation reminiscent of the March 2020 decision taken by many adult hospitals The “all out” approach when the coronavirus started sweeping the United States.

“I’ve never seen anything like this during my tenure,” said Salazar, who has worked in the infectious disease field for 30 years.

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Salazar One possible reason for the rise in RSV cases is that “pandemic babies” born in the past three years have been protected from respiratory pathogens by social distancing and wearing masks, Dr. and other doctors said.

Another theory suggests that children exposed to covid-19 have weakened immune systems, even if they have asymptomatic or mild cases, Salazar said. Even if infants have asymptomatic or mild cases, he said the percentage of infection-fighting B cells may have declined, creating “some degree of immunosuppression” when they become infected with the virus.

“So the virus found a very susceptible population and spread very quickly,” Salazar said.

As of Friday, Texas Children’s Hospital, the nation’s largest pediatric medical center, had more than 40 hospitalized patients with RSV, including several children in intensive care.

James Versalovic, chief pathologist at Texas Children’s, said RSV surges outside of typical seasons may be attributable to how different respiratory viruses interact and how the pandemic has changed children born in recent years.

“Their immune systems and immunity may have changed in ways that we’re just starting to realize,” he said, adding that the pandemic has changed the “pattern of susceptibility to respiratory viruses” in humans.

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Wearing a mask during a pandemic simply delays the normal infection pattern of respiratory pathogens, said Hacker of the American Academy of Pediatrics. “We’re seeing more cases at a time that used to be scattered,” he said.

Andrew Pavia, an infectious disease specialist at the University of Utah Health and Intermountain Elementary Children’s Hospital, said RSV, which primarily infected infants and young children before the pandemic, has now been found in children over the age of 3.

Most cases of RSV and other respiratory diseases do not require hospitalization. But when so many kids are sick at the same time, even a small percentage of those requiring hospitalization can run out of beds.

Elizabeth Murray, a pediatric emergency physician at the University of Rochester’s Golisano Children’s Hospital, said her hospital sees 20 to 30 patients a day because of the severity of the respiratory illness. About one in five patients has RSV. Some live in emergency rooms or post-surgery areas instead of traditional wards because hospitals are overcrowded.

“We have to use the space more creatively,” Murray said.

Marc Lashley, a pediatrician at United Physicians Group in New York, one of the largest pediatric organizations in the U.S., said his pediatric practice is experiencing a busier decline due to the rise in RSV cases.

“Keeping them out of the hospital is pretty labor-intensive,” Lashley said, advising parents to keep sick children at home to reduce the spread of disease and strain on the health care system. “We don’t want kids living in a bubble, but we do want parents to be cautious when their kids have cold symptoms, and that’s how RSV can start.”

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Experts have also been concerned that coronavirus vaccination and booster immunization rates among children have been low as authorities prepare for a winter influx of variants that can infect people despite previous vaccinations and infections.

While covid-19 cases in children tend to be milder, in a wave of mass infections, pediatric cases can still overwhelm hospitals, and the proportion of severely ill children is small, in the thousands.

Staff at the Intermountain Primary Children’s Hospital were at 92 per cent capacity as of Friday and are bracing for a confluence of RSV, flu and covid-19 surges.

“All three wave overlap components are in place,” Pavia said.

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“If you get infected without being vaccinated, your infection is much more severe,” said Angela Myers, director of infectious diseases at Children’s Mercy in Kansas City. RSV cases are on the rise.

For Foster-Bankey, her 3-year-old daughter was hospitalized this week with RSV, a virus that proved unpredictable.

On Thursday, doctors prepared to release Isabelle from the hospital, but her oxygen levels plummeted and she nearly passed out. She received overnight oxygen support and started to bounce back on Friday, cheering up after playing with the Elsa doll.

After three nights in hospital, Isabelle was able to get home in time for dinner on Friday. Her sisters welcomed her back with a new pumpkin headband.

Jenna Portnoy contributed to this report.

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