A pediatrician in Mount Zion, Illinois, sent a video of a 6-month-old girl named Natalie to a colleague for advice: The baby’s belly swelled and contracted with each pair of pants as she struggled to breathe , her nostrils dilated and bubbles formed on her lips.
Like dozens of Dr. Caitlyn Berg’s patients in recent weeks, Natalie was infected with respiratory syncytial virus, known as RSV. But the nearest hospital had no pediatric intensive care unit, and the one in Springfield – nearly an hour to the west – was completely full.
For Dr. Berg, this case was personal: Natalie is his daughter.
“I try to separate my doctor brain from my mother brain,” she said. “But watching her breathe, I was terrified.”
A drastic and unusually early spike in RSV, a respiratory infection that impairs the airways, is overwhelming pediatric units across the United States, leading to long waits for treatment and prompting hospital systems to reorganize staff and resources to respond on demand.
“Every children’s hospital I know is absolutely overwhelmed,” said Dr. Coleen Cunningham, chief pediatrician at Children’s Hospital of Orange County, a 334-bed facility in Southern California that is so full. that children are treated properly. in the emergency room while they wait for hospital beds – sometimes for 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 children falling ill – and seriously ill – is significantly higher than usual. Doctors suspect that those who would normally have been exposed to RSV over the past two years have been isolated from it by social distancing measures and are now pushing the numbers up.
“The immune system works by recognition and repetition,” said Dr Sarah Combs, an emergency physician at Children’s National Hospital in Washington, DC, where more than 1,000 children tested positive for RSV between July and early October this year. . “And when you give it some rest, like we did during the pandemic – and for good reason – we now have a generation of immune-naive children.”
The onslaught of cases coincides with the seasonal outbreak of other respiratory viruses like rhinoviruses and influenza, as well as the continued burden of Covid. This is particularly difficult in areas where pediatric units have shrunk or even been closed in recent years, creating bottlenecks in emergency rooms and shifting pressure to children’s hospitals which focus on services specialties such as cancer treatment or heart surgery.
Doctors and public health experts are encouraging parents to do all they can to protect their children’s health in other ways (like getting flu shots and Covid boosters) because there is no no vaccine widely available for RSV
Nearly one in 500 babies 6 months and younger have been hospitalized with RSV since early October, according to preliminary estimates from the Centers for Disease Control and Prevention. The agency said the true numbers are most likely higher because many people infected with the virus – even those who have been hospitalized – never get tested.
The Johns Hopkins Children’s Center in Baltimore, which has also reached capacity, is deploying floor nurses to the pediatric emergency department and will soon see children treated by doctors who normally deal with adults – a reversal from it two years ago, when pediatric staff helped treat adult Covid patients.
“It all has a very Covid-esque feel to it,” said Dr Meghan Bernier, medical director of the children’s center’s pediatric intensive care unit. “It’s the pediatrician’s Covid. It’s our March 2020.”
RSV mainly affects the small airways, called bronchioles, which branch off from the bronchi in the lungs. These tiny, straw-like tubules can become clogged with even minute amounts of mucus, especially in infants and young children.
“The smaller you are, the smaller your airways – it’s just physics,” Dr Combs said.
High-risk babies are sometimes given a monoclonal antibody that can prevent infection, called Synagis. But the drug is so expensive it’s rarely offered – an approach some doctors say should be reversed during such an extreme virus season.
The elderly and immunocompromised people are also at increased risk of serious illness from RSV, which even in a typical year kills around 14,000 adults 65 and older and up to 300 children under 5. year.
The infection can be “somewhat unpredictable,” said Dr. Meredith Volle, the Springfield, Ill., pediatrician Dr. Berg saw, because what feels like a few days of a bad cold for some patients “leads very rapidly to respiratory failure. ” at the others.
Disease experts say there is no evidence that a more serious strain of RSV has emerged. Instead, the number of hospitalizations is on the rise because in most regions, more children are being infected overall, and “a small percentage of a high number is still a high number,” he said. said Dr. Buddy Creech, professor of pediatric infectious diseases at Vanderbilt University Medical Center.
Virtual learning during the Covid pandemic has halted the spread of many respiratory viruses that land children in hospitals. RSV has become so rare that some second-year residents at Vanderbilt who joined staff during the pandemic are only now seeing their first pediatric cases of RSV, Dr. Creech said.
As a result, older children are admitted with RSV for longer and with more severe disease than usual. Many of them had never contracted the virus before or had been immune to further exposure as their immunity waned, doctors said.
“When I first saw a 7-year-old child without asthma who needed respiratory support in August, I thought: what’s going on?” said Dr. Combs.
Now, with virus-prone children returning to classrooms and activities, the demand for pediatric beds falls largely on children’s hospitals taking transfers from increasingly distant emergency rooms.
Boston Children’s Hospital has postponed some elective surgeries to make room for more patients with respiratory illnesses, according to Dr. Daniel Rauch, a hospitalist there.
Illinois doctors received a list from the state Department of Public Health of 36 pediatric intensive care units in eight other states that doctors should call for patient transfer requests. The document, which was reviewed by The Times, lists facilities spread over a distance of 1,000 miles from Minneapolis to Chattanooga, Tenn.
The Johns Hopkins Children’s Center has 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, Calif.; Seattle; and Lubbock, Texas – is already at full capacity. He ferried his own overflow of patients to places like Richmond, Va., and Philadelphia.
Bringing doctors who treat adults into pediatric units to help with the ramp-up will be complicated, Dr. Bernier said, given the expertise required for high-quality care for children. Reassignment can also be stressful.
“Watching a baby breathe 90 or 100 times a minute and struggle – it can be very disturbing,” she said.
About 2,800 miles from Johns Hopkins, at Seattle Children’s Hospital, several patients are now being housed together in single rooms, and areas typically used for procedures have been turned into bed spaces, according to Dr. Surabhi Bhargava Vora, an infectious disease specialist. doctor. Doctors are being pressured to ramp up testing and get patients out as quickly as possible to free up space, she said, in a season ‘worse than any other RSV season I’ve ever seen’ .
Dr. Berg, the Mount Zion, Illinois pediatrician, eventually drove 6-month-old Natalie nearly an hour to Springfield, where a line had formed just to check into the ward. waiting at HSHS St. John’s Children’s Hospital. After spending eight hours in the emergency room, a pediatric bed opened up, and in the evening Natalie was transferred to the intensive care unit, where she remained for four nights. She is now back home and has largely recovered, although she still suffers from congestion and an intermittent cough.
According to doctors and hospital officials, one of the side effects of the surge in respiratory infections is that children who go to the emergency room for non-life-threatening conditions like broken legs or dog bites will have downtimes. wait longer because they rank lower on the triage scale. Parents should, for the sake of their children and hospitals, do what they can to help flatten the curve, they said.
For Covid and flu – unlike RSV – that means getting the vaccines available. (No RSV vaccine has been licensed in the United States, but candidates made by Pfizer and GSK have both entered late-stage clinical trials. Dr. Cunningham, who is also the chairman of the University of California, Irvine Department of Pediatrics, is leading another trial of a nasal drop vaccine for children under 2 years of age.)
“I don’t want to tell parents, ‘Be scared’ or ‘Hide,’ because RSV is not new, and I think fueling that anxiety in the age of the pandemic is detrimental,” said Dr Combs. “But take your photos, and if your child rides a bike, put a helmet on them. Now is not the time to go wild at the trampoline park.
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