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. This month, the United States has seen about 5,000 cases per week, according to federal data, which is comparable to last year but well above October 2020, when more coronavirus restrictions were in effect and very few people contracted RSV.
Hospitals are concerned about RSV in children this year. Here’s what you need to know.
“It is very difficult to find a bed in a children’s hospital – especially an intensive care unit bed for a child with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a physician who chairs the American Academy of Pediatrics Committee on Practice and Ambulatory Medicine.
Nearly three-quarters of pediatric hospital beds are occupied, according to federal health data. Rhode Island, the District of Columbia and Delaware report more than 94% of pediatric beds occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. The data is limited to facilities reporting the information.
Several DC-area children’s hospitals have been at full capacity for weeks; 18 children were waiting a intensive care room on Tuesday at the Children’s National in the District.
DC Realtor Kate Foster-Bankey was more tuned into RSV after she began hearing from clients whose children had the virus in recent weeks, including one whose child was admitted to Children’s National.
Then her 3-year-old daughter, Isabelle, fell ill, becoming lethargic, complaining of a rapid heartbeat and not eating. They waited two hours in the crowded waiting room of a pediatric urgent care center where Foster-Bankey, a mother of four, used to see only a handful of patients.
During a follow-up visit on Tuesday, Isabelle 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 for a bed.
“It looks like covid, we’ve gutted our pediatric care,” said Foster-Bankey, 41. “Children shouldn’t have to wait in a waiting room with a group of other sick children for hours.”
At Connecticut Children’s Hospital, the emergency room is so full that patients are being triaged in the hallways. Teenagers with bone fractures and appendicitis are being diverted or transferred to adult care centers to create additional space for respiratory patients. Hospital officials are considering the possibility of bringing in the National Guard to set up tents and deal with the influx of patients.
In the past nine days, 110 children with RSV have come to the emergency room, and at times as many as 25 children with RSV have been 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 had to commission physicians from other specialties such as endocrinology and rheumatology to work with patients with RSV – a situation reminiscent of the “everyone world on deck” that many adult hospitals adopted in March 2020, when the coronavirus began sweeping the United States.
“During my tenure here, I haven’t seen anything like it,” said Salazar, who has worked in infectious disease for 30 years.
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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 due to social distancing and masking.
Salazar said another theory suggests that children exposed to covid-19 have weakened immune systems, even if they have asymptomatic or mild cases. Even if the babies had asymptomatic or mild cases, he said it’s possible the percentage of infection-fighting B cells has dropped, creating “a certain level of immunosuppression” by the time they are hit with an infection. viral.
“So the virus 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 with RSV on Friday, including 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 the children born in recent years.
“Their immune system and their immunity may have been altered in ways that we’re only just beginning to appreciate,” he said, adding that the pandemic has changed humanity’s “pattern of virus susceptibility.” respiratory”.
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Hackell of the American Academy of Pediatrics said masking during the pandemic simply delayed the normal infection pattern of respiratory pathogens. “We see a lot more cases at the time they were spread out,” he said.
RSV, which primarily infected infants and toddlers before the pandemic, has now been seen in children older than 3, said Andrew Pavia, an infectious disease expert at the University of Utah Health and at the Intermountain Primary Children’s Hospital.
Most cases of RSV and other respiratory illnesses will not require hospitalization. But when so many children fall ill at the same time, even a small percentage needing hospital care can exhaust the beds.
Elizabeth Murray, a pediatric emergency physician at the University of Rochester-Golisano Children’s Hospital, said her hospital was seeing between 20 and 30 more patients a day due to the crush of respiratory illnesses. About a fifth of patients have RSV. Some stay in the emergency department or post-surgery areas instead of getting a traditional room because the hospital fills up.
“We need to use 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 seeing a busier decline due to rising RSV cases.
“It takes a lot of work to keep them out of the hospital,” Lashley said, recommending that parents keep sick children home to reduce the spread of illness and the strain on the healthcare system. “We don’t want kids to live in a bubble, but we want parents to be careful if a child has cold symptoms, that’s how RSV can start.”
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Experts have also worried about stubbornly low coronavirus vaccination and booster rates among children, as authorities brace for a winter influx fueled by variants adept at infecting people despite previous injections and infections.
While children tend to have milder cases of covid-19, hospitals can still be overwhelmed with pediatric cases during waves of mass infection when the small percentage of children who become seriously ill rises to thousands.
Staff at Intermountain Primary Children’s Hospital, which was at 92% capacity on Friday, are preparing for a confluence of RSV, influenza and covid-19 outbreaks.
“The ingredients are in place for all three waves to overlap,” Pavia said.
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“If you’re not immune and you get infected, you’re going to have a much more severe infection,” said Angela Myers, director of the infectious disease division at Children’s Mercy Kansas City, who is also are experiencing an increase in RSV cases.
For Foster-Bankey, whose 3-year-old daughter was admitted to hospital with RSV this week, the virus proved unpredictable.
Doctors had prepared to discharge Isabelle on Thursday, but her oxygen level dropped dramatically and she nearly passed out. She was put on oxygen overnight and started bouncing back on Friday, rejoicing after playing with an Elsa doll.
After three nights in the hospital, Isabelle was able to get home in time for dinner on Friday. Her older sisters greeted her with a new pumpkin headband.
Jenna Portnoy contributed to this report.
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