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Doctors are asking the Biden administration to declare an emergency in response to an “alarming increase” in children hospitalized with respiratory syncytial virus and influenza this season.
The Children’s Hospital Association and the American Academy of Pediatrics warned President Joe Biden and Health Secretary Xavier Becerra in a letter this week that “unprecedented levels” of RSV combined with increasing circulation of influenza are pushing some hospitals to the breaking point.
Infants 6 months and younger are being hospitalized with RSV at more than seven times the weekly rate seen before the Covid-19 pandemic in 2018 right now, according to data from the Centers for Disease Control and Prevention. Flu hospitalizations are also at a decade-long high, with children and the elderly most at risk, according to the CDC.
As respiratory viruses rise, more than three-quarters of pediatric hospital beds are occupied in the United States, according to data from the Department of Health and Human Services. Seventeen states report that more than 80% of beds are full, according to the data. Children’s hospitals in Arizona, the District of Columbia, Maine, Minnesota, Rhode Island, Kentucky and Utah are nearly full.
An emergency declaration would give hospitals the flexibility to free up bed capacity and staff to ensure children receive the care they need, said Children’s Hospital Association CEO Mark Wietecha, and AAP CEO Mark Del Monte to Biden and Becerra in the letter this week.
The president should declare an emergency under the Stafford Act or national emergency law, and the health secretary should declare a public health emergency, Wietecha and Del Monte wrote.
“We need emergency financial support and flexibilities along the lines of what has been provided to respond to COVID surges,” they wrote.
The rise in the number of children falling ill with respiratory viruses comes amidst staff shortages, as many healthcare workers have changed careers or retired due to occupational burnout. pandemic era. In addition, a large number of children are hospitalized for mental problems, which also puts a strain on abilities.
The American College of Emergency Physicians, in a letter to Biden earlier this month, warned that emergency departments are at a “breaking point” as patient volume exceeds staffed beds. Hospitals are often forced to keep patients in emergency departments because there are no inpatient beds available, which can lead to long waits, diminished care, and poor patient outcomes. . CAPE has described the situation as a public health emergency.
Oregon this week became the first state to declare a state of emergency in response to the RSV surge. Governor Kate Brown said the statement would support the state’s two pediatric hospitals through the deployment of volunteer emergency medical teams. Oregon’s pediatric hospitalization rate has more than tripled since late October, according to the governor’s office.
A spokesperson for the Department of Health and Human Services said the federal government is offering support to communities on a case-by-case basis. A national public health emergency would be determined based on national data, scientific trends and the insight of public health experts, the spokesperson said.
Senior U.S. health officials, in a call with reporters earlier this month, said the federal government was working with state and local partners to ease capacity issues in hospitals as respiratory illnesses surge. Dawn O’Connell, assistant secretary for preparedness and response, said federal health teams and national stock medical supplies are available to states when needed. So far, no state has requested that level of support, O’Connell said.
Newborn hospitalization rate doubles
Public health officials in the United States have repeatedly called on all eligible people to receive their Covid booster and flu shot to help ease the burden of respiratory disease this winter. There is no vaccine against RSV.
About 171 of every 100,000 infants younger than 6 months were hospitalized with RSV in the week ending Nov. 12, according to the CDC’s surveillance system that tracks 12 states. That’s more than double the hospitalization rate for RSV in newborns last year and more than seven times the rate in 2018, the last full season before the Covid-19 pandemic.
The flu hospitalizes about 13 in every 100,000 children under age 5, according to CDC data. The hospitalization rate for these children is at its highest in a decade and nearly double the current overall national rate. Seven children have died of the flu so far this season, according to the CDC.
RSV and influenza are increasing in part because people have largely abandoned public health measures implemented at the height of the Covid pandemic, such as masking and social distancing, which suppressed the circulation of these viruses, according to Dr. Jose Romero, director of the CDC National Center for Immunization and Respiratory Diseases.
Romero, in a call with reporters earlier this month, said many children had not been infected with RSV in the past two years due to Covid health precautions. As a result, many children have not developed any immunity and are catching the virus for the first time. The first infection tends to be more serious.
RSV is a common respiratory virus that almost all children catch before the age of 2. It normally causes mild cold-like symptoms, but the virus can be dangerous for infants 6 months and younger as well as school-aged children with weakened immune systems. It is the leading cause of hospitalization for infants in the United States, according to the CDC.
No underlying conditions
RSV causes inflammation and congestion of the lower airways, called bronchiolitis. Infants often need oxygen because their airways are smaller and inflammation makes it difficult for them to breathe. They also often need IV fluids for several days because they are dehydrated or not feeding well.
About 2% of all infants are hospitalized with RSV and 79% of those hospitalized under the age of 2 have no underlying medical conditions. According to the CDC, up to 300 children under the age of 5 die each year from RSV.
Colorado Children’s Hospital is “packed to capacity” primarily due to an increase in RSV cases, said pediatrician and infectious disease expert Dr. Sean O’Leary. Both inpatient beds and the intensive care unit are full, O’Leary said.
The hospital’s emergency department set up a tent outside to see patients. Staff who don’t typically work in the ER put in hours there to help, and the primary care clinic also adds hours to help relieve the pressure, he said.
“We’re breaking census records every day for the history of the hospital. It’s unprecedented,” said O’Leary, who also serves as vice chair of the AAP’s infectious disease committee.
Comer Children’s Hospital in Chicago has been at capacity for two months, said Dr. Allison Bartlett, a pediatrician and infectious disease expert. RSV came in earlier and in greater force this year than in the past, Bartlett said. Many hospitalized children tended to be older this year, aged 2 and older, likely because they weren’t infected during the pandemic, she said.
UPMC Children’s Hospital in Pittsburgh has been dealing with a huge increase in respiratory illnesses since September, said Dr. Raymond Pitetti, director of the hospital’s emergency department. The surge started with RSV, but now flu cases are skyrocketing, Pitetti said. About 20% of children brought to hospital with a respiratory illness are admitted and about five children end up in the intensive care unit daily, he said.
Complete hospital beds
Some days the hospital is full and children have to be held in the emergency room until an inpatient bed opens, Pitetti said, but UPMC has been able to create new beds each day to get children out. emergency children.
More than 80% of beds at Children’s Healthcare Atlanta have been full for several months, said Dr. Andi Shane, chief epidemiologist at the hospital. The RSV started circulating in the summer months, then surged in early September, Shane said. Then other children started getting the flu in early October as RSV cases began to decline, she said.
“We had Covid, then we had RSV, then we had the flu,” Shane said. “So basically four months without a break and very many children needing emergency care, needing urgent care, needing hospitalizations. It’s been very difficult to keep up with all these children.”
Flu activity is highest in Alabama, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and Washington, DC, according to CDC data. Arkansas, Louisiana, Maryland, New Mexico, New Jersey, New York City and Texas are experiencing high levels of flu-like illnesses.
In the Southeast, the influenza A H3N2 strain appears to be the most common right now, the CDC’s Romero told reporters earlier this month. This strain is associated with more serious illnesses in the elderly and young children, he said.
Almost all children hospitalized with the flu at Children’s Healthcare Atlanta have not received their annual vaccination, Shane said. Part of the problem is that the virus arrived earlier this year, so people didn’t have time, she said.
“We usually say you need to get your flu shot before Halloween. Well, on Halloween we had lots and lots of flu here in Georgia,” Shane said.
In addition to vaccinations, public health officials are encouraging people to stay home when sick, avoid close contact with sick people, cover coughs and sneezes, and wash their hands frequently. . Those who want to take extra precautions can also wear a mask in public.
Romero said parents should seek immediate medical attention for their children if they have any of the following warning signs: difficulty breathing, bluish lips or face, chest or muscle pain, dehydration (dry mouth, crying without tears or absence of urine for hours), or not being alert or interactive when awake.
Update: This story has been updated to include the latest data on RSV, influenza and pediatric bed occupancy.