From coast to coast, children’s hospitals are packed, largely with children with respiratory viruses. Some are fielding requests for beds from hospitals in other states.
For children’s hospitals, it feels a lot like the start of the COVID-19 pandemic.
When the COVID-19 pandemic arrived more than two years ago, hospitals ran out of beds in intensive care units and struggled to treat a massive influx of patients.
This fall, that’s what children’s hospitals are experiencing with the surge of patients with respiratory syncytial virus, also known as RSV, and other respiratory viruses.
“In many ways, for children’s hospitals, this is sort of our beginning of 2020,” said Sage Myers, a pediatric emergency medicine physician at the Children’s Hospital of Philadelphia.
Just as New York hospitals ran out of beds in the early days of the pandemic, Myers said, “That’s what we’re facing now with pediatric ICU beds.”
“I’ve been doing this for over 15 years,” Myers told Chief Healthcare Executive. “I’ve never seen wait times like we’ve seen now.”
Children’s Hospital of Philadelphia is filled to capacity, and getting referrals from systems beyond its normal service area because they’ve run out of room. The hospital has received requests from as far as Virginia for pediatric ICU beds. “As soon as someone is available to be discharged, we’re figuring out how to get someone in the space,” Myers said.
After finishing an overnight shift last week, Myers posted on Twitter, “Whatever you are imagining when you hear the news about RSV, and increased viral illnesses, and high pediatric volumes…it’s 1000 times worse.”
The surge in RSV cases has arrived early and children’s hospitals across the country are over capacity. Children’s hospitals are running out of beds from coast to coast.
Doctors are also worried about RSV, the expected rise in flu cases and the possible uptick in COVID-19 cases leading to a “tripledemic” in the coming weeks.
Still, children’s hospitals are struggling right now. With such high volumes, health systems are urging patients to take their children to primary care doctors or urgent care facilities before going to the hospital. But physicians say many of those kids going to pediatricians or urgent care are ending up at the hospital anyway.
Children’s Hospital of Philadelphia is seeing small children with RSV, but also some older children with asthma and other chronic conditions leaving them more vulnerable to respiratory viruses.
“Across the board, the acuity or level of illness we’re seeing is much higher than we’ve seen normally,” Myers said. ”The kids are sicker and do require admissions, as opposed to kids we can treat and send home.”
Children’s hospitals are seeing an enormous number of patients even as they struggle with staffing shortages, like most hospitals. “We’re constantly working,” Myers said.
‘Two and three times the volume’
Seattle Children’s is seeing an extraordinarily high volume of patients with RSV.
Seattle Children’s pediatric volume is consistently at 200%, peaking at 300%, the system said. About half of the patients being seen have some kind of respiratory concern, and the emergency department has been packed.
“Most recently, the ED has jumped to nearly 250% most evenings and we are anticipating this to increase over the next several months,” the system said in a statement via email.
Andy Anderson, executive vice president, chief medical and quality officer for RWJBarnabas Health, said at times, the pediatric ICU bed capacity is full. “Over the past couple of weeks in particular it’s been a challenge, due to the surge in RSV,” Anderson told Chief Healthcare Executive.
“It’s been worse than we’ve seen in the past five years,” he said of the volume.
RWJBarnabas Health has received patients from other New Jersey systems that have been overloaded. They have had requests for transfers from New York, Philadelphia and Delaware and have had to turn some down, simply because they haven’t had the capacity.
“Our emergency rooms are seeing two and three times the volume we see this time of year,” Anderson said.
UPMC Children’s Hospital in Pittsburgh has seen such a high volume of children with RSV that the hospital has set up a tent that can accommodate 8 to 10 more beds to see more kids quickly.
Over the past several weeks, Raymond Pitetti, director of the UPMC Children’s emergency department, said, “We’ve seen a huge increase in the number of children coming to our emergency department, and the vast majority of them are coming in with respiratory illnesses. And of those, many of them have RSV.”
James Stein, chief medical officer of Children’s Hospital Los Angeles, said in a statement this week that the positivity rate for children tested for RSV is 37%. Last winter, the positivity rate peaked at 24%.
“This increase in RSV and other respiratory illnesses have stretched our capacity in the Emergency Department (ED), but we are still able to accommodate inpatient RSV admissions from our ED at this time,” Stein said. “We continue to do our best to accept respiratory transfers from other EDs in the community during this surge, but we are not always able to accommodate them due to our ED capacity constraints.”
Ryan Else, vice president of medical affairs at Allina Health, said the spike in RSV and respiratory virus cases began a month ago.
“This is a much bigger spike than we’ve historically seen before,” Else told Chief Healthcare Executive. “What is straining the system is the number of children that do need high-level care and hospitalization.”
Hospitals across Minnesota are concerned about the strain on the system if all of the state’s pediatric hospitals get to the point where they can’t accept other patients. They’re also worried about rising flu cases and COVID-19 cases, especially as the holidays arrive and Americans are traveling more to see their families. “We are all bracing for increased respiratory illnesses,” Else said.
Michigan hospitals are struggling mightily with the volume of cases, the Detroit Free Press reported Thursday. "There is not a hospital in Michigan that takes care of pediatric patients that has not told us that they are feeling stress right now, immense stress," Dr. Natasha Bagdasarian, Michigan's chief medical executive, told the Free Press.
Helen DeVos Children’s Hospital in Grand Rapids, Michigan is seeing about 225 patients per day in the emergency department, well above the norm of 145 per day, according to an MLive.com report. “The emergency department is incredibly busy,” Dr. Erica Michiels, an emergency department physician at Helen DeVos Children’s Hospital, told MLive.
Brian Cummings, medical director of pediatrics at Mass General for Children, described the situation as an "inpatient bed crisis,” WCVB-TV reported Thursday. The hospital is seeing so many patients with respiratory viruses, some pediatric surgeries have had to be canceled, he said.
More than a surge
Children’s hospitals aren’t just overwhelmed by the spike in RSV and other viruses, Moira Szilagyi, the president of the American Academy of Pediatrics, wrote in an op-ed for CNN that published Thursday.
“This crisis is not simply due to an unusual surge in a few viruses circulating simultaneously,” she wrote. “Several factors have led us to this moment – the respiratory illnesses, a crisis in mental health and reduced hospital capacity. But the underlying cause is a more fundamental issue: This is what happens when we fail to invest in children’s health care.”
Some hospitals have closed pediatric units for financial reasons, she noted. Since more than half of all children are enrolled in Medicaid, Szilagyi called for higher Medicaid reimbursement rates that would provide more capacity to treat kids.
She also said there needs to be greater investments in the mental health of children, since some children are in emergency departments and in hospitals for mental health needs, because they have nowhere else to go.
Officials at Children’s Hospital of Philadelphia, RWJBarnabas and Allina said they are regularly on calls with other health systems in their area to talk about case numbers and to see what can be done to help each other.