Children’s hospitals struggle with RSV, respiratory cases: ‘It’s unprecedented’

Around the country, children’s hospitals are at or above capacity due to high numbers of patients with respiratory viruses.

Children’s hospitals continue to struggle with a high number of patients with RSV and other respiratory illnesses, with many hospitals at or above their normal capacity.

Hospitals began seeing scores of patients with respiratory syncytial virus, also known as RSV, and other respiratory viruses in October, several weeks earlier than normal. Hospital leaders and physicians say they are seeing extremely long wait times in their emergency departments.

Hospitals all around America are packed with kids with respiratory illnesses. Wendy Woods, chief medical officer of Blank Children's Hospital in Des Moines, Iowa, told Chief Healthcare Executive Thursday that the system is seeing far more patients with RSV and respiratory viruses than in previous years.

“It’s unprecedented,” Woods said in a phone interview.

Typically, the hospital sees around 80 patients in the emergency department each day, but lately the number is between 140 and 150. Other hospitals in Iowa have been packed, making it difficult to find available beds, Woods said.

“All those around us in our region are full and are at capacity themselves,” she said. Similar shortages are being seen in Nebraska and Missouri, she said. Blank Children’s also transports patients from rural areas to other hospitals when beds are available. Recently, a transport crew traveled into Illinois to get a child to an open bed at a hospital in Iowa, a round-trip that took several hours, she said.

In Texas, 91% of the state’s pediatric beds are occupied, John Hawkins, president and CEO of the Texas Hospital Association, said in a media briefing this week.

Pediatric hospitals are experiencing a “double whammy,” because some general hospitals have cut back on their pediatric services, Hawkins said. As a result, pediatric hospitals are seeing more patients and have fewer options to transfer kids to other hospitals.

“You’re seeing the lack of capacity play out in a lot of our facilities,” Hawkins said.

Setting up tents

Some hospitals, such as UPMC Children’s Hospital in Pittsburgh, have set up tents to help accommodate the number of patients coming to the emergency department. Dr. Raymond Pitetti, director of the emergency department at UPMC Children’s Hospital of Pittsburgh, said the tent is helping the system accommodate the volume.

“The hospital is still seeing a steady uptick in RSV and other respiratory illnesses in Pittsburgh,” he said in a statement. “This tent is well equipped and fully staffed, enabling us to further streamline our process as we assess the needs of our patients.”

UCSF Benioff Children's Hospital in San Francisco set up a tent last month to accommodate children who needed treatment but were less seriously ill, CBS News reported. Children’s Hospital Colorado set up a tent a few weeks ago at the medical campus in Aurora, CBS reported.

More than three quarters of the nation’s pediatric hospital beds are occupied, and in some states, more than 90% of pediatric beds are filled, according to the Children’s Hospital Association and the American Academy of Pediatrics. The two groups sent a letter to President Biden’s administration on Nov. 14 urging the declaration of a national emergency to address the crisis in children’s hospitals.

“Our system is stretched to its limit and without immediate attention the crisis will only worsen,” Mark Wietecha, CEO of the Children’s Hospital Association, said in a statement last month.

Hospital officials have warned of fears of a “triple-demic,” referring to a mix of patients with RSV, the flu and COVID-19 cases.

Nemours Children’s Health is seeing many patients with RSV, but now more children with the flu are showing up.

“Children’s hospitals across the U.S., including Nemours Children’s Health, continue to experience an influx of respiratory illness cases,” Dr. Jonathan Miller, medical director of value-based care and chief of primary care at Nemours Children's Health, Delaware Valley, said in a statement. “While RSV continues to drive hospital admissions, we are now beginning to see an increase in flu cases as well.”

Nationally, RSV cases may be starting to drop, according to data from the Centers for Disease Control and Prevention. However, the volume of RSV cases seen this fall remains high, well above the past two years, and flu cases are rising nationwide, the CDC says.

It feels like déjà vu

Some physicians and healthcare leaders have likened the current situation at children’s hospitals to the early days of the COVID-19 pandemic, when hospitals were overwhelmed with cases. Brian Peters, CEO of the Michigan Health and Hospital Association, made that comparison in a column he published Dec. 1 on LinkedIn.

“In short, it feels like déjà vu in Michigan’s children’s hospitals, but instead of a surge of COVID-19 patients stressing capacity to the limits, our facilities are strained by a high number of pediatric patients suffering from respiratory illnesses largely driven by RSV,” Peters wrote. “Similar tactics that have been implemented in prior years, such as initiating incident command systems, have been in operation to ensure appropriate direction and communication is occurring throughout those systems impacted by this crisis.”

Just as in Texas, Michigan pediatric hospitals are feeling extra pressure because other hospitals don’t have enough staffing to accommodate more patients.

“Hospitals operating at capacity is nothing new and the staffing challenges that continue to result in Michigan operating with 1,700 fewer staffed beds than we had prior to the pandemic are well documented,” Peters wrote. “What we’re seeing today is the real impact of what those staffing challenges mean: longer wait times in the emergency department, lack of available beds for patient transports (particularly in rural Michigan) and pediatric ICUs operating at beyond 100% capacity.”

California hospitals continue to see a high volume of patients with RSV and respiratory viruses, The Los Angeles Times reported this week.

Vidya Mony, pediatric infectious disease specialist and associate hospital epidemiologist at Santa Clara Valley Medical Center, told The LA Times that the hospital is seeing “an acute surge of patients … in both our inpatient pediatric ward and pediatric ICU.”

While no vaccine is available for RSV, doctors are urging parents to get the flu vaccines and the COVID-19 vaccines for their kids. They are also urging parents to take their children to primary care physicians or urgent care centers before arriving at the emergency departments, which have been packed for weeks.

Staffing shortages, combined with the high number of patients, are taxing pediatric hospitals. At Blank Children’s Hospital, Woods said the shortage of nurses and other staff are limiting the facility's capacity, because only so many beds can be safely staffed.

Since the RSV wave started early, Woods said she’s hopeful it will subside in the near future, but she’s not exactly confident that will happen.

“I don’t think we’re near the exit,” she said.