A pediatrician in Mount Zion, Ill., sent a video of a 6-month-old baby named Natalie to a colleague asking for advice: Newborn babies’ bellies swell and contract with each gasp. when baby tries to breathe, nostrils flare and bubbles form her lips.
Like dozens of Dr. Caitlyn Berg’s patients in recent weeks, Natalie was infected with the respiratory syncytial virus, known as RSV.
For Dr. Berg, the case was personal: Natalie was her daughter.
“I try to separate my doctor’s brain from my mother’s,” she said. “But watching her breathe, I was so scared.”
RSV spikes early and abnormally, respiratory infection that obstructs the airwayare overwhelming pediatric units across the United States, lengthening wait times and forcing hospital systems to rearrange staffing and resources to meet demand.
“Every children’s hospital I know is completely flooded,” said Dr Coleen Cunningham, a pediatrician at Children’s Hospital of Orange County, a 334-bed facility in Southern California. in the emergency room as they wait for inpatient beds – sometimes for more than 24 hours.
RSV is a common seasonal infection and most cases are very mild. But this year, the number of children who are sick – and seriously ill – is significantly more than usual. Doctors suspect that people who have been exposed to RSV over the past few years have been isolated from it by social distancing measures and are now increasing in number.
“The immune system works by recognizing and repeating,” says Dr. Sarah Combs, an emergency medicine physician at Children’s National Hospital in Washington, DC, where more than 1,000 children tested positive for RSV between July and early October of this year. “And when you give it a little break, 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 seasonal outbreaks of other respiratory viruses such as rhinovirus and influenza, plus the continued burden of Covid. This is especially difficult in areas where pediatric units have shrunk or even closed in recent years, creating congestion in emergency rooms and diverting stress to young hospitals. children focus on specialized services such as cancer treatment or heart surgery.
Doctors and public health experts are encouraging parents to do whatever they can to protect their children’s health in other ways (such as flu shots and Covid boosters). because there is no widely available vaccine for RSV
According to preliminary estimates from the Centers for Disease Control and Prevention, nearly one child 6 months or younger has been hospitalized with RSV since early October. The agency says the true number is most likely higher. , because many people infected with the virus – even those who have been hospitalized – have never undergone testing.
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 have children treated by doctors who care for ordinary adults – a a reversal from two years ago, when the pediatric staff helped with the treatment. adult Covid patients.
“It all has a very vintage feel to it,” says Dr. Meghan Bernier, medical director of the pediatric intensive care unit at the children’s center. “This is the pediatrician’s Covid. This is our March 2020.”
RSV mainly affects the small airways, called bronchioles, that branch from the bronchi in the lungs. These straw-like tubes can become clogged with even small amounts of mucus, especially in babies and young children.
“The smaller you are, the smaller your airways – it’s just physical,” says Dr. Combs.
High-risk babies sometimes receive a monoclonal antibody that can prevent infection, called Synagis. However, the drug is so expensive that it is rarely offered – an approach that some doctors believe should be reversed during such a harsh virus season.
Older adults and immunocompromised individuals are also at increased risk of severe illness from RSV, which even in a typical year can kill about 14,000 adults 65 years of age and older and up to 300 children under 5 age.
Meredith Volle, a pediatrician in Springfield, Ill., the pediatrician with whom Dr. Berg consulted, said infections can be “a bit unpredictable,” because some patients look like one. A few days of colds “quickly lead to respiratory failure. ” in others.
Experts on the disease say there is no evidence that a more serious strain of RSV has emerged. Instead, the number of hospitalizations is increasing because in most regions more children are infected than in general, and “a small percentage of these are still a high number,” said Dr. Buddy Creech, Professor of Pediatric Infectious Diseases at Vanderbilt University Medical Center.
Virtual learning during the Covid pandemic stop the spread of many respiratory viruses that send children to the hospital. Dr Creech says RSV has become so rare that some second-year residents at Vanderbilt who joined staff during the pandemic are now seeing their first case of childhood RSV.
As a result, older children are infected with RSV for longer and become sicker than usual. Many of them have never contracted the virus before or have been shielded to avoid re-exposure as their immunity declines, doctors say.
“When I first saw a 7-year-old without asthma needing breathing assistance in August, I thought, What’s going on?” Dr. Combs said.
Now, with infected children returning to classrooms and activities, the demand for pediatric beds has largely fallen to children’s hospitals that receive transfers from increasingly distant emergency rooms.
Daniel Rauch, a hospital physician there, Boston Children’s Hospital has postponed some elective surgeries to make room for more patients with respiratory illnesses.
Doctors in Illinois received a list from the state’s Department of Public Health of 36 pediatric intensive care units in eight other states that doctors should call when they have a transfer request. The document, reviewed by The Times, lists facilities spanning 1,000 miles, from Minneapolis to Chattanooga, Tenn.
The Johns Hopkins Children’s Center received requests to move schools from upstate New York, hundreds of miles away, and West Virginia, among other places. But it – like other pediatric specialty hospitals in Orange County, California; Seattle; and Lubbock, Texas – were operating at full capacity. It has moved patient numbers to places like Richmond, Va. And Philadelphia.
Bringing doctors who treat adults to pediatric units to assist with surgery would be complicated, said Dr. Bernier, because of the high expertise required for high-quality child care, said Dr. Bernier. . Reassignment can also be stressful.
“Watching a baby breathe 90 or 100 times a minute and struggle – it can be very unsettling,” she says.
About 2,800 miles from Johns Hopkins, at Children’s Hospital Seattle, several patients are now together in single-patient rooms, and areas commonly used for procedures have been converted into bed space , follow Dr. Surabhi Bhargava Vora, an infectious disease doctor. Doctors are being pushed to expedite tests and discharge patients as quickly as possible to free up space, she said, in a season “worse than any other RSV season I’ve seen.” .
Berg, a pediatrician in Mount Zion, Ill., ended up driving 6-month-old Natalie nearly an hour to Springfield, where a line had formed just to check out the waiting room at HSHS Children’s Hospital. St. John. After they spent eight hours in the emergency room, a pediatric bed was opened, and by evening Natalie was transferred to the intensive care unit, where she stayed for four nights. She is now home and mostly recovered, although she still has a stuffy nose and intermittent cough.
Doctors and hospital officials say a side effect of the rise in respiratory infections is that children coming to the emergency room for non-life-threatening conditions such as broken legs or being bitten by a dog will have longer wait times because of the lower rating in the scale. For the sake of both their children and the hospital, parents should do what they can to help flatten the curve, they said.
For Covid and flu – unlike RSV – that means vaccinations are available. (No vaccine for RSV has been authorized in the United States, but the candidates made by Pfizer and GSK have all completed end-stage clinical trial. Dr. Cunningham, pediatrician at Children’s Hospital of Orange County, is a leader of another test for nasal drops vaccine for children under 2 years old)
“I don’t want to say to parents, ‘Fear’ or ‘Run away’,’ because RSV is not new and I think it’s stoking anxiety in times of a pandemic,” says Dr. Combs. is very dangerous. “But shoot for him, and if your kid rides a bike, put a helmet on him. This is not the time to go wild at the trampoline park.”
