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Doctors are urging the Biden administration to declare an emergency in response to an “alarming surge” of children hospitalized with respiratory syncytial virus and the flu 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 coupled with an increasing flu circulation are pushing some hospitals to the limit.
According to data from the Centers for Disease Control and Prevention, infants ages 6 months and younger are being hospitalized with RSV at more than seven times the weekly rate observed at that time prior to the 2018 Covid-19 pandemic. Flu hospitalizations are also at their highest in a decade, according to the CDC, with children and the elderly being most at risk.
With the rise in respiratory viruses, more than three-quarters of beds in children’s hospitals in the United States are occupied, according to the Department of Health and Human Services. According to the data, 17 states report that more than 80% of their beds are occupied. Children’s hospitals in Arizona, the District of Columbia, Maine, Minnesota, Rhode Island, Kentucky and Utah are almost at full capacity.
An emergency declaration would give hospitals the flexibility needed to free up bed capacity and staff to ensure children get the care they need, said Mark Wietecha, CEO of the Children’s Hospital Association, and Mark Del Monte, CEO of AAP. Biden and Becerra in the letter this week.
The President should declare an emergency under the Stafford Act or the National Emergencies Act, and the Secretary of Health should declare a public health emergency, Wietecha and Del Monte wrote.
“We need emergency funding support and flexibility in the same way as what has been provided to respond to COVID flare-ups,” they wrote.
Government Emergencies
The rise in children getting sick from the respiratory virus is due to staffing shortages as many healthcare workers switched careers or retired due to burnout during the pandemic. There is also a large number of children hospitalized for mental health problems, which also strains capacity.
The American College of Emergency Physicians warned in a letter to Biden earlier this month that emergency departments are at a “breaking point” as patient traffic exceeds occupied beds. Hospitals are often forced to admit patients to emergency rooms because of unavailable inpatient beds, which can result in long wait times, diminished care, and poor patient outcomes. ACEP 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. Gov. Kate Brown said the statement will support the state’s two children’s hospitals by deploying volunteer emergency medical teams. The rate of pediatric hospital admissions in Oregon has more than tripled since late October, according to the governor’s office.
A spokesman 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 nationwide data, scientific trends and the insights of public health experts, the spokesman said.
Senior US health officials said in a call with reporters earlier this month the federal government is working with state and local partners to address capacity issues at hospitals as respiratory illnesses rise. Dawn O’Connell, the assistant secretary for preparedness and response, said federal health teams and medical supplies in the national stockpile are available to states when needed. To date, no state has requested this level of assistance, O’Connell said.
Hospitalization rates for newborns are doubling
Public health officials across the US have repeatedly urged all eligible individuals to get their Covid booster and flu shots to reduce the burden of respiratory illness this winter. There is no vaccine against RSV.
About 171 out of 100,000 infants under 6 months were hospitalized with RSV in the week ended Nov. 12, according to the CDC’s surveillance system, which tracks 12 states. That’s more than double the RSV neonatal hospitalization rate last year and more than seven times the rate in 2018, the last full season before the Covid-19 pandemic.
The flu sends about 13 out of every 100,000 children under the age of 5 to the hospital, according to CDC data. The hospitalization rate for these children is at a decade high and nearly double the current national rate. According to the CDC, seven children have died from the flu so far this season.
RSV and influenza are on the rise in part because people have largely abandoned the public health measures taken during the peak of the Covid pandemic, such as masking and social distancing, that suppressed the spread of these viruses, according to Dr. Jose Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases.
Romero said during a call with reporters earlier this month that many children had not contracted RSV in the past two years due to Covid health precautions. As a result, many children have not developed immunity and catch the virus for the first time. The first infection tends to be more severe.
RSV is a common respiratory virus that nearly all children get by the age of 2. It usually causes mild symptoms similar to a common cold, but the virus can be dangerous for infants 6 months of age and younger and school-age children with weakened immune systems. It is the leading cause of infant hospitalizations in the United States, according to the CDC.
No framework
RSV causes inflammation and congestion in the lower airways called bronchiolitis. Infants often need oxygen support because their airways are smaller and the inflammation makes it difficult for them to breathe. They also often require intravenous fluids for several days because they are dehydrated or are not eating well.
About 2% of all infants are hospitalized with RSV, and 79% of children hospitalized younger than 2 years of age have no underlying medical conditions. According to the CDC, up to 300 children under the age of 5 die from RSV each year.
Children’s Hospital Colorado “is bursting at the seams,” largely due to a surge in RSV cases, Dr. Sean O’Leary, a pediatrician and infectious disease expert. Both the inpatient beds and the intensive care unit are full, O’Leary said.
The hospital’s emergency department has set up a tent outside to see patients. Staff who don’t normally work in the emergency room are taking hours there to help, and the primary care clinic is also adding hours to relieve the pressure, he said.
“We are breaking census records for hospital history every day. This is unprecedented,” said O’Leary, who is also vice chair of the AAP’s Infectious Diseases Committee.
Chicago’s Comer Children’s Hospital has been operating at full capacity for the past two months, said Dr. Allison Bartlett, pediatrician and infectious disease expert. RSV has arrived earlier this year and with greater vigor than in the past, Bartlett said. Many of the children hospitalized this year tended to be older, as young as 2, likely because they didn’t catch the infection during the pandemic, she said.
UPMC Children’s Hospital in Pittsburgh has faced a huge spike in respiratory illnesses since September, said Dr. Raymond Pitetti, director of the hospital’s emergency department. The surge started with RSV, but now influenza cases are skyrocketing, Pitetti said. About 20% of children hospitalized with respiratory illnesses are admitted, and about five children end up in intensive care every day, he said.
Full hospital beds
Some days the hospital is full and children must be held in the ER until an inpatient bed becomes available, Pitetti said, but UPMC has been able to create new beds each day to move children out of the ER.
More than 80% of the beds at Children’s Healthcare Atlanta have been occupied in recent months, said Dr. Andi Shane, head of epidemiology at the hospital. RSV began circulating during the summer months and then spiked in early September, Shane said. Then, in early October, more children started getting the flu as RSV cases dropped, she said.
“We had Covid, then we have RSV, then we have influenza,” Shane said. “Basically four months without a break and lots and lots of kids who need to go to the ER, need urgent care, need hospitalizations. It was a big challenge to keep up with all these kids.”
According to CDC data, flu activity is highest in Alabama, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and Washington, DC. Arkansas, Louisiana, Maryland, New Mexico, New Jersey, New York City and Texas are seeing high levels of influenza-like illness.
In the Southeast, the influenza A H3N2 strain appears to be the most prevalent right now, the CDC’s Romero told reporters earlier this month. This burden is linked to more serious illness in the elderly and young children, he said.
unvaccinated
Almost all of the 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 came early this year, so people didn’t have time, she said.
“We usually say get your flu shot by Halloween. Well, by Halloween we had a lot of flu here in Georgia,” Shane said.
In addition to vaccination, health officials are encouraging people to stay home when sick, avoid close contact with those who are sick, cover coughs and sneezes, and wash 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 exhibit any of the following warning signs: difficulty breathing, bluish lips or face, chest or muscle pain, dehydration (dry mouth, crying without tears, or not urinating for hours), or not alert while awake or to be interactive.
Update: This story has been updated to include the latest RSV, flu and pediatric bed occupancy data.
