The nation's infants and toddlers have been badly affected by the respiratory virus season so far. The notorious initialism for respiratory syncitial virus, orRSV, has caused most of the problems, so I will focus on it. The current situation in hospitals around the country will be discussed in this post. Next time, I will explain more about the potential for a new vaccine to reduce the risk of disease in the most vulnerable population.
There were reports in July of a particularly bad Fall and Winter for the United States, with the early start to the season being an indicator. Our Summer in the Boston area was a bit more busy than we anticipated, and I saw this in my patient population as well. As Fall approached, admissions for lower respiratory infections continued to increase, and we saw an odd surge in rhinoviruses causing wheezing and asthma flares that required hospitalization.
In September, I wrote about a specific enteroviruses that is linked to cases of a disease in young children. We had surpassed the total number of similar admissions in all of 2020 and 2021. It was easy. In the month leading up to the mid-term elections, news of hospitals being overrun with children with respiratory infections began to make the media rounds.
NBC reported on capacity problems in five states in October. The situation in Connecticut and Colorado was featured in a report on October 21st. An October 24th article from NPR focused on Texas, Washington, D.C., Maryland, and Washington, all of which were dealing with having more children that needed to be in the hospital. This is not an isolated problem.
I have been a doctor since 2003 and know a lot about medicine, but this is the first time I have ever experienced a month like this. Prior to the Pandemic-related lull,RSV kept us busy. It is the most common reason for infants to go to the hospital. I have never seen admissions come in so fast.
There aren't any beds available in the emergency department for a child who needs to be admitted to an inpatient unit. They can be taken from the ED to a children's hospital. I think it's easy. It isn't so fast.
What if there aren't any beds for children in the vicinity? Some children are being moved hundreds of miles away from where they entered the system in order to transport them to a facility that is not so close. If there are no beds to be found, the child has to board in the emergency department and wait for a bed to open up. This isn't ideal. It increases the cost and the chance that a mistake will be made.
It doesn't get better. The number of children requiring admission historically high and these patients are sicker than usual Most children with infections have a mild and self-limiting illness that is similar to a cold. Most children don't develop lower respiratory involvement when they are under 2 years old. Most don't need to go to the hospital when they do. They usually only need supportive care for a few days with IV fluids, oxygen, and a nasogastric tube.
Some kids, particularly young or premature infants and children with underlying heart or lung disease, need help with high-flow nasal cannula or even CPAP. Most of the admitted patients can be cared for in the hospital. The year so far has been very different. The kids are sicker. Older toddlers are requiring admission in high numbers in addition to the babies we are used to managing.
When a child needs a higher level of care than can be provided on an insturment unit, they are transferred to a children's intensive care unit I've never seen so many need to leave. What happens when there isn't a place to stay? We try our hardest. For the first time in my career, I've seen children sitting on a critical level care unit because there isn't any other place to go. Extreme physical, emotional, cognitive, and moral fatigue are caused by this and it is not ideal for the patient.
The Boston area is home to Boston Children's Hospital, Massachusetts General for Children, University of Massachusetts Children's Medical Center, and a number of community hospitals. There are a lot of hospital beds in the area. We start most days with no new admissions or transfers anywhere.
The hospital I work at has a 12-bed unit for children. For weeks, we've been at 100% capacity and have been able to manage about 80% of the patients. The ED is working hard. We have been working long hours to help each other out. It has been difficult but we will make it. There were 7 staffedPICU beds available to start the day in the Boston area. They can fill up fast, but that is better than some days.
I will go into a bit more detail next time. This season has nothing to do with "immune debt" and is just as bad as it is. There is hope as a promising vaccine is close to being ready for prime time in a couple of years.
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