A pediatrician in Mount Zion, Illinois, sent a video of a 6-month-old named Natalie to a colleague for advice. The infant’s belly was struggling to breathe, he had trouble breathing, his nostrils were dilated and had bubbles. her lips.
Like dozens of Dr. Caitlin Berg’s patients in recent weeks, Natalie had been infected with the respiratory syncytial virus known as RSV.
For Dr. Berg, the case was personal. Natalie is her daughter.
“I’m trying to separate the doctor’s brain from the mother’s brain,” she said. “But I was horrified to see her breathing.”
A dramatic and unusually early spike in RSV, Respiratory infections that block the airwaysare overwhelming pediatric units across the United States, resulting in long wait times for treatment and prompting hospital systems to redeploy staff and resources to meet demand.
“All the children’s hospitals I know are completely flooded,” he said. Dr. Colleen CunninghamThe chief pediatrician at Orange County Children’s Hospital, a 334-bed facility in southern California, says children are being treated in the emergency room while they wait for inpatient beds, sometimes for 24 hours or more. doing.
RSV is a common seasonal infection and the majority of cases are very mild. This year, however, the number of children falling ill or becoming seriously ill is significantly higher than in previous years. Physicians suspect that social distancing measures have isolated people who were normally exposed to RSV in the past few years, and that numbers are now rising.
“The immune system works by recognition and repetition,” he said. Dr. Sarah CombsAn emergency physician at Children’s National Hospital in Washington, DC found more than 1,000 children tested positive for RSV from July through early October of this year. “And if we let them rest a little bit, as we did during the pandemic, we will have generations of children who are not immune, and for good reason.”
The onslaught of cases coincides with the ongoing burden of Covid, along with seasonal explosions of other respiratory viruses such as rhinovirus and influenza. This is particularly difficult in areas with high severities, creating bottlenecks in emergency rooms and straining children’s hospitals, which focus on specialized services such as cancer care and heart surgery.
Doctors and public health experts say that because a vaccine against RSV is not widely available, parents are doing whatever they can to keep their children healthy (such as flu shots or Covid boosters). I encourage you to do so.
Preliminary estimates from the Centers for Disease Control and Prevention show that since the beginning of October nearly 1 in 500 babies aged 6 months or younger has been hospitalized with RSV. The agency said many people who have contracted the virus, even those who have been hospitalized, have not been tested, so the true number is likely higher.
Baltimore’s Johns Hopkins Children’s Center is also at capacity, has floor nurses in its pediatric emergency department, and doctors who normally treat adults will be treating children. adult covid patient.
“It all has a very Covid-esque feel,” he said Dr. Megan Bernier, Medical Director of the Children’s Center’s Pediatric Intensive Care Unit. “This is Covid for pediatricians. This is March 2020.”
RSV primarily affects the small airways called bronchioles that branch off from the bronchi in the lungs. These small, straw-like tubules can become clogged with even a small amount of mucus, especially in infants and young children.
“The smaller the body, the narrower the airway. It’s just physics,” Dr. Combs said.
At-risk babies may be given a monoclonal antibody called Synagis that can prevent infection. However, this drug is very expensive, so it is rarely offered. Some doctors believe it should be undone during extreme virus seasons like this.
Older people and people with weakened immune systems are also at increased risk of serious illness from RSV, with approximately 14,000 adults aged 65 and over and 300 children under 5 dying in a typical year. I’m here.
Infection can be “somewhat unpredictable,” said Dr. Meredith Volle, a pediatrician in Springfield, Illinois, whom Dr. Berg consulted. ” Other people.
Experts on the disease say there is no evidence that more severe strains of RSV have emerged. Instead, hospitalizations are rising as more children are globally infected in most areas, and “a small percentage of the high numbers are still high,” says Vanderbilt University Medical Center. Buddy Creech, Ph.D., professor of pediatric infectious diseases at .
Virtual learning during the Covid pandemic stopped the spread Many respiratory viruses that send children to hospitals. RSV has become so rare that some of his second-year residents at Vanderbilt, who joined the staff during the pandemic, are seeing her RSV cases in children for the first time, he said. said Dr.
As a result, older children are hospitalized with RSV for longer and more severely ill than usual. Many of them had never had the virus before, or had weakened immune systems that protected them from reexposure, doctors said.
“When I first saw a 7-year-old with no asthma who needed respiratory support in August, I wondered what was going on,” Dr. Combs said.
Now, as virus-prone children return to classrooms and activities, demand for pediatric beds has plummeted to children’s hospitals accepting transfers from increasingly distant emergency rooms.
Boston Children’s Hospital has postponed some elective surgeries to make room for more patients with respiratory illnesses, said Daniel Rauch, M.D., of the hospital.
Physicians in Illinois received a list of 36 pediatric intensive care units in eight other states from the state’s Department of Public Health. The doctor should request the patient’s transfer. The document, reviewed by The Times, lists facilities that span 1,000 miles from Minneapolis to Chattanooga, Tennessee.
Johns Hopkins Children’s Center receives referrals from hundreds of miles away, including upstate New York and West Virginia. Seattle; and Lubbock, Texas — are already at capacity. It is sending patients to places like Richmond, Virginia and Philadelphia.
Given the expertise required for quality child care, it will be complicated to bring doctors treating adults to pediatric wards to support the surge, according to Dr. Vernier. Reassignment can also be stressful.
“Seeing a baby take 90 to 100 breaths a minute is very disturbing,” she said.
At Seattle Children’s Hospital, about 2,800 miles away from Johns Hopkins University, several patients are now housed in single rooms, where areas normally used for procedures have been converted into bed spaces. Dr Surabhi Bhargava Vora, an infectious disease doctor. Doctors are being asked to expedite tests and discharge patients as soon as possible to make room, she said.
Dr. Berg, a pediatrician in Mount Zion, Illinois, ended up driving six-month-old Natalie nearly an hour to Springfield. In Springfield, HSHS St. John’s Children lined up just to check into the waiting room of his hospital. In the emergency room he spent eight hours, after which the pediatric bed opened and by the evening Natalie was moved to the intensive care unit, where he spent four nights. She is now home and mostly recovered, but still has some congestion and an intermittent cough.
One of the side effects of the surge in respiratory infections, according to doctors and hospital officials, is that children who arrive at the emergency room with non-life-threatening conditions, such as broken legs or dog bites, are more likely to fall on the triage scale. Because of the low rank in , the waiting time is long. Parents should do what they can to flatten the curve, both for their children and for hospitals, they said.
For Covid and flu, unlike RSV, that means getting an available vaccine. (No vaccine for RSV is licensed in the United States, but both the candidates created by Pfizer and his GSK are finished. Late clinical trialDr. Cunningham also Professor of Pediatrics at the University of California, Irvine, another trial leader for nasal vaccines for children under 2 years).
“Since RSV is not new, I don’t want to tell parents to ‘fear’ or ‘hide’. I think it’s harmful to create anxiety in the pandemic era,” Dr. Combs said. “But take a shot. If your kid rides a bike, wear a helmet. Now is not the time to rampage in his trampoline park.”
