US children’s hospitals overwhelmed by RSV cases | Health news

Los Angeles, California – “It seems like this endless, huge influx that keeps coming through our emergency department or phone calls from outside hospitals that are also bursting at the seams,” Hui-wen Sato, an intensive care unit (ICU) nurse at Children’s Hospital in Los Angeles, she said of the recent rise in RSV cases.

RSV or respiratory syncytial virus is a common virus that spreads mainly through direct contact or coughing. It usually causes mild symptoms, but can be dangerous for young children and the elderly.

Across the United States, children’s hospitals are experiencing a surge in RSV cases that is severely straining their capacity. As in Early days of the COVID-19 pandemic, some hospitals are building overflow tents to accommodate more beds.

Sato, who has worked as a pediatric nurse for 12 years, said she had never seen such a high number of RSV cases, telling Al Jazeera that this year seemed “extremely devastating”. Before the waves, her ICU was already under pressure due to lack of staff. Nurses in the ICU can have a maximum of two patients, and while the department physically has 24 beds, sometimes they had to limit the number of occupied beds to 20 because there they don’t have enough staff.

Now, with RSV on the rise, Sato said it’s difficult to keep enough “wiggle room” for severe trauma patients going through the emergency room. In the past, patients with respiratory diseases accounted for 50 to 60 percent of those admitted, and this year, he estimates, they are around 70 percent.

low morale, psychological stress and diseases have forced many healthcare workers to quit their jobs since the start of the pandemic.

“It’s started a real steady exodus of nurses from our hospital, but we’re hearing it’s happening everywhere,” Sato said. “Domino effect pandemicoutgoing nurses, a [staffing] deficiency and the biological reasons why there is such a large RSV wave is creating this perfect storm.”

Covid-19 isolation

Children’s Hospital and the American Academy of Pediatrics have called on the administration of US President Joe Biden to declare an emergency over RSV. But the administration has yet to do so, telling NBC News that “public health emergencies are determined based on data from around the country, scientific trends and insights from public health experts.”

On Sunday, the nation’s top infectious disease expert, Dr. Anthony Fauci, told CBS that children’s hospitals in some regions are overcrowded: “When nurses and pediatric associations say this is really critical, it is.”

The rise in the virus this fall could be linked to a lack of contact between children who were isolated during the pandemic, experts told Al Jazeera. Daniel Rauch, chief of pediatric inpatient medicine at Tufts Medicine, said that preschoolers ages two to four are usually more resistant to RSV than infants, but this year it’s making them sicker than usual.

“There is a hypothesis that the children who get it now, especially the preschool age group, are children who didn’t get it last year and the year before last during the pandemic, because they were isolated and weren’t around other sick children, and they didn’t share these viruses,” he said. Rauch for Al Jazeera.

The decline in the number of pediatric hospital beds over the past 20 years is contributing to the current crisis, he said. Hospitals in the US charge for the care they provide, and generally hospitals are paid more for an adult in bed than for a child in bed, because adults are more likely to need billable procedures, while children often just need supportive care, such as is putting them on a ventilator or giving them oxygen if they have a respiratory illness.

“A hospital operating on a very small margin has to decide: are we going to take care of children and potentially lose money on it? Or will we take care of adults and make more money for it – and that will support our care for everything else we do in the hospital? It’s unfortunately very simple math for many hospital administrators,” Rauch said.

“We’ve lost this ability over the last few decades, and that’s because we don’t pay for pediatric care like we do for adult care,” he added. “And that’s what happens when you don’t value caring for children.”

Vaccine development

One final, unexpected factor is also contributing to the bed shortage, experts say: getting bigger mental health crisis among young people.

The pandemic has led to increased isolation and stress among children and teenagers, leading to higher rates of young people struggling with mental illnesses such as depression and substance abuse — and those children may end up in intensive care if they attempt suicide, Rauch said.

“Five years ago, I was able to handle this wave better because my beds weren’t full of kids with behavioral health issues… There are no psychiatric beds for them. They are just stuck in hospitals,” he said. “So my capacity is actually a lot less than it seems, because I have all these kids with mental problems that I can’t send anywhere else. It’s a storm of combined events that has made access to hospital care very difficult.”

Until there isn’t vaccine for RSV, the US pharmaceutical company Pfizer has announced that it will submit one for approval to the US Food and Drug Administration by the end of the year. The vaccine would be given to pregnant women who would then pass the antibodies on to their infants.

Janet Englund, a professor of pediatrics and infectious disease specialist at Seattle Children’s Hospital, told Al Jazeera that her hospital is also contributing to research into the development of an RSV vaccine. “The vaccine could be available for elderly high-risk people by 2023 or 2024,” she said. Until then, Englund and other experts recommend wearing a mask or staying home when sick to protect others and reduce pressure on the health care system.

Sato says that she constantly worries that she might take one person too many, which means she would have to deny a bed especially a sick child. She also feels moral distress about having to push her staff, “when all I want to do is support them – because as head nurse, I have to keep this going”.

He recommends that people wash their hands, postpone gatherings if they are sick and wear masks.

“We’re not asking people to mask up forever,” Sato said. “We’re just asking people to help the health system survive and just be able to wear their masks during this winter, so we don’t see burnt-out staff leaving and the whole system falling apart.”