Los Angeles, California – “It looks like this endless, high-volume influx that keeps coming into our emergency department, or phone calls from outside hospitals that also burst into overdrive,” Hui-wen Sato, unit nurse from intensive care unit (ICU) at a Children’s Hospital in Los Angeles, said of a recent increase in RSV cases.
RSV, or respiratory syncytial virus, is a common virus that is spread 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 seeing an increase in RSV cases that are straining their capacity. Similar to the start of the COVID-19 pandemic, some hospitals are building overflow tents to house more beds.
Sato, who worked as a pediatric nurse for 12 years, said she had never seen such a high number of RSV cases, telling Al Jazeera this year was “unusually overwhelming”. Prior to the surge, her intensive care unit was already under pressure due to a lack of staff. ICU nurses can have a maximum of two patients, and although the unit physically has 24 beds, they have sometimes had to limit the number of filled beds to 20 because there are not enough staff.
Now, with the surge in RSV, Sato said it’s hard to keep enough “wiggle room” for severe trauma patients coming through the emergency room. In the past, patients with respiratory conditions made up 50-60% of those admitted, but this year she estimated they made up about 70%.
Low morale, mental stress and illness have driven masses of healthcare workers to resign since the pandemic began.
“That’s when this real steady departure of nurses from our hospital started, but we hear it happening everywhere,” Sato said. “The domino effect of the pandemic, the departures of nurses, a [staffing] the shortage and the biological reasons why there is such a surge of RSV create this perfect storm.
Isolation related to covid-19
Children’s hospitals and the American Academy of Pediatrics have asked 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 national data, scientific trends and the insight of public health experts.”
On Sunday, the nation’s top infectious disease expert, Dr. Anthony Fauci, told CBS that children’s hospitals in some areas were overwhelmed: “When nurses and pediatric associations say it’s really critical, that’s the is.”
The rise of the virus this fall may be linked to the lack of contact between children who have been isolated during the pandemic, experts have told Al Jazeera. Daniel Rauch, chief of pediatric hospital medicine at Tufts Medicine, said preschoolers aged two to four are generally more resistant to RSV than infants, but this year it’s making them sicker than habit.
“There’s an assumption that the kids who are getting it now, especially this preschool age group, are the kids who didn’t get it last year and the year before in the pandemic, because ‘They were in isolation and they weren’t with other sick kids, and they weren’t sharing these viruses,’ Rauch told Al Jazeera.
The decline in the number of pediatric hospital beds over the past 20 years is contributing to the current crisis, he said. American hospitals charge for the care they provide, and in general, hospitals are paid more for a bedridden adult than for a bedridden child, because adults are more likely to need billable procedures, while children don’t. often only need supportive care, such as being put on a ventilator or receiving 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 the children and potentially lose money on it? Or are we going to take care of the adults and earn more money for it – and it will help us take care of everything we do in the hospital? This is unfortunately a very simple calculation for a lot of hospital administrators,” Rauch said.
“We’ve lost that ability over the past two decades, and it’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 taking care of children.”
A final unexpected factor is also contributing to the bed shortage, experts say: the growing mental health crisis among young people.
The pandemic has led to increased isolation and stress among children and adolescents, leading to higher rates of young people struggling with mental illnesses such as depression and substance use disorders – and these children can end up in intensive care if they attempt suicide, Rauch said.
“Five years ago, I could have handled this surge better because my beds weren’t full of children with behavioral health issues… There are no psychiatric beds for them. They’re just stuck in hospitals,” he said. “So my capacity is actually much less than it seems, because I have all these kids with mental health issues that I can’t send anywhere else. It’s the combined storm of events that made it very difficult to access hospital care.
Although there is no vaccine against RSV, the American pharmaceutical company Pfizer has announced that it will submit one for approval by the American Food and Drug Administration by the end of the year. The vaccine would be given to pregnant women who would then pass antibodies on to their infants.
Janet Englund, professor of pediatrics and infectious disease specialist at Seattle Children’s Hospital, told Al Jazeera that her hospital is also helping research for the development of an RSV vaccine. “The vaccine could be available for high-risk older adults 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 healthcare system.
Sato says she constantly worries about admitting one too many people, which means she would have to deny a bed to a particularly sick child. She also feels the moral distress of having to push her staff, “when all I want to do is support them – because as a charge nurse I have to keep it going”.
She recommends people wash their hands, postpone social gatherings if they feel sick and wear masks.
“We’re not asking people to mask up forever,” Sato said. “We’re just asking people to help the healthcare system stay afloat, and if they could just wear their masks this winter, so that we don’t see exhausted staff leave and see the whole system fall apart. collapse.”
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