RSV surge is overwhelming some hospitals and pediatric care capacity

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The Centers for Disease Control and Prevention is warning of a surge in flu; Respiratory Syncytial Virus, or RSV; and other viral infections this season, especially among children and older adults.

The rise of respiratory diseases this year may be the direct result of COVID-19, according to the CDC. In the past two years, respiratory viral disease activity has been highly impacted by COVID-19, resulting in the circulation of other viruses, according to Dr. Jose Romero, director of the CDC National Center for Immunization and Respiratory Diseases. 

"We suspect that many children are being exposed to some respiratory viruses now for the first time, having avoided these viruses during the height of the pandemic," Romero said during a CDC news conference Friday. "Currently, the United States is experiencing a resurgence in the circulation of non-COVID-19 respiratory viruses. Specifically, CDC has tracked elevated levels of influenza; respiratory syncytial virus, known as RSV; and Rhino viruses and animal viruses. However, it's important to note that COVID-19 is not gone, and CDC is continuing to track via the virus and its known variants."

Delayed care during the pandemic has also led to higher acuity in patients seeking care, causing them to occupy hospital beds for longer periods, according to experts at two Maine health systems.

"We are still seeing many cases of COVID and, increasingly, influenza. As a result, our emergency departments are still extremely busy," said Dr. Dora Mills, chief health improvement officer at MaineHealth. "We can all do our part to protect those at highest risk, such as infants and the elderly, by continuing the measures we were taking at the height of the COVID pandemic like masking and social distancing if you or a loved one are high-risk and staying home when you're sick."

WHY THIS MATTERS

Hospitals are being overwhelmed by cases of RSV.

Experts at Maine health systems Northern Light Health and Maine Health held a joint press conference Friday on the RSV surge, saying it's getting worse and significantly straining pediatric inpatient capacity statewide.

On Friday, all 87 staffed pediatric beds at The Barbara Bush Children's Hospital at Maine Medical Center (MMC) in Portland were occupied, and other pediatric patients were boarding in the MMC Emergency Department. The 37 staffed pediatric beds at Northern Light Eastern Maine Medical Center in Bangor were 97% full. 

Hospitals are considering postponing some non-emergent surgeries to create bed capacity. 

Eastern Maine Medical Center has already begun a process to increase availability of care, such as moving some pediatric patients with non-respiratory conditions to its neonatal intensive care unit. Additional measures are being considered as needed.

Capacity challenges at Maine hospitals are not limited to pediatrics, experts said. The nationwide shortage of healthcare workers at hospitals and post-acute care facilities such as nursing homes has significantly limited the ability of both health systems to increase capacity when there are surges of respiratory illnesses like RSV, influenza or COVID-19, they said. 

Health experts from MaineHealth and Northern Light Health asked the public to remain vigilant in protecting themselves against respiratory illness.

"Our inpatient capacity is really stretched right now," said Dr. Mary Ottolini, the George W. Hallett chair of Pediatrics at BBCH. "We are fast approaching a tipping point where we won't be able to provide the level of care we know patients need."

Children with severe RSV can receive supportive care at the hospitals, they said, including fluids and oxygen and, on occasion, more advanced respiratory support. 

Pediatricians with both health systems urge parents not to delay care but to be mindful that emergency care should be reserved for the sickest patients, and parents with concerns should call their primary care provider first.

Parents should seek immediate care right away if their child is having trouble breathing or is breathing very fast, seems very drowsy, or has lips or fingernails that look blue.

"Rest assured, if you do need medical care, you are in very good hands and we will get to you as quickly as possible, but cases are being triaged to get to our sickest, more acute patients first," said Dr. Jonathan Wood, pediatric intensivist with Northern Light Eastern Maine Medical Center.

THE LARGER TREND

RSV laboratory test detection is increasing in all 10 Health and Human Services regions, except regions four and six, which include Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North and South Carolina, Oklahoma, Tennessee and Texas, according to the CDC. 

There are decreases in Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming.

In most regions, RSV is trending downward, and influenza is beginning to increase or surge, according to the CDC.

RSV is a common respiratory illness with no specific treatment beyond supportive care. Most children are able to recover at home, but the disease can lead to bronchiolitis or pneumonia in babies and toddlers. 

More than 97 million COVID-19 cases have been reported in the U.S. with counts trending downward and leveling off in the last three weeks, the CDC said. 

However, laboratory surveillance networks show that influenza activity has been increasing over the past several weeks. 

In the southeastern U.S., nearly 20% of respiratory specimens are testing positive for influenza virus, which in the past have been associated with more severe seasons, especially for young children and older individuals, the CDC said. 

In parts of the mid-Atlantic and Midwest, there are early signs of influenza causing severe illness in younger and older age groups with higher hospitalization rates, compared with the same time last year and in previous years.

"In fact, we're seeing the highest influenza hospitalization rates going back a decade," the CDC said. 

This week, the CDC reported the second influenza related pediatric death of the season. 

"Moving on to RSV, or Respiratory Syncytial Virus, this is a common respiratory virus that usually causes cold-like symptoms," the CDC said. "And most children experience a mild case before they are two years of age." 

Diagnosis and treatment of RSV are well understood among healthcare providers, with most older children, adults and adolescents recovering within one to two weeks of infection. 

"However, RSV can be serious, especially for infants and older adults," the CDC said. "It is the most common cause of bronchiolitis, and inflammation of the small airways of the lungs, and pneumonia in children, less than one year of age in the United States. Children ages four to four years and younger are the most likely to be hospitalized."

Vaccines are available for two of the three viruses – flu and COVID 19. 

Pfizer said earlier this month that it would seek approval for its RSV vaccine this year.

ON THE RECORD

"Our ask to the public is to remain vigilant while we see an unprecedented rise in differing respiratory viruses," said Dr. James Jarvis, senior physician executive, system incident command, Northern Light Health. "Remember all the things we have done over the past three years: wash your hands or use sanitizer frequently, cough or sneeze into your elbow or tissue or better yet wear a mask in all indoor public places, stay home when you are not feeling well, and get vaccinated against COVID-19 and influenza."

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org