At the height of the coronavirus pandemic, as ambulance lines roamed the streets and freezer carts crowded parking lots, the pediatric emergency department at Our Lady of the Lake Children’s Hospital, in Baton Rouge, Louisiana, was quiet.
It was an odd juxtaposition, given what was happening only a few doors away, says Chris Woodward, a pediatric and emergency specialist at the hospital. As adult emergency departments were inundated, his team was so low on work that he feared jobs might be cut. A small percentage of the children were very sick with COVID-19 – and some are still suffering – but most were not. Because of school closures and meticulous hygiene, they understand They have not had any other infections– Flo, RSV, and the like – he probably sent them to the hospital in the pre-pandemic years. Woodward and his colleagues couldn’t help but wonder if the brunt of the crisis had overtaken them. “He was, like, the least sick I’ve ever seen in my career,” he told me.
This is no longer the case.
Across the country, kids have been weeks Criticize With a massive early wave of viral infections – driven Largely by RSV, but also influenza, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive care units now in or Previous abilityresorting to extreme measures. At the Johns Hopkins Children’s Center in Maryland, staff pitched a tent outside the emergency department to accommodate the excess; Connecticut Children’s Hospital Thinking of calling in the National Guard?. It’s already the biggest wave of infectious diseases some pediatricians have seen in their decades-long career, and many fear the worst is yet to come. “It’s a crisis,” Sapna Kodshadkar, a pediatric intensive care specialist and anesthesiologist at Johns Hopkins, told me. “It’s a banana; “She’s been having full nostrils since September,” says Melissa J. Sacco, MD, pediatric intensive care specialist at UVA Health. “Every night I turn a patient away, or tell the emergency department that they should have a pediatric ICU level baby for the foreseeable future.”
I asked Chris Carroll, a pediatric intensive care specialist at Connecticut Children’s, how bad things were on a scale of 1 to 10. “Can I use Spinal tap Reference?” he asked me again. “This is 2020. This is as bad as it gets.”
Experts tell me that the fall crush is driven by two double factors: the disappearance of COVID mitigation and the decline in the population’s immunity. For much of the pandemic, a combination of concealment, distancing, distance learning, and other tactics has reduced transmission of nearly all respiratory viruses that typically come during the colder months. This fall, even though kids return to daycare and classrooms with virtually no precautions, those microbes have made disastrous comeback. Rhinovirus and enterovirus were among the first hospitals to invade late this summer; Now RSV has joined them, all while SARS-CoV-2 is still in play. also Influenza loomswhich began to pick up South and Central AtlanticLeading School closures or turns into distance learning. During the summer of 2021, When delta swept the nation“We thought this was busy,” Woodward said. “We were wrong.”
Children, in general, are more susceptible to these microbes than they have been in years. Babies are already having a tough time with viruses like RSV: The virus infiltrates the airways, causing them to swell and flood with mucus that their tiny lungs may struggle to expel. “It’s like breathing through a straw,” says Marietta Vasquez, MD, a pediatric infectious disease specialist at Yale University. The narrower and more clogged the tubes, the less space you need to move air in and out. Accumulated immunity from previous exposures can mitigate this severity. But with the great viral waning of the epidemic, children lost early encounters that would have trained defensive knights with their own bodies. Hospitals are now caring for the usual RSV group — infants — as well as young children, many of whom are sicker than expected. An infection that, in other years, would have produced a mild cold develops into pneumonia severe enough to require respiratory support. “Kids just don’t handle it well,” says Stacey Williams, a pediatric intensive care unit nurse at UVA Health’s pediatric intensive care unit.
Co-infection has always been a threat – but it’s becoming more common with SARS-CoV-2 in the mix. “There is one virus that is more susceptible to infection,” Vasquez told me. Each additional bug can burden a child with “climbing a bigger hill, in terms of recovery,” says Shelby Layton, a nurse at UVA Health. Some patients leave the hospital in good health, but return straight away. Woodward told me there have been children who “have had four respiratory viral illnesses since the beginning of September.”
Sally Bermar, a pediatrician at NewYork-Presbyterian and Weill Cornell Medicine, whose hospital was among those that cut beds from the Pediatric Intensive Care Unit (PICU), told me that childcare capacity in many parts of the country had already diminished after the COVID-19 hit. a exodus of health care workers –nurses In particular – leaving the system ill-equipped to meet the new wave of demand. At UVA Health, the pediatric intensive care unit is staffing perhaps two-thirds of the essential staff it needs, Williams said. Many hospitals are trying to call in reinforcements from inside and outside their institutions. “You can’t just quickly train a group of people to take care of a two-month-old baby,” Kudshadkar said. To do this, some hospitals are doubling the number of patients in rooms; Others have shifted parts of other care units to pediatrics, or are sending specialists across buildings to stabilize children who can’t get into an ICU bed. In Baton Rouge, Woodward regularly visits patients who have just been hospitalized and are still being held in the emergency department, trying to see who is healthy enough to go home so more space can be made. The emergency department used to receive, on average, about 130 patients per day; Recently, that number was closer to 250. “They can’t stay,” he told me. “We need this room for someone else.”
Experts also wrestle with how to strike the right balance between raising awareness among caregivers and managing fears that may turn into exaggerations. On the one hand, with all the talk about SARS-CoV-2 being “mild” in children, some parents may ignore the signs of RSV, which at first can resemble those of COVID, then become more serious, says Ashley Geoffreon, a respiratory therapist. At Baton Rouge General Medical Center. On the other hand, if families flood already stressed hospitals with illnesses mild enough to resolve at home, the system may crack even further. “We definitely don’t want parents to bring their kids after every cold,” Williams told me. The Key tags Acute respiratory illnesses in children include wheezing, snoring, rapid or labored breathing, difficulty drinking or swallowing, and yellowing of the lips or fingernails. When in doubt, experts tell me, parents should contact their pediatrician for help.
As winter continues, the situation may take a darker turn, especially with flu rates rising, and new SARS-CoV-2 subvariants looming. In most years, the cold viral disruption doesn’t subside until late winter, which means hospitals may be at the start of only a stressful few months. Sporadic uptake of COVID vaccines among young children continues, along with up-to-date vaccines Decreased absorption of influenza And abandoning infection-prevention measures on a large scale could make matters worse, says Abdullah Dalabih, a pediatric intensive care specialist at Arkansas Children’s.
The sudden rise in respiratory disease represents a stark departure from Dominant reassuring story Cross Infectious diseases And the Young children’s health For nearly three years. When it comes to respiratory viruses, young children have always been a vulnerable group. This fall may force Americans to reset their expectations about youthful resilience and remember, as Layton told me, “just how badly one can catch a cold.”