Flu activity continued to rise across the U.S. in the past week, adding to a crunch on emergency departments and pediatric hospitals from an early surge in respiratory viruses.
Flu has caused an estimated 4.4 million illnesses, 38,000 hospitalizations and 2,100 deaths so far this season including seven pediatric deaths, the Centers for Disease Control and Prevention said Friday. The highest flu hospitalization rates are among adults ages 65 and older, followed by children under the age of 5, the CDC said.
Pediatric hospitals across the U.S. have been under strain for weeks from a rush of patients with RSV and other respiratory viruses. RSV amounts to a cold in most people, but the virus can be dangerous for younger children and older adults, especially those with other health concerns.
“You have flu that is starting to surge in other areas where they’re trying to deal with the RSV surge, and you also have Covid,” said Tina Tan, vice president of the Infectious Diseases Society of America. “It’s one after the other after the other.”
RSV cases appear to be plateauing or declining in parts of the U.S., doctors said. Within the CDC’s RSV-surveillance network of 12 states, the hospitalization rate for RSV remains higher than the most recent prepandemic peak.
Some 76% of pediatric inpatient beds are occupied across the U.S. and occupancy of pediatric intensive-care beds is just above 80%, according to the Department of Health and Human Services. That’s up from 65% of pediatric beds and 70% pediatric ICU beds occupied in early August.
States including Massachusetts, Nevada, Pennsylvania and Texas have more than 90% of their pediatric intensive-care beds occupied, the data show. The data doesn’t specify why patients are in the hospital.
“We really maxed out all the space we have,” said Kristina Deeter, physician-in-chief at Renown Children’s Hospital in Reno, Nev., and specialty medical officer for pediatric critical care at
Pediatrix Medical Group.
Pediatric patients at Renown Children’s are backed up into the waiting room, some teenagers have been sent to the adult floor and a list of kids from nearby emergency departments are waiting for a bed, she said.
Other respiratory viruses, including Covid-19, and high demand from pediatric mental-health patients are contributing to the strain at pediatric hospitals, doctors said. Nursing shortages and a decrease in pediatric beds have compounded the crunch.
From 2008 to 2018, the number of pediatric inpatient beds in the U.S. decreased by 12%, according to a 2021 study in the journal Pediatrics. Declines in rural areas were steeper than average, and pediatric specialty care has been increasingly concentrated at large children’s hospitals. The pandemic exacerbated those trends, doctors said.
“When we combine that decrease in beds with a surge in the need for those beds, I certainly think we feel it,” said Anna Cushing, lead author on the study and a pediatric emergency medicine physician at Children’s Hospital Los Angeles. Children’s Hospital Los Angeles hasn’t had space to accept all the transfer patients looking for a bed, said chief medical officer James Stein.
At Rady Children’s Hospital-San Diego, emergency department wait times have fluctuated between two and six hours. In October, the hospital started sending administrative staff to volunteer there, freeing up the regular workers to focus on the sickest patients.
The staffers give kids blankets and alert a triage nurse if patients get sicker, said Nicholas Holmes, chief operating officer at Rady Children’s. A trained pediatric urologist, Dr. Holmes said he worked in the emergency room several times last week.
“Handing out a coloring book and giving a kid a Popsicle, it helps them feel a little bit better,” Dr. Holmes said.
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People should wash their hands, stay home if they’re sick, consider wearing masks indoors and while traveling and get vaccinated against Covid-19 and the flu, doctors and health officials said. They said people should be particularly conscious of risks to infants and older adults during Thanksgiving gatherings.
There are no specific treatments for RSV, but over-the-counter medication can help with fever and patients should stay hydrated. Parents should consult pediatricians if a child is having trouble breathing, having trouble staying hydrated or appears lethargic, doctors said.
The American Academy of Pediatrics said eligible high-risk infants could receive more than the standard five consecutive doses of the monoclonal antibody palivizumab to protect them during this unusually early and long RSV season. Hospital referrals should be reserved for children who need a higher level of care, to avoid overcrowding and extended wait times, the academy said.
—Jon Kamp contributed to this article.
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