by Annmarie Timmins, New Hampshire Bulletin
A year ago, it was adults sick with COVID-19 who filled intensive care units, many requiring oxygen or full intubation. Now beds are increasingly occupied by children who are so sick with respiratory syncytial virus, or RSV, they too require ICU-level care.
All eight of the state’s pediatric ICU beds are full, and there are even more sick children receiving high-level care in other areas of hospitals around the state. Some hospitals treat seriously ill pediatric patients in their adult intensive care units. Others are providing that level of care in beds outside the ICU.
It’s not a result of sicker children but rather more sick children, Dr. Neil Meehan, chief executive physician at Exeter Hospital, said.
“I don’t think the season is any more virulent than other seasons, but just the sheer numbers of children coming in has been somewhat overwhelming,” he said. “Many of them require oxygen, and some even require more advanced respiratory support. We had a child last week who required full ventilation.”
Meehan’s comments were echoed by medical leaders around the state Wednesday in an online presentation hosted by GoTruthNH, a public education initiative to promote accurate health information. Their experiences confirm a November health advisory from the Centers for Disease Control and Prevention warning that a surge in pediatric RSV infections would strain health care systems that are already contending with a surge in flu admissions and ongoing COVID-19 cases.
In the hour-long conversation, providers discussed why pediatric RSV cases are skyrocketing, how COVID-19 helped prepare them for this surge, and what parents and caregivers should do if a child develops a runny nose, cough, and fever, all symptoms of RSV.
Why are so many New Hampshire hospitals straining to treat kids with RSV?
Two words: “immunity debt.”
Respiratory syncytial virus, discovered more than 60 years ago, is common and causes mild, cold-like symptoms in most cases. But it can pose serious health risks for infants and older adults. It’s highly contagious, and nearly all children are exposed to the virus or infected before they turn 2. That exposure builds immunity.
But children’s exposure to RSV – and all viruses – was drastically reduced during the pandemic, due to masking, frequent hand washing, and social distancing. Experts say that “immunity debt” may be leading to increased cases of pediatric RSV.
Koren Superchi, vice president of patient services at Littleton Regional Healthcare, said the hospital has had more pediatric admissions in the last month than it had in the last year. “And those are all RSV admissions, so it is concerning,” she said, especially since the season for respiratory illness is just beginning.
Hospitals like Superchi’s and Meehan’s are facing a second challenge. The specialty hospitals they’d typically transfer these high-risk pediatric patients to, like Dartmouth-Hitchcock or sites in Boston, are also full.
“So you can imagine that we’re getting ready to take care of even more sick kids for longer than what we normally are comfortable with,” Meehan said.
The common cold, COVID-19, the flu, and RSV share several symptoms, including cough, runny nose, and fever. What should parents and caregivers do when they see those symptoms in their child?
“I think it gets very tricky because now you have a pediatric population who really cannot voice their symptoms, or how they’re feeling, especially when they’re less than the age of 2,” said Dr. Aalok Khole, an infectious disease physician at Cheshire Medical Center in Keene. He suggested parents call their pediatrician if they are concerned about symptoms. “You don’t need to wait and watch at home without any assistance,” he said.
Khole also suggested parents test for COVID-19. If a negative test rules that out, he said parents should monitor for more serious symptoms associated with RSV, which include decreased appetite, unusual tiredness, and wheezing.
“If you have a kid who’s not eating or drinking or is at risk of getting dehydrated, or … doesn’t want to interact much, that’s a cause for concern,” Khole said. If a cough becomes so serious that a child is struggling to breathe, he said they need to go to an emergency room.
When COVID-19 hit, hospitals had to rethink their approach to caring for patients and managing resources. That has left them better prepared for the current triple surge of increased pediatric RSV patients, more flu patients, and ongoing COVID-19 cases.
During the worst days of the COVID-19 pandemic, leaders from all of the state’s hospitals talked daily and shared their experiences, from new approaches to treatment to sources for medical expertise and protective equipment.
Meehan said hospitals are doing the same to manage the surge in RSV and flu cases.
“We’re now standing up another essentially incident command (system),” he said. When one hospital’s pediatric beds are full, another hospital may have space. Hospital leaders are also making their respiratory therapists available to one another.
“It’s, ‘We have ventilators that you can possibly borrow. I have beds that you can get into. Do you have extra equipment we can borrow?’ ” Meehan said. “Getting the decision makers on the line was instrumental in helping us through that crisis, and I think will be instrumental if this crisis continues to escalate. And I do think it will.”
COVID-19 also taught hospitals to anticipate supply chain problems. Hospital leaders said they ordered medication pumps and more ventilators to treat children ahead of the RSV surge. Meehan said his hospital has proactively connected with pediatric care experts who have more experience treating young patients. Littleton has done additional staff training to expand their ability to treat pediatric RSV patients. And the telemedicine options the hospital relied on to care for and monitor COVID-19 patients is proving useful now, Superchi said.
“For the sicker kids we’ve admitted in the ICU, we can utilize that service and have Dartmouth pediatricians at the push of a button and be able to provide guidance and support to our nursing staff, as well as our pediatricians,” she said.
This story was written by Annmarie Timmins, a reporter at the New Hampshire Bulletin, where this story first appeared.
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