While pediatric hospitals across the United States have been in "crisis mode" amid a surge of respiratory syncytial virus (RSV) cases, providers at EDs, urgent care centers, and pediatricians' offices are also experiencing high volumes and limited capacity, Sophie Putka writes for MedPage Today.

RSV is placing a strain on 'the healthcare system as a whole

Amid a "tripledemic" surge of RSV, influenza, and Covid-19, providers around the country are urging parents to keep children who are not seriously ill at home.

According to Katie Lockwood, a primary care physician at Children's Hospital of Philadelphia, parents should only visit the ED if their child has severe symptoms, including rapid breathing of more than 60 breaths a minute, dehydration, and uncontrollable crying.

"It's just important that people recognize that when you step back and look at the healthcare system as a whole, that volume is high everywhere," said Lockwood.

"It's not as simple as saying, 'Oh, you shouldn't go to the ER because we're busy, or the ER saying you should go to primary care because we're busy. Everybody is busy," Lockwood added. "One of the things that I had been hearing from my own patients ... was how long they were having to wait when they did go to an emergency department, and urgent cares were really full, and we were seeing a lot of volume in [my] office."

Typically, seasonal spikes in respiratory illness occur later in the year. According to CDC, this year's surge in RSV-associated hospitalizations has surpassed the peaks seen in December and January in previous years.

Last week, Jay Varma, a professor of population health sciences at Weil Cornell Medical College, said in a tweet that there were more visits to New York EDs for respiratory illnesses this month in children under five years old than during last year's omicron wave in December.

"The impact of RSV and respiratory viruses is hitting children more acutely than we're seeing on the adult side," said Bradley Uren, an emergency physician at University of Michigan Health System, and a spokesperson for the Michigan chapter of the American College of Emergency Physicians (ACEP).

"The theory goes that there have been a lot of people that have not been exposed to a lot of respiratory viruses, including RSV, and now as we mobilize and we get back together and we drop some of those precautions, like masks and distancing ... that it spreads a little bit more easily," Uren added, noting that there is still no consensus on what is driving the surge.

Uren's colleagues have estimated that the number of pediatric RSV cases and other respiratory illnesses have recently doubled or tripled—and children with other conditions are also experiencing difficulties finding care.

Smaller hospitals are having a hard time securing specialized care for patients at larger hospitals. "I hear this all the time -- [people from] smaller hospitals saying, 'I've called dozens of other facilities, I'm calling other states and trying to find a hospital that can accept my patient,'" Uren said.

Hospitals face ongoing capacity issues

Currently, issues with boarding, staffing, and reduced pediatric beds have placed a strain on hospitals' capacity. "Many hospitals used their pediatric beds for other purposes, like adults, and the staffing as well as the bed capacity may not have picked back up after COVID cases calmed down," Lockwood said.

Earlier this month, ACEP sent a letter to President Biden, highlighting an ongoing problem known as "boarding," when patients seeking inpatient care wait in the ED for a bed to become available. In the letter, ACEP describes bottlenecks of new patients with critical conditions waiting for hours to be triaged, only to wait hours more before being seen.

"Think about having one room in an emergency department tied up for 5 months. Think of the number of patients with RSV or with pneumonia or with a heart attack that could have gone into that room," said Uren, "and you start to see how this becomes a bottleneck running upstream."

Separately, Uren noted that ACEP is calling for a summit to bring health care leaders together to raise funds to increase inpatient capacity for medical and behavioral health patients.

Lockwood noted that pediatricians want things like staffing resources, higher Medicaid payment rates, and increased investments in infrastructure for children's hospitals.

"I was just thinking about how scary it can be for families who are experiencing a sick child, and trying to take care of them, and feeling that the healthcare system is really busy and they have to wait a long time," Lockwood said. "My heart breaks for those families." (Putka, MedPage Today, 11/11)