As a "tripledemic" of respiratory viruses continues to surge this winter, many hospitals across the country are struggling to care for patients. Pediatric hospitals in particular have been overwhelmed with children suffering from influenza and respiratory syncytial virus (RSV), leading to long ED wait times and overworked providers.

Respiratory viruses are keeping hospitals full this winter

In recent weeks, hospitals across the country have been overloaded with Covid-19, influenza, and RSV patients. According to HHS data, hospitals nationwide have been roughly 80% full throughout late November and early December—rates that have not been seen since the first omicron wave.

Currently, 77.38% of all inpatient beds in the United State are occupied, largely due to surging hospitalizations from flu and RSV. In comparison, Covid-19 patients currently make up 5.87% of inpatient beds.

For the week ending Dec. 10, 23,503 patients were hospitalized with influenza, and the cumulative hospitalization rate was 32.7 per 100,000 people—roughly 7.6 times higher than the previous record set in week 49 of the 2010-2011 flu season.

And although RSV is not tracked as comprehensively, CDC data shows that the cumulative hospitalization rate for RSV for the 2022-2023 season is currently 33.9 per 100,000 people, significantly higher than any of the previous four seasons that have data available.

RSV cases also appear to be more severe than they have been in years past. In a survey of 100 physicians published Dec. 14, 64% of respondents said RSV cases are more severe than in prior years.

"When you think about some of the winter and spring omicron surges, where it was just going crazy and we had 100,000-plus cases, a million cases a day, we have higher hospitalizations now, which is mind boggling," said Kavita Patel, a medical contributor for NBC News.

Pediatric hospitals are overwhelmed amid viral surges

Although the current surge of respiratory viruses has impacted all hospitals, pediatric hospitals have been hit especially hard, with five states reporting bed occupancy rates of over 90%.

According to Erica Michiels, director of pediatric emergency medicine at Corewell Health Helen DeVos Children's Hospital, their ED typically sees around 140 kids each day, but on a Tuesday in mid-December, they saw 253. The hospital has also been inundated with transfer requests from hospitals, including those from other states, that either have no room or lack the necessary equipment to care for certain patients.

"I have had many calls come in where they said, 'We've called 15 other places and they've all said no,'" said Andrea Hadley, chief of pediatric medicine at the hospital.

In response to the surge in patients, DeVos Children's has doubled up their rooms and is not allowing more than one parent or guardian to stay overnight. Still, the hospital only has capacity for the sickest children.

"We've had to say, 'We see you, we're going to support you, but we can't bring you here yet,'" Hadley said.

Staff shortages have also added to the strain. According to the Michigan Health & Hospital Association, the state has lost 1,700 staffed hospital beds since 2020. At Children's Hospital of Michigan, there's only enough staff to cover around 60% of beds, according to Rudy Valentini, the hospital's CMO.

"So we have ICU patients in our emergency department that can't get up to our ICU, because either there's no available beds, there's no available staff beds," he said.

With overwhelming numbers of patients, a lack of available beds, and staffing shortages, many pediatric hospitals must contend with difficult decisions about who they can provide care to.

"There's also a moral distress associated with the thought of having to turn patients away," Hadley said. "And how do we balance that distress that comes with knowing, potentially — if we as a system don’t stretch a little more — that there might be patients that are turned away?"

However, Jamie West, a nurse manager at DeVos Children's, said that many health care workers are already "on the brink of burnout" in the current conditions. West's floor has enough nurses to safely care for 18 patients, but they've had to stretch these nurses to care for up to 33 patients.

"These kids are just so much sicker [than we typically see during RSV season]," West said. "And when you think about nurses that are already in very large patient assignments, nurses are very worried that their child's going to go downhill very quickly, that they're going to maybe miss something because they're spread so thin." (Wells, Kaiser Health News/Michigan Radio, 12/20; Hohman/Murphy, Today, 12/12)