RSV surge overwhelms pediatric wards across the country

RSV surge overwhelms pediatric wards across the country

BY Mylika Scatliffe,
AFRO women’s health writer,

The 2022-2023 cold and flu season is here with a bang.

Across the country there has been a spike in cases of respiratory syncytial virus, or RSV, and Maryland is no exception.

“We have seen an increase in RSV since around the beginning of September with a particular increase in the last two weeks. It has coincided with high levels of other viruses such as influenza and rhino-enterovirus. It’s a big deal for kids when viruses overlap like this,” said University of Maryland Children’s Hospital Intensive Care Chief Jason Custer, MD.

The Centers for Disease Control and Prevention (CDC) defines RSV as a common respiratory virus that usually causes mild, cold-like symptoms from which most people recover within a week or two , but that can be serious for vulnerable populations such as infants and the elderly.

“RSV is quite common, especially in children. Anyone who has reached adulthood and had a common cold is likely to have been exposed to RSV multiple times and developed immunity,” said Dr. Meghan Bernier, medical director of the Children’s Center Pediatric Intensive Care Unit. Johns Hopkins in Baltimore. . “Older school-age children can handle RSV better, but children from birth to three years old have not yet developed the ability to fight off RSV, making it very dangerous for them.”

“It’s not just RSV, it’s all the viruses that are circulating. The rhinovirus is the typical common cold virus that can also make babies very sick.”

RSV, like other viruses, is spread through droplets when people cough or sneeze and on fomites. Fomite is the medical term for objects that can transmit disease. Hands and frequently touched items such as cell phones, play mats, toys, and doorknobs are fomites.

“Maryland Hospital Association member hospitals and health systems, including Nationwide Children’s Hospital in Washington, DC, are reporting an increase in children suffering from respiratory illnesses, including RSV,” said Bob Atlas, president and executive director of the Maryland Hospital Association. “The same increase is evident across the country, particularly in the Northeast.”

RSV causes inflammation in the small airways, putting infants and young children at extreme risk since they have small airways to begin with. “We have been at capacity in terms of pediatric beds for the last few weeks and are understaffed than we were before COVID,” Custer said. “Every day that someone is discharged, someone is admitted.”

The increase in patients is seen in community contact with RSV through emergency departments, as well as in acute care situations resulting in hospital admissions. Consequently, patients experience longer waiting times for emergency room care and for admission if they need more support than can be obtained in emergency rooms.

“Our hospitals are prepared to care for very sick children; however, this latest surge is testing capacity,” Atlas said. “There is a nationwide shortage of doctors with the special skills needed to care for sick children, leaving our hospitals unable to staff a fifth of available pediatric beds.”

“We encourage families with children who have less urgent medical needs to seek care first from their pediatrician or in an urgent care setting,” Atlas continued. “Help us preserve limited hospital resources for those who need more advanced care.”

The mainstay of RSV treatment is respiratory supportive care.

“One of the main symptoms you look for in an infant or young child is an increased work of breathing. If your baby or toddler is working hard to breathe, it’s time to seek medical attention,” Bernier said. “When the severity of the disease reaches the point that a child must be hospitalized, the central element of treatment is oxygen therapy, often with specialized nasal cannulae, and intravenous hydration. If the disease escalates to the point where treatment is needed in the pediatric intensive care unit, children receive greater control of breathing and heart rate and even higher flows of oxygen, perhaps even under pressure with a C machine. -PAP. In the most severe disease, a child may be intubated, but that is the least seen scenario.”

“You need to take action quickly if your baby or toddler is refusing to eat or breathing so heavily, can’t take a bottle or breastfeed, or their ribs are contracting with each breath,” Custer said.

While RSV is usually seen in children under the age of three, older children with underlying chronic medical conditions, such as asthma or neurological disorders, are also dangerously susceptible.

“Along with reports from our local emergency care providers reporting an increase in pediatric cases, we also received reports that a local hospital’s pediatric intensive care unit is full, and has been for several days. RSV appears to be adding stress to the overall system and PICU beds are hard to come by, which is in line with what hospitals are seeing nationally. We are also seeing outbreaks of RSV in schools across the city,” said Arinze Ifekauche, director of communications for the Baltimore City Department of Health.

Immunity against RSV and other viruses among children may be low because there weren’t as many opportunities for the virus to circulate these past two years during the pandemic. “While there is no vaccine for RSV, we can reduce the spread by practicing good handwashing, staying home if you are sick, not sending your children to school or daycare when they are sick, and isolating yourself from those who are sick. especially vulnerable. to get infected (especially babies) and get the vaccines that are available, like the flu and COVID,” Custer said.

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