January 31, 2023

During the worst of the COVID-19 pandemic, the greatest need for critical care was in the elderly. As a result, part of the children’s intensive care unit was converted for adults.

Not all of the space has shifted back to pediatrics, leaving some regions running short of capacity to care for critically ill children, said Dr. Stacey Cummings, vice president of outpatient pediatric services at Geisinger.

It’s another factor straining the pediatric capacity at many Pennsylvania hospitals as they face a week-long spike in children with seasonal respiratory illnesses, Cummings said.

Many of the hospitalized children, particularly those requiring intensive care, have a potentially life-threatening illness called respiratory syncytial virus, or RSV. RSV cases have been piling up in Pennsylvania and the United States for nearly two months.

The good news is that Geisinger’s RSV surge, which began almost two months ago, may be showing signs of slowing down, although there are still many cases, Cummings said.

“It just means that we don’t have to open every day without appointments and overbook every appointment to take patients, we’ve started to see some open appointments and we’re not seeing quite as many positive RSVs,” she said. “There are still many sick children.”

Another reason to cross your fingers: Cases of influenza, neither in children nor in adults, have not yet put much pressure on hospitals, and so far there has been no increase in COVID-19 cases.

But that could change soon. In the week ending Saturday, flu cases in Pennsylvania rose to their highest level in a decade, according to records from the Pennsylvania Department of Health.

Health systems, including Penn State Health and Wellspan, said this week they continue to see abnormal numbers of people seeking care in their emergency rooms and emergency centers. WellSpan said some emergency care locations are “more than doubling or tripling” the volume of previous years, with the situation compounded by staff shortages. WellSpan said it has transferred employees and consolidated some locations and is asking people to go online to check hours before visiting a location.

This week, five percent of all Pennsylvania hospitals were at full occupancy or higher for occupied beds and 10 percent were at full occupancy or higher for occupied ICU beds, according to records from the Hospital and Health System Association of Pennsylvania.

The main pressure on hospitals continued to come from children sick with RSV, another respiratory disease, with cot supplies taking a heavier strain than adult cot supplies, according to the HAP.

Nationwide, 93% of all pediatric beds and 87% of all pediatric intensive care beds were occupied, according to the HAP.

The nationwide surge in RSV cases is attributed to the fact that many young children have never been exposed to it due to restrictions and precautions taken to prevent the spread of COVID-19.

Now restrictions are mostly gone and many people are no longer social distancing or wearing masks and many have likely relaxed things like frequent hand washing.

Cummings expects these factors, combined with children being exposed to RSV and other seasonal diseases for the first time, could result in a harsh winter for children.

“I think it’s going to be a bumpy winter for sick kids,” she says.

Children who have already had RSV typically don’t get it again in the same season, Cummings noted.

It continues to pose a serious threat to children who haven’t had it.

In many cases, RSV is the equivalent of a bad cold and does not require hospital treatment. But it can be life-threatening for certain children, especially children under 12 months and those who already have lung or heart disease, or are newborns prematurely.

RSV symptoms can include fever, runny nose, cough, and wheezing. They are similar to those of the flu and COVID-19, making it difficult to tell the difference.

RSV can be especially harmful to children under the age of six months because their chest muscles may be too weak to cough up congestion caused by RSV.

Cummings said parents of children with symptoms should look for signs their child is trying to breathe unusually hard. These include recognizing the outline of individual ribs or tense neck muscles, pauses between breaths or the child turning blue. These are signs of an emergency that requires immediate medical attention.

Doctors say people can protect children from RSV and other respiratory illnesses by taking steps like washing their hands frequently and staying away from others when they’re sick.

Although there is no vaccine to protect against RSV, doctors are asking parents to vaccinate their children against the flu and COVID-19, which can prevent illness and also limit the burden on the healthcare system.

Adults also get RSV and, as with very young children, it is especially dangerous for older adults.

Meanwhile, COVID-19 has not yet shown any signs of another winter surge. 1,129 people were hospitalized with COVID-19 this week, about a third of the level of a year ago, according to HAP. Of these, 144 adults with COVID-19 were in intensive care and 54 on ventilators. That’s good news, too, since most people with COVID-19 weren’t seriously ill because of it and were likely hospitalized for other reasons.

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