RSV, flu, covid put pressure on pediatric healthcare providers

Every day around 3 p.m., nurses, doctors and emergency room staff at UPMC Children’s Hospital in Pittsburgh brace for impact.

This time marks the start of an eight-hour period that in recent months has been the busiest time of day for the department, which has seen a spike in activity due to a combination of respiratory syncytial virus ( RSV), covid-19 and flu cases. .

Dr. Raymond Pitetti, director of pediatric emergency medicine at Children’s, said the surge, which aligns with a national increase in cases of all three viruses, is taking its toll on the emergency team.

“The volume of patients we’re seeing is worse than it was during covid,” he said. “We’re seeing historic numbers in terms of volume coming into the emergency department, and it’s really difficult right now for staff.”

Of the three viruses, covid cases are the most under control, he said. The first increase in RSV cases began in August and September and is stabilizing “a bit” but still showing higher than normal numbers. Flu cases are also on the rise, he said.

“We are still seeing, every day, a few children with covid, but far from the numbers we were seeing before,” Pitetti said. “I think with vaccinations and public awareness, we’ll still have covid – we’ll still have covid – but it’s a bit more controlled right now.”

Contagious Challenges

RSV and the flu often have symptoms that resemble a cold. RSV, in particular, can be devastating for young children and infants, Pitetti said.

“What RSV does is it causes inflammation in your lungs, but it also causes increased secretions,” he said. “The lungs are congested and babies are especially congested in the nose. If their nose is completely blocked, it is very difficult for them to feed themselves if they have a bottle in their mouth. We will often see babies who have RSV have difficulty feeding. »

RSV cases increased tenfold from 2019, he said. Influenza and RSV are normally prevalent at this time of year, but the gradual reduction in disease mitigation precautions such as masks, social distancing and staying home when sick has resulted in bringing more sick children to the hospital.

In 2020, there were virtually no cases of RSV, he said.

“At the height of the pandemic, it was easier to stay at home – and business and employment, from my perspective, would cut you off on a break. I think that sort of disappeared,” he said. “The mitigation efforts we have in place for covid have worked very well for RSV and influenza.

“Now, as we move into this new normal, people aren’t masking up and distancing like they used to be.”

Fewer families are having their children vaccinated against the flu, Pitetti said.

“This whole anti-vax movement has really hurt childhood vaccinations, inappropriately,” he said.

A flood of sick people

On a normal day, Pitetti said, the volume of children’s emergency room patients over a 24-hour period hovers around 220 children. ERs these days see “easily 250, 260, 270 a day”, with some days exceeding 300 patients. The ED sees between 25 and 50 RSV patients a day.

In early November, Children’s pitched a tent outside its Lawrenceville hospital to add resources to deal with the influx of RSV patients.

The tent is still used whenever the number of incoming patients requires more space, Pitetti said.

“We use (the tent) when we need it, when all the emergency rooms are full and there are a lot of patients waiting to be seen,” he said. “We only staff it when we need it, and usually that’s in the evening. I understand why it might be kind of concerning to the public when they see this tent, but I kind of see it as, we’re responding to the need and trying to provide resources to be able to effectively see these patients.

The higher number of sick children meant longer wait times, he added.

“There is a lot of anger, anxiety and frustration on the part of families because they have to wait,” he said.

Busy schedule

Dr. Jennifer Bradford, a pediatrician in the Irwin office of Pediatric Associates of Westmoreland, said her office has been busier in recent weeks.

“In a day you would usually see 20 to 25. … Recently it was in the 30s because of all the illnesses,” Bradford said. “Probably the most right now is the flu, more than anything. We still have covid here and there and certainly RSV, but I would say by far the majority of my kids are testing positive for the flu.

Bradford has seen increased parental concern about both illnesses. She said that while the situation is not serious, children do not always need to be taken to the emergency room.

If the child is otherwise healthy and breathing normally and staying hydrated, she says, it’s fine for a parent to monitor them at home. If the child’s fever lasts more than three or four days, or if he is in respiratory distress, caregivers should contact a doctor or the emergency room, she said.

“If it’s more serious I would definitely take them to the ER, but more often than not I think it’s probably something we can do here,” she said.

Schedules are also hectic at the offices of Allegheny Health Network pediatricians, said Dr. Joe Aracri, president of AHN Pediatrics.

“We’re seeing a lot of volume and a lot of kids coming into our offices, but the acuity isn’t high,” he said. “We don’t see a lot of what we would call high acuity – that is, very sick children – but we do see a lot of sick children.”

Aracri described the pediatricians’ schedules as “completely booked,” adding that parents brought their children in more frequently for RSV concerns than they did for covid.

“Especially when home testing for covid came around, parents were testing their kids and keeping them home if they had covid. For that, parents want to be seen,” he said.

For most children who aren’t vulnerable infants, RSV is treated like a bad cold virus, he said, with rest, increased fluids and acetaminophen or ibuprofen.

“Every child will have RSV twice before the age of 2. It’s a common cold,” he said. “The ones that really concern us are babies who have a history of being premature or have heart conditions that require them to be on oxygen or who are immunocompromised, or children who are having chemo, babies under the age of one, children having a history of bad asthma.

Wendy Reynolds, clinical director of the Family Additions Maternity Center at Excela Health Westmoreland Hospital, said new mothers learn common signs of illness in their babies before they go home.

“Lethargy, not wanting to eat, crying, just general discomfort, any time a baby doesn’t look well or act normal, you have to bring the baby back,” Reynolds said.

Gretchen Peske, a liaison with Excela Health Homecare Hospital, said Excela sends children with more severe cases of RSV to Children’s for treatment.

The future of surge

Aracri expects pediatricians to be busy throughout the winter.

“RSV has already peaked and is starting to come down a bit, but we are seeing the flu and other colds,” he said. “The fact that the kids have been separated and masked for the past two years, their bodies aren’t really good at dealing with viruses, so we’re expecting it to be quite a busy year throughout the month of march.”

Likewise, Pitetti predicted that the surge could last several months.

“When kids go back to school, that’s when we start to see these viruses circulating,” he said. “Winter break, spring break, when we take a break for the summer, we will definitely see a drop then. … I think it will take another three, four, five months before we see that break.