番茄社区

Children's hospitals aren't the only ones drowning in patients with respiratory illness -- it's also general emergency departments (EDs), urgent care clinics, and pediatrician's offices.

Hit by a surge of respiratory syncytial virus (RSV), flu, and COVID-19, physicians and nurses across the country are calling for help and asking parents to keep children home unless they're seriously ill.

"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," Katie Lockwood, MD, MEd, a primary care physician at Children's Hospital of Philadelphia, told 番茄社区.

"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," she 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."

Physicians say that seasonal increases in respiratory illness, which are expected, normally come later in the year. This year's early surge in RSV-associated hospitalization, , is higher than December and January peak rates in recent years.

Jay Varma, MD, a professor of population health sciences at Weil Cornell Medical College in New York City, that visits to New York EDs for respiratory illnesses this month in children under 5 years old are higher than during last December's Omicron wave.

RSV generally causes mild illness that can manifest in cold-like symptoms, but can also infect the lower airway, leading to difficulty breathing. Adults have generally already developed antibodies against RSV -- but the younger a child is, the more serious RSV can be, said experts.

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

Uren says this is because their airways are much smaller, and swelling and inflammation there can have a bigger impact. Infants under 6 months are than even 6- to 12-month-old infants to be hospitalized with RSV, with progressively less risk as time goes on. These very young children are also less likely to have been exposed to respiratory viruses in general, because of the COVID-19 precautions in place during much of their lives.

Uren said, "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 , like masks and distancing ... that it spreads a little bit more easily," though he emphasized that there's still not a definitive consensus on the reasons for the surge.

He added that his colleagues in Michigan have estimated that the volume of pediatric RSV and other respiratory cases have doubled or even tripled recently. But even children without respiratory illnesses are having trouble finding care.

Smaller hospitals are having trouble getting care for patients who need specialized care 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 that can accept my patient,'" Urea said.

Hospitals are battling other constraints on their capacity, fueled by ongoing problems with boarding, staffing, and, Lockwood said, a pandemic-era reduction in pediatric beds that had . "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."

Last week, the ACEP sent to address the ongoing problem known as "boarding," when patients waiting to be admitted to a hospital for inpatient care wait in the ED until a bed opens up. The letter described backlogs of new patients, their critical conditions worsening in waiting rooms after hours just to be triaged, only to wait hours more to be seen.

"Think about having 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."

What's more, Uren emphasized, people who lost jobs or insurance in the pandemic may have delayed care, further contributing to backups across the health system.

Lockwood noted that to help with the problem in the short-term, parents should be urged to limit visits to the ED if the child's symptoms are mild, while children needing to use their muscles to breathe should go to the ED. Other signs of serious illness are rapid breathing at more than 60 breaths a minute, dehydration (i.e., fewer than three wet diapers a day), and uncontrollable crying.

At a higher level, stakeholders and policymakers need to convene urgently, Uren said, noting that the ACEP is calling for a summit to bring leaders together to raise funding for more inpatient capacity for medical and behavioral health patients.

For Lockwood, what the pediatricians would want includes resources for staffing, increased Medicaid payment rates, and greater investment 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," she said. "My heart breaks for those families."

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