In the United States, respiratory syncytial virus, or RSV, is creating a health care crisis in the pediatric system, which already has less capacity than the adult health care system, putting the youngest children and children at risk. more vulnerable.
RSV, which typically peaks in late fall and continues through winter, showed up early this year, with a dramatic increase in cases in recent weeks, creating undue pressure on wards. hospital emergency rooms, inpatient units and intensive care units.
After nearly two years of masking, physical distancing and rigorous hygiene practices to curb the spread of COVID-19, other respiratory viruses have declined sharply in prevalence but have returned this year with a detrimental impact on people. pediatric hospital systems.
RSV causes the common cold in many people, but can lead to life-threatening and sometimes fatal complications in young children. The virus can cause inflammation in the lower airways, causing a condition called bronchiolitis, or inflammation deeper in the air spaces of the lungs, causing pneumonia.
Infection in young children often results in difficulty breathing, eating, and drinking, which may require hospitalization to provide breathing or rehydration support. Children sometimes need help with a breathing tube and a mechanical ventilator, which necessitates the availability of intensive care services.
Yet the recent increase in RSV cases, combined with hospital staffing shortages in clinical units, has pushed some hospitals back into what could be considered crisis states. Even in non-crisis states, some children may have more limited access to specialized regional pediatric intensive care services. This could get worse when regional resources are stretched.
Pediatric critical care doctors see how quickly babies with respiratory conditions can decline. There are sometimes literally minutes between a baby whose small body is able to keep up with the breath with support and a baby who quickly decompensates, requiring quick and skilled intervention to place a small tube through the mouth into the airway so that a machine can take over and the body can rest. Without such intervention, a baby whose body is overwhelmed may not breathe efficiently enough, so their heart and lungs may stop due to illness.
Currently, pediatric emergency departments are full of patients requiring care but are unable to move patients to general practice or intensive care beds, leaving children in the emergency department, which is not intended to provide longer-term hospital care.
Many emergency departments are therefore already in a state of emergency, using resources in non-traditional ways in an attempt to maintain the standard of care. In other cases, children are cared for in emergency departments in adult-dominated facilities or are transferred to distant but available pediatric resources. Some children who are denied transfer to regional pediatric centers that are at full capacity are receiving care in adult facilities, which again stretch resources in non-traditional ways.
Many hospitals are operating at 70% or more bed capacity, sometimes more in specialist intensive care units, where doctors are specially trained to provide the increasingly intensive therapies that very sick RSV children may need.
We learned from COVID that stretching more than 75% of capacity leads to increased mortality in patients. Already, 100 to 300 children die each year from RSV and around 58,000 children under the age of 5 need to be hospitalized.
Although it is too early to know what the impact of this early presentation and increased disease rate will be, it is reasonable to predict that mortality could increase solely due to more cases, but also because of the constraints exerted on the pediatric system. For the sake of children, it is imperative to return to the basic principles that helped to curb the pressure on the health system during the COVID pandemic.
These basic principles are that preventing the spread of the virus will reduce the number of children presenting with the disease at the same time, thus reducing the pressure on hospital systems. RSV is spread by direct contact with the respiratory secretions of infected children. Transmission can be prevented by preventing children infected with respiratory viruses from coming into contact with other children. Parents of children with such diseases should not send their children to daycare or school. Schools and daycares should maintain strong hygiene practices and have policies to ensure that infected children are not in these environments. Although masking is generally not necessary to prevent the spread of RSV in particular, the virus often coexists with others that spread more easily via droplets, for which masking can be useful.
We also need regional coordination for the availability of pediatric resources to create a separate resource pool. The recent expansion of a pediatric pandemic preparedness network will help. Continued funding and focus on public health preparedness is crucial. Health care providers need clear guidelines on procedures when there is a risk of entering crisis care standards. A central database and coordination of bed availability would ensure that a sick child receives the necessary care in a hospital capable of providing that level of care.
Policy makers should work with hospital and medical care administrators, as well as health care foundations focused on children’s health, to ensure sufficient funding for pediatric workforce development . In this way, more pediatric resources can become available in more hospitals. Employers should give families time off to care for children who must stay home or provide childcare resources in the event of illness.
Ensuring that a sick child is in the right place, with the resources to support them, is the best way to avoid a devastating outcome. The pandemic has shown us the tools available and it’s time to use them for children.
Erin Paquette, MD, JD, MBe is a pediatric intensivist and public health bioethicist at Ann & Robert H. Lurie Children’s Hospital in Chicago, associate professor of pediatrics at Northwestern University Feinberg School of Medicine, and associate professor of law ( out of courtesy) at the Northwestern Pritzker School of Law. Follow her on Twitter @ErinPaquetteMD.
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