RSV, flu, covid put pressure on pediatric providers

The emergency room staff at UPMC Children's Hospital of Pittsburgh prepares for impact every day at around 3 o'clock.

Beginning at that hour, an eight-hour period has historically been the busiest period of the day for the department due to an uptick in activity brought on by a confluence of respiratory syncytial virus (RSV), covid-19, and flu cases.
The surge, which coincides with an increase in instances of the three viruses nationwide, is having a negative impact on the ER staff, according to Dr. Raymond Pitetti, director of pediatric emergency care at Children's Hospital.

He claimed that "the sheer number of patients we are treating is worse now than it was before COVID." The emergency department is currently experiencing historic levels of patient load, which is quite taxing on the staff.
"Covid" instances are the most under control of the three infections, he claimed. The initial increase in RSV cases started in August and September and is "kind of" leveling off, although the numbers are still higher than usual. According to him, flu cases are also on the rise.

Pitetti stated, "We are still seeing a few kids with COVID every day, but nowhere near the numbers we were seeing before." I believe that with immunizations and increased public knowledge, COVID will always exist, but it is currently somewhat more under control."

contagious difficulties

RSV and the flu frequently exhibit signs and symptoms similar to the common cold. According to Pitetti, RSV can be particularly harmful to newborns and young children.

In addition to inflaming the lungs, RSV also produces increased secretions, the doctor explained. "The lungs get congested, and babies are especially susceptible to nasal congestion." If they have a bottle in their mouth, it is quite difficult for them to eat if their nose is completely blocked. Babies with RSV frequently have a very difficult time sucking in.
RSV cases have multiplied ten-fold since 2019, he claimed. RSV and influenza are often common at this time of year, but the reduction in the use of disease-mitigating measures like masks, social isolation, and staying home while unwell has led to an increase in the number of sick children being admitted to hospitals.

RSV "virtually disappeared" in 2020, he claimed.

"At the height of the pandemic, it was simpler to stay at home, and from my experience, businesses and employers would be understanding. I believe that's kind of faded away," he remarked. "The COVID mitigation strategies we implemented for RSV and influenza worked pretty effectively."
"People are no longer hiding and avoiding social contact like they were as we transition into this new normal."

According to Pitetti, fewer families are vaccinating their children against the flu.

He remarked, "Before COVID, we strongly pushed flu vaccines." Less children are getting the flu shot now, as we can see. The number of families avoiding standard vaccinations has grown, according to pediatric offices.

He claimed that the anti-vax movement as a whole had adversely affected childhood vaccinations.

Lots of patients arrive

Pitetti claimed that on an average day, there are roughly 220 kids treated in the Children's ER in a 24-hour period. Today, the ER sees "easily 250, 260, 270 patients every day," sometimes exceeding 300. Between 25 and 50 RSV patients visit the ER every day.

Children's placed a tent outside its Lawrenceville facility at the beginning of November to boost personnel and facilities to help with the influx of RSV patients.

When extra space is needed due to the quantity of patients arriving, the tent is still used, according to Pitetti.
"We use (the tent) when we need it," he said, "when all the ER rooms are full and a lot of patients are waiting to be seen." "We just staff it as needed, which is often in the evening. I can see how the public could find this tent to be somewhat alarming, but I sort of look at it from the perspective that we are attempting to meet the need and give the tools necessary to adequately treat these patients.

Longer wait times have resulted from the greater number of unwell youngsters, he continued.
The fact that the families must wait has caused a great deal of their angst, anxiety, and irritation, he claimed. "Before the pandemic, we worked incredibly hard to cut down on wait times and ensure that patients were seen as soon as possible." Nobody enjoys waiting, especially when a child is ill. It's challenging. Dealing with families that aren't always understanding, the volume, and managing the patients are all challenging.

hectic schedules

Pediatrician Dr. Jennifer Bradford claims that business has picked up recently at the Pediatric Associates of Westmoreland facility in Irwin.

Typically, 20 to 25 people are seen in a day. "Due to all the illness, it has recently been in the 30s," Bradford added. "Flu is perhaps the most typical illness at the moment. The vast majority of my kids are testing positive for flu, while we still have the occasional case of COVID and RSV.

Bradford has noticed an upsurge in parental worry over the two illnesses. She suggested that children don't always need to be rushed to the ER if the situation is not serious.
She stated that it is OK for a parent to watch their child at home if they are otherwise healthy, breathing normally, and maintaining proper hydration. Caretakers should call a doctor or the ER if the child's fever persists for more than three or four days or if they exhibit any respiratory distress, she advised.

She said, "Most of the time, I feel like it's probably something we can do here, but if it's more severe, I would definitely have them go to the ER." If the parents feel comfortable driving them, we can send them to the ER, or we'll even call an ambulance. We can get that youngster to the ER if they really, truly need it.
According to Dr. Joe Aracri, chair of AHN Pediatrics, schedules are full in the physicians' offices as well.

The acuity is not high, he noted, despite the enormous volume and number of children visiting his offices. "We are seeing a lot of sick children, but we are not seeing a lot of what we would term high acuity, which is very sick children."

Pediatricians' schedules are "totally filled," according to Aracri, who also noted that parents have been bringing their kids in more frequently for RSV-related issues than for COVID.
Parents would test their children and keep them at home if they tested positive for COVID, especially after home testing for COVID became available. Parents want to be seen for this, he added. We were only seeing 60% of what we would normally see with COVID, but now we are seeing 110% of what we would see.

According to him, RSV is typically treated like a nasty cold virus in children who are not at-risk newborns by resting, increasing fluid intake, and using acetaminophen or ibuprofen.
By the age of two, every child will have experienced RSV twice. "It's just a typical cold," he remarked. "The ones that we get very worried about are babies with a history of being premature or with heart conditions that need oxygen therapy or are immunocompromised, or kids going through chemo, babies under the age of 1, kids with a history of serious asthma," said the expert.

Before new moms go home, they are taught the frequent symptoms of disease in their infants, according to Wendy Reynolds, clinical director of the Family Additions Maternity Center at Excela Health Westmoreland Hospital.
Every time a baby doesn't act or seem right, Reynolds advised bringing them back in. "Lethargy, not wanting to eat, screaming, just general malaise."

According to Gretchen Peske, a liaison for Excela Health Homecare Hospital, Excela refers kids with more serious RSV cases to Children's for treatment.

Reynolds advised parents to call their pediatrician first. If a problem is too serious to handle over the phone, they might be told to go to the emergency department.

Reynolds advised treating this as soon as possible. "It's terrifying as a new mom when your baby gets sick."

Prospects for the surge

Aracri anticipates that the winter will be hectic for pediatricians.

We are seeing flu and various colds, but RSV has already peaked and is beginning to decline slightly, he said. Given that children have been separated and disguised for a number of years and that their bodies are not particularly adept at handling viruses, we anticipate a quite active year up to March.

In a similar vein, Pitetti thought the upsurge may endure for several months.
"We start to see these diseases proliferate when kids go back to school," he said. "We will undoubtedly observe a reduction during the winter, spring, and summer breaks. Before we see that break, I predict another three, four, or five months.

I can assure you that we won't ever turn anyone away," he continued. "This hospital and my team have done a remarkable job of adjusting to the situation, and we will keep doing so when volumes and surges occur." We will take further action if the spike worsens.