When her son was born seven weeks early, weighing just 2.5 pounds, RH watched the baby boy stay in the neonatal intensive care unit for 37 days.
When they finally left the hospital, RH, who asked to use his initials for privacy reasons, breathed a sigh of relief. The baby, despite its difficult beginnings, was in perfect health. But only a few months later, the child ends up in the hospital with a dangerous virus, RSV.
“It’s terrifying,” he said. Her little son was hooked up to a maze of beeping wires and monitors, including oxygen to help him breathe and intravenous fluids for dehydration. He stayed there for a week.
Hospitalizations for respiratory viruses like RSV, influenza and others are increasing in the United States, with children under five – especially newborns and premature babies – being most at risk, while simultaneous shortages of antivirals and antibiotics swept the country.
RSV hospitalization rates among newborns are seven times higher than they were in 2018, the last full season before the pandemic hit, and flu hospitalizations are the worst in a decade . Rhinoviruses, enteroviruses, adenoviruses, metapneumoviruses and parainfluenza are also contributing to this wave of disease, and Covid cases are starting to rise again in the United States.
More than three quarters of pediatric hospital beds were already occupied in mid-November. A hospital in Oregon has instituted pediatric crisis care standards, an emergency measure to expand existing capacity. Hospitals in California and Maryland have started using overflow tents in an attempt to cope with swells in pediatric patients. Children’s hospitals in Boston and Salt Lake City have canceled scheduled surgeries.
At least three children have died from RSV and 12 children have died from the flu so far this year, according to the US Centers for Disease Control and Prevention (CDC).
Leading child health organizations are calling on the Biden administration to declare a national emergency, as some 55 million Americans return from Thanksgiving holiday trips and many prepare for Christmas and New Year celebrations.
“I think this should have been called a national emergency a month ago,” said Anita K Patel, pediatric critical care specialist at Children’s National Hospital in Washington, DC, and assistant professor of pediatrics at the George Washington School of Medicine and Health Sciences. .
Children’s National has been operating at or near capacity for the past two months amid a “huge spike” in cases of RSV and influenza, as well as other viruses, she said.
“It’s like a viral petri dish right now,” said Mark Kline, chief medical officer and chief medical officer at New Orleans Children’s Hospital. He has seen a ‘deluge’ of children requiring hospitalization for viral respiratory illnesses over the past four to six weeks.
The curves for new cases and hospitalizations are “almost vertical,” Kline said. “You’re at peak winter levels in the first half of November.” Its hospital system sees double the number of patients usually seen at this time of year, and positivity rates for the flu, for example, have been “extremely high” at 30-35%.
Respiratory viruses like influenza and RSV typically increase in winter – but not as early, often not simultaneously, and not on this scale. “What’s unique this year is the sheer volume of cases,” Patel said.
Another challenge has been the number of different viruses circulating at the same time. “Any one of them individually would have strained the system, but we’re dealing with at least four simultaneously,” Kline said. Pediatricians and primary care practices are also overwhelmed.
The child health crisis has had an impact on American society. Some schools have closed or temporarily switched to virtual learning as staff and students fall ill. And the resurgence of illnesses, even mild ones, has wreaked havoc on parents. In October, more than 100,000 people took time off from work due to childcare issues – a higher number than any other point in recent years, including 2020.
RH’s son caught Covid in August, and his pediatrician has warned he could get sicker than usual in the coming weeks as he recovers. A friend had also warned him that RSV particularly strikes newborns and premature babies. When the baby sniffled a few weeks later, RH and his wife watched him closely. After a few days, he seemed to get sicker and sicker, more lethargic. Then he vomited and his breathing was labored.
“It’s just that you feel like you’re where you are, something’s not right,” RH said.
His worries were confirmed. After a few hours of waiting in the emergency room, the medical team agreed that it looked like the baby had a severe case of RSV and needed to be admitted for care. This hospital was full of pediatric patients, however. They had to be transferred by ambulance to another hospital about 45 minutes from their home.
“It turned out to be the last bed they had,” RH said. He felt lucky that he had listened to his instincts and not waited.
The causes of this wave of diseases are complex and still being understood.
A term, “immunity debt,” has emerged during the pandemic, but it’s not a scientific or medical term, and definitions can be confusing.
Some have proposed that Covid precautions will lead to weakened immune systems for children – similar to the hygiene hypothesis, or the discredited idea that getting sick is good for the immune system. The idea that taking precautions weakens the immune system is a “totally undesirable assumption,” Patel said.
Another interpretation is that Covid itself has weakened the immune system, making other infections more severe. But there is no indication of permanent damage to the immune system, as can be seen with viruses like HIV. “I haven’t seen any evidence of that,” Kline said.
Several viral infections, including measles, are able to temporarily suppress immune responses, and more research into possible post-Covid complications needs to be done, experts have said. Some immunological dysfunctions can persist for months after mild or moderate Covid infections, study finds. Another recent study found that babies seemed to have worse episodes with RSV soon after a Covid infection.
“We see Covid affecting every organ system in your body,” Patel said. “Most of the children at this stage have had Covid, which unfortunately could have also weakened their immune system. But it’s too early to tell.”
It is also possible that a more severe variant of RSV is circulating in some communities.
But it could just be the large number of infections causing the strain.
The pediatric push was compared to the Covid crisis of March 2020 which threatened to paralyze hospitals. And this is happening on top of an existing health crisis, with years of health worker shortages, disease and burnout.
Yet some of these dangerous viruses can be prevented by vaccination, and all could be mitigated by measures such as improving air quality and wearing masks.
The International Epidemiological Association called last week for global vaccination of children against Covid-19 amid staggeringly low vaccination rates for children. The flu vaccine was also little used.
Although there is no vaccine against RSV, there are monoclonal antibodies that are extremely effective in preventing RSV hospitalization in infants at risk, including premature babies – but many parents do not. still don’t know and getting approval from insurance companies can take time.
The children most vulnerable to the worst outcomes are also too young to get flu and Covid shots, and they are too young to wear masks.
This means that other precautions must also be taken by everyone around them.
Masks, for example, have been shown to be very effective in preventing respiratory viruses. “Masks will help prevent transmission of these other respiratory viruses in the same way masks prevent transmission of Covid-19,” Kline said.
Schools and daycares should also invest in better ventilation and air filtration to remove many pathogens — including respiratory viruses and allergens — from the air, he said.
And staying home when you’re sick is one of the most effective ways to reduce transmission. Even illnesses that seem mild in older children and adults can be devastating for young children.
“If your child is sick, please don’t send him to school, please don’t take him to family gatherings,” Kline said. “Keep them at home.”
After a week in the hospital, RH’s son had improved considerably, although he still had a persistent cough a few weeks later. He has already been vaccinated against the flu, and then he is vaccinated against the Covid.
RH is now on a mission to let other parents know how dangerous these viruses can be for children. He took a fact sheet on bronchial disease that a doctor had given him and “just passed it on to everyone I knew who had a child under the age of two or who was pregnant,” he said. -he declares. “I had to be like, ‘Read this.'”
RH urges families to be careful this holiday season, limit gatherings, take precautions and avoid travel.
Even when you can access care, watching your child battle disease in a hospital bed is nerve-wracking, RH said. “Any hospital stay is going to be quite traumatic – mentally, physically, financially. So take all of that into account when making your vacation decisions.
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