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Children's hospitals reaching capacity, call for national health emergency due to RSV surge

Infants 6 months and younger are getting hospitalized at seven times the rate in 2018, according to CDC data.

WASHINGTON, D.C., USA — The Children's Hospital Association and the American Academy of Pediatrics wrote President Joe Biden and Health Secretary Xavier Becerra a letter warning them of "unprecedented levels" of RSV and flu hospitalizations pushing hospitals to the limit.

Children younger than 6 months get hospitalized with RSV at seven times the usual rates observed in years previous as well as flu hospitalizations at a decade high, more than three-fourths of pediatric hospital beds are filled.

Seventeen states report that more than 80% of beds are occupied, while children's hospitals in Arizona, Maine, Rhode Island, Utah and more are almost at capacity.

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If Biden declares an emergency, it would provide hospitals with the flexibility they need to free up bed capacity and staffing to help care for the patients, Children's Hospital Association CEO Mark Wietecha and AAP CEO Mark Del Monte told Biden and Becerra wrote in the letter.

They suggested the president should declare an emergency under the Stafford Act of the National Emergencies Act and the health secretary should declare a public health emergency.

RSV hospitalizations have gone up while staffing in hospitals continues to fall short. Many healthcare workers either retired or switched careers due to burnout acquired from the pandemic. 

The American College of Emergency Physicians also wrote a letter to Biden earlier this month warning that emergency departments are at the "breaking point" as the number of patients in need of care exceeds the staff available to provide it.

Oregon was the first state to declare an emergency due to the RSV surge.

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Oregon's pediatric hospitalization rate has increased more than threefold since late October, according to the governor's office.

Dawn O'Connell, the assistant secretary for preparedness and response, said federal health teams and medical supplies are available for states in a national stockpile when needed, but that no state has requested that level of support yet. 

Additionally, there is no vaccine for RSV. 

According to the CDC, about 171 of every 100,000 infants younger than 6 months were hospitalized with RSV for the week ending Nov. 12.

This is in combination with the flu, where hospitals are seeing 10 out of every 100,000 kids younger than 5 in a bed. These numbers are double the overall current national rate.

Five kids have died of the flu so far this season, CDC reports.

This surge is largely due to the public abandoning the public health measure implemented during the height of COVID-19 which helped to suppress these viruses as well, according to Dr. Jose Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases. 

Because of these safety precautions, many children didn't get infected with RSV over the past two years, Romero said. But, as a consequence, these children did not develop any immunity and are catching the virus for the first time. 

The first infection tends to be more severe. 

While RSV is a common respiratory virus that almost all children catch by age 2, it can be dangerous for infants 6 months and younger as well as school-age children with weak immune systems. 

RSV is the leading cause of hospitalization for infants in the U.S., according to the CDC. 

About 2% of all infants are hospitalized with RSV and 79% hospitalized under age 2 have no underlying medical conditions. 

This is because RSV causes inflammation and congestion in the lower airways of the lungs, called bronchiolitis. These airways are smaller in infants, and the inflammation makes it harder for them to breathe. They need oxygen support to treat this, as well as IV fluids because they are dehydrated or not feeding well. 

“We are breaking census records for the history of the hospital every day. It’s unprecedented,” Dr. Sean O'Leary, pediatrician and the vice chair of AAP's infectious disease committee, said. 

On days the hospital is full, children have to be held in the emergency room until an inpatient bed opens up. 

More than 80% of the beds at Children’s Healthcare Atlanta have been full for the past several months, said Dr. Andi Shane, head of epidemiology at the hospital. Then more children started falling with the flu in early October as RSV cases started to decline, she said.

“We had COVID, then we have RSV, then we have influenza,” Shane said. “So basically four months with no break and many, many children needing emergency room care, needing urgent care, needing hospitalizations. It’s been very challenging just to keep up with all those children.”  

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Flu activity is highest in Alabama, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and Washington, D.C., according to the CDC.

In the Southeast, influenza A H3N2 strain appears to be the most common right now. This strain is associated with more severe illness in the elderly and young children, Romero said.

Lastly, almost all the children hospitalized with the flu at Children's Healthcare Atlanta have not received their flu vaccine, but because the virus came early this year, most parents didn't have time to get it administered.

“We usually say get your flu vaccine by Halloween. Well by Halloween, we were having lots and lots and lots of flu here in Georgia,” Shane said. 

Public health officials are encouraging people to get the vaccine, stay home when sick, avoid close contact with sick people, cover coughs and sneezes and wash their hands frequently. Those who want to take extra precautions can wear a mask in public as well. 

Romero said parents should seek immediate medical attention for their children if they notice their child has trouble breathing, blue-ish lips or face, chest or muscle pain, dehydration (such as dry mouth, crying without tears, or not urinating for several hours), or not being alert or interactive while awake. 

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