RSV spurs plea for federal support
Pediatricians beg for more help to fight wave of virus
WASHINGTON » After two winters spent masked and 6 feet apart, pediatric respiratory viruses have returned with a vengeance, and pediatric hospitals, emergencyroom doctors and pediatricians are lobbying Congress and the Biden administration to provide more support.
Pediatric hospitals deal with a wave of respiratory syncytial virus, also known as RSV, every year. But this year, the wave of RSV is more like a tsunami, because COVID-19 mitigation measures have driven down immunity among many children.
For most children, RSV is mild and does not require hospitalization, but it can be severe, especially in infants and toddlers. There is no vaccine.
“This is our March 2020. This truly is an overwhelming wave,” said Daniel Rauch, chair of the American Academy of Pediatrics Committee on Hospital Care, of the current surge of respiratory illnesses.
Coupled with an earlierthan-usual flu season and a cold-weather uptick in COVID-19 cases, the RSV outbreak has children’s hospitals on the brink. Pediatric hospitals are seeing the highest influenza hospitalization rate going back a decade, said Jose Romero, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases.
Across the United States, hospitals have run out of room as pediatricians pull long hours and face burnout, with many states reporting more than 90% of pediatric beds occupied.
Virus trifecta
This week, the Children’s Hospital Association and the American Academy of Pediatrics asked the Biden administration to declare a public-health emergency to respond to the respiratory virus trifecta: RSV, flu and COVID-19.
The pediatric care organizations argue that significant capacity issues in hospitals can only be solved by a federal emergency declaration from the White House and Health and Human Services secretary, like the ongoing COVID-19 public health emergency.
An emergency declaration would allow for more telehealth flexibilities and waive certain Medicare, Medicaid and Children’s Health Insurance Program requirements that make it difficult for providers to share resources.
“We also hope that an emergency declaration will galvanize federal response,” American Academy of Pediatrics CEO and Executive Vice President Mark Del Monte and Children’s Hospital Association CEO Mark Wietecha wrote in the letter to President Joe Biden and HHS Secretary Xavier Becerra.
Emergency departments are overwhelmed and gridlocked with patients waiting for admission, waiting to be seen, or waiting for a bed, that it is nearly impossible to function, the American College of Emergency Physicians said in a Nov. 7 letter to the White House.
The term for admitted patients being held in the emergency department when no inpatient bed is available is known as “boarding,” and it is worse than it has ever been, ACEP says, because of the “triple threat” of flu, COVID-19 and pediatric RSV.
“Patients with nowhere else to go are being held in emergency departments for days, weeks, or even months in some cases. Boarding is straining our system, accelerating emergency physician burnout, and putting patients’ lives at risk,” ACEP President Christopher S. Kang said in a press release.
During the early days of the COVID-19 pandemic, doctors of all medical specialties helped staff COVID-19 units and treat patients in overflowing emergency departments. But it is not as easy for pediatric RSV, said Aaron Glatt, chief epidemiologist at Mount Sinai South Nassau, because pediatricians are a smaller group with more specialized training.
Existing physicians need to be cross-trained to treat young children.
“In pediatrics, one of our sayings is that kids are not small adults. And it’s very hard if you’re used to taking care of adults to take care of a 2-month-old or even a 2-year-old,” Rauch said.