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November 8, 2022

'Crisis mode': RSV surge overwhelming pediatric hospitals

Daily Briefing

    Respiratory syncytial virus (RSV) is currently surging across the United States, especially in young children, and pediatric hospitals are in "crisis mode" as they struggle to care for a growing number of patients.

    RSV is surging across the US

    Alongside Covid-19 and flu, RSV cases are also growing across the United States, especially as the weather gets colder. "With increased RSV infections, a rising number of flu cases and the ongoing burden of covid-19 in our communities, there's no doubt we will face some challenges this winter," said Dawn O'Connell, assistant HHS secretary for preparedness and response.

    RSV is a common and typically mild illness, but it can lead to pneumonia and bronchiolitis in young children and can be life-threatening to infants and young adults. Because of the pandemic, many children were not exposed to RSV until now, meaning that their immune systems do not have protection against the virus.

    "We had RSV last year, but it wasn't to the level this year, partially because we were still doing some of the mitigation efforts around masking and people were still staying away," said Jason Newland, a pediatric infectious diseases specialist at Washington University in St. Louis.

    Now, "[we're] seeing older patients that are being admitted with RSV because they've just never seen it before," Newland said. "And your first illness is usually the worse and it's leading to some more people being hospitalized."

    According to CDC data, RSV cases are rising in eight out of 10 HHS regions, with Midwestern states, including Minnesota, Nebraska, Missouri, and Wisconsin, seeing the highest positivity rates. Currently, pediatric hospitals across the country are struggling to keep up as RSV cases continue to rise.

    Andrew Pavia, chief of the Division of Pediatric Infectious Diseases at the University of Utah, said, "There are regions in which the pediatric health care system is really overwhelmed and there are no ICU beds for children throughout the entire region. And that's happening right now in the Midwest where people are reaching across two or three states to find an ICU bed."

    Elizabeth Meade, medical director of quality for pediatrics at Providence Swedish in Seattle, said the hospital's inpatient pediatric units are currently at capacity, and between 50% and 75% of all pediatric patients are being treated for RSV.

    Similarly, Connecticut Children's Hospital has been operating over capacity for the last few weeks due to a surge in RSV patients. The hospital is currently in talks with the National Guard and the Federal Emergency Management Agency about setting up a tent outside to care for more patients.

    "Pediatric hospitals are in crisis mode right now," said Lisa O'Connor, senior managing director at FTI Consulting. "They are pulling out emergency preparedness policies and activating everything functionally possible from a policy and regulatory standpoint."

    How to support pediatric hospitals through future crises

    According to policy experts, health care providers, as well as the government, should invest in pediatric care to boost capacity and prevent future crises.

    For example, Daniel Rauch, a pediatrics professor at Tufts University and chair of the committee on hospital care for the American Academy of Pediatrics, suggested CMS codify the more relaxed telehealth rules that emerged during the pandemic, such as not requiring providers to be licensed in the same states as their patients.

    He also recommended Congress lift caps on graduate medical education payments for teaching hospitals and that federal and state governments increase pediatric Medicaid reimbursement rates to match Medicare rates.

    "It has been a perfect storm," Rauch said. "If most smaller and safety-net hospitals are, at best, breaking even on Medicaid, they can't afford to keep pediatric beds open."

    Separately, Bob Garrett, CEO of Hackensack Meridian Health, said facility waivers enacted during the pandemic should be extended to allow hospitals to convert space that isn't typically used for patient care when needed.

    In addition, Garrett said adding more graduate medical education slots for pediatrics and pediatric psychology students would help increase the number of specialists in the long term.

    "Anytime you are looking for a pediatric specialist, the pool of candidates narrows," said Carrie Kroll, VP of advocacy, public policy, and political strategy at the Texas Hospital Association (THA). "The only real way to flip the boat around is to put more people into the workforce."

    According to Kroll, over 15,000 qualified applicants were turned away from Texas nursing schools last year due to insufficient resources. Currently, THA is developing a $65.5 million legislative proposal to increase nursing school capacity, fund training programs to replace retiring professors, and increase loan repayments.

    "Pediatric care in general is not as profitable as adult care," said Larry Kociolek, medical director of infection prevention and control at Lurie Children's Hospital of Chicago. "Hospitals are businesses and hospitals need a margin to stay open, and so hospitals are making business decisions about how to staff those beds in order for them to be able to recoup the costs of providing healthcare." (Choi, The Hill, 11/4; Hudson, Modern Healthcare, 11/4; Nirappil, Washington Post, 11/4)

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