On November 10, 2022, experts from Mass General for Children (MGfC) gathered on the Bulfinch lawn at Massachusetts General Hospital to share insight into an unprecedented capacity crisis, especially for pediatric patients admitted for respiratory syncytial virus (RSV) and other respiratory illnesses.
RSV is a common illness that affects the airways and is usually most prevalent in December and January every year. In older children and teens, symptoms are often mild and similar to a cold. In babies and younger children, RSV can lead to inflammation of the small airways, creating a condition called bronchiolitis, that may require hospitalization.
For the past several weeks, MGfC’s main campus has been operating beyond full capacity with staffing shortages, longer emergency department (ED) and admission wait times and no available beds in pediatric inpatient wards, the Pediatric Intensive Care Unit (PICU) and the Neonatal Intensive Care Unit (NICU). MGfC community locations have been experiencing a surge in RSV and other respiratory illnesses and struggling to transfer patients in need of admission. Much of the challenge is resulting from other viruses that are also circulating that can also cause breathing difficulties, including rhinovirus, enterovirus, COVID-19, adenovirus, parainfluenza and, most recently, influenza (flu).
There were 2000 cases of RSV seen throughout MGfC in October, including 250 admissions to the hospital. About 10% of admissions were sent to the PICU, which has 14 beds. “During the first week of November, there were 1000 cases of RSV,” said Brian Cummings, MD, medical director and vice chair of MGfC and attending physician in the PICU at MGfC. “Most were seen at our urgent care facilities and Emergency Department and discharged home.”
MGfC has implemented several measures to cope with the case surge and shortages in beds and staffing, including following regulations from the Massachusetts Department of Public Health (MDPH) to admit patients 15 years and older to adult units and setting up high-flow nasal canula protocols, a form of oxygen support. The NICU at MGfC is also admitting older infants to be cared for there. Providers and staff from across the hospital meet daily to review procedural volume to see if they can meet the needs of patients who need post-surgical care, as well as general capacity, available staff and supplies. Due to lack of beds, some surgeries have been cancelled.
There have also been challenges with discharging patients to long-term care facilities, behavioral and mental health resources and overcrowded EDs, said Paul Biddinger, MD, chief of Emergency Preparedness and director of the Center for Disaster Medicine at Mass General. “This is very different from what we saw at the beginning of the pandemic in March 2020 where we had a busy health care system, but one that didn’t have the high levels of crowding that we see today,” said Biddinger.
This year, most cases of RSV and other respiratory illnesses are in children who have not previously been exposed to those viruses, especially when social distancing and wearing a mask were part of daily life during the pandemic. “For these children, their immune systems are responding exactly as we expected,” said Alexy Arauz-Boudreau, MD, MPH, associate chief of Pediatrics at MGfC and the MGfC medical director for Population Health Management at MGB.
Children are affected by various respiratory illnesses every year, and most will be fine, said Boudreau. “What’s important is that we monitor them. We see how they’re breathing, how they’re playing, and if we start to get concerned that they’re tired at rest, struggling to breathe or not drinking fluids, that’s when you call your pediatric office,” she said. “For the most part, we can manage it by staying home, resting, drinking fluids and controlling fever.”
It is also recommended that everyone who is eligible for a COVID-19 vaccine or flu vaccine to get one. “It is possible to have more than one respiratory infection at the same time,” said Vandana Madhavan, MD, MPH, clinical director of Pediatric Infectious Disease and Immunodeficiencies at MGfC.
In the coming weeks or months, health care experts expect RSV cases to wane just as cases of the flu start to rise. “Influenza is rapidly rising to the south of us and will be moving into New England pretty soon,” said Biddinger.
Kimberly Whalen, RN, MSN, CCRN, nurse director of the Pediatric Critical Care Medicine/PICU at MGfC, was also present at the press conference while Boudreau also responded to questions in Spanish.