Pediatric respiratory cases, flu strain Pacific NW hospitals

By CLAIRE RUSH
Associated Press/Report for America

PORTLAND, Ore. (AP) — Children's hospitals in the Pacific Northwest are struggling to maintain enough space for their young patients, and some report being over capacity amid increasing strain due to a surge in respiratory illness and hospitalizations.

At the same time, the Seattle area's first pediatric death from flu since the 2019-2020 season was reported Wednesday.

There has been a nationwide surge in a common respiratory illness known as RSV, which can cause severe breathing problems for babies. RSV cases fell dramatically two years ago as the COVID-19 pandemic shut down schools, day cares and businesses.

Two hospitals in Oregon that account for much of the state's pediatric intensive care capacity have moved to crisis standards of care. The state government standards provide guidelines for hospitals on how to provide care in cases of limited resources.

Both in Portland, the two hospitals are Doernbecher Children’s Hospital at Oregon Health & Science University and Randall Children’s Hospital at Legacy Emanuel.

Cindy Hill, vice president and chief nursing officer at Randall Children’s Hospital, described the decision as “heart-wrenching.”

“We are implementing safe solutions to meet the community demand for pediatric beds, including pulling staff to work extra shifts," she said in a news release. “To create capacity, we’ve postponed some non-urgent pediatric procedures and will continue to use creative staffing options to ensure we can provide the best possible care through this crisis.”

The two hospitals’ decision to move to crisis standards of care came the week after Oregon Gov. Kate Brown declared a state of emergency due to increasing hospitalizations among children.

Similar challenges are burdening hospitals in neighboring Washington state.

Health authorities there said an elementary-school-aged child died from flu complications on Nov. 13 in King County, which is home to Seattle, according to the county's public health agency.

“It’s tragic to lose a child to illness, and our hearts go out to this child’s family and loved ones,” said Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County. “This death comes on top of a steep and unprecedented rise in illnesses and hospitalizations in King County and nationally among children for infections caused by multiple respiratory viruses.”

Duchin said the infection and hospitalization trends will likely continue in the coming weeks.

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Claire Rush is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues. Follow Claire on Twitter @ClaireARush

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Health experts ask people to take action to lower risk for children as RSV, flu cases push hospitals to brink

Health officials issue call to action to protect kids ahead of post-holiday surge in serious respiratory illnesses that will worsen pediatric ICU bed shortages

PORTLAND, Ore. – State health officials are asking people to take immediate, urgent action to protect children and ensure there are pediatric intensive care beds available in Oregon hospitals to treat any child or youth with a serious illness or injury. Oregon health officials expect respiratory syncytial virus (RSV) cases to peak after the Thanksgiving holiday, which will further strain pediatric hospital intensive care units in the Portland area that are already at their limit.

In response to Oregon’s acute shortage of pediatric intensive care beds, state health officials recommend that people:

• Stay home when sick.
• Cover coughs and sneezes with the inside of your elbow, or with a tissue that you immediately throw away after use.
• Clean and disinfect all high-touch surfaces, including doorknobs, faucets, chairs, countertops and tables.
• Regularly wash hands with soap and water or use hand sanitizer, especially after coughing or sneezing into a tissue.
• Get a flu shot and stay up to date on COVID-19 vaccinations, including new bivalent boosters. There is no vaccine for RSV.
• Consider wearing a mask in crowded indoor spaces.

The recommendations come as at least two Portland-area hospitals – Doernbecher Children’s Hospital at Oregon Health & Science University and Randall Children’s Hospital at Legacy Emanuel Medical Center – notified OHA they have enacted crisis standards of care for their pediatric intensive care units. Crisis care standards allow hospitals to adjust their staffing to help treat as many critically ill children in the state as possible.

Patrick Allen, Oregon Health Authority (OHA) said, “Oregon children’s hospitals are pushed to the limit. If you have young children and they get sick, there may not be a hospital bed for them. Our recommendations are a call to action for Oregonians to help slow the spread of respiratory disease and make sure no child’s life is put at risk because every pediatric ICU bed in our state is full with another seriously ill kid.”

“Multiple respiratory infections circulating in our community are of great concern to all of us in health care, says Providence St. Vincent Medical Center’s Genevieve Buser, MDCM, a pediatric infectious disease specialist. “Children have been especially hard hit, and we are caring for unprecedented numbers of very sick young people in our hospitals, immediate care facilities, and clinics. Right now, more than half of our kids sick enough to be hospitalized have RSV (respiratory syncytial virus), and almost all of those are babies less than 6 months of age. It causes babies to need oxygen to breathe, and even stop breathing.”

Dr. Buser added that since the Oregon region is in a crisis for critical pediatric hospital beds, “we should do what we can as a community to slow transmission to our most vulnerable neighbors,” including getting COVID and flu vaccinations. “Older adults, too--especially those with chronic lung disease--can become very ill with RSV, in addition to COVID and flu.”

State health officials are working with hospitals to bring additional nurses into Oregon from out of state. OHA officials also are pursuing health care volunteers through Serv-OR, the state’s emergency volunteer registry. In addition, OHA is providing hospitals with recent legislatively appropriated funds to aid staffing.

Parents of children younger than 5, especially newborns to 6-month-olds, are especially advised to take precautions that keep their children safe and help to limit the spread of RSV and influenza in coming weeks. Young children, as well as older adults – people 65 and older – are at higher risk of severe illness from these respiratory viruses, including hospitalization and death.

Data showing that the RSV hospitalization rate for children quadrupled between Oct. 29 and Nov. 19, from 2.7 to 10.8 children per 100,000 population. RSV hospitalizations are expected to rise further over the next few weeks.

Hospitalizations are also being fueled by a rapid increase in influenza cases around the state. According to OHA’s weekly Flu Bites influenza surveillance report, the percentage of positive influenza tests has doubled each week since mid-October – it was 1% the week ending Oct. 22, 2% on Oct. 29, 4.5% on Nov. 5, 9.3% on Nov. 12 and 16.4% on Nov. 19.

A 5% positivity rate for influenza tests is considered a threshold for significant influenza circulation.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms, such as runny nose, coughing and sneezing. Most infections go away on their own in a week or two. Almost all children will have had an RSV infection by their second birthday.

People experiencing mild RSV symptoms should:

• Stay home from work or school, and avoid indoor and outdoor holiday gatherings and events.
• Manage fever and pain with over-the-counter fever reducers and pain relievers.
• Drink plenty of fluids to prevent dehydration.
• Make sure to talk to your health care provider before giving your child over-the-counter cold medicines which are typically not indicated for this age group.

While cold-like symptoms are more typical of RSV infections, some children can experience severe symptoms requiring immediate care. Parents should call their pediatrician or seek care right away if child has any of the following symptoms:

• Difficulty breathing or increased work of breathing.
• Symptoms of dehydration, or fewer than one wet diaper every eight hours.
• Gray or blue color to tongue, lips or skin.
• Decreased activity and alertness.

Some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection. Call your pediatrician if your child has:

• Symptoms that worsen or do not start to improve after seven days.
• A fever of 100.4°F or higher if they are younger than 3 months old (12 weeks).
• A fever that rises above 104°F repeatedly for a child of any age.
• Poor sleep or fussiness, chest pain, ear tugging or ear drainage.

For more information about RSV, visit OHA’s RSV page. Information about influenza is available at OHA’s Flu Prevention page.