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While respiratory viruses surge, shortage of pediatric hospital beds delays care for some kids

<i>Katie McKoy</i><br/>Hospitals across the country say they are being overwhelmed by an early surge in respiratory infections including RSV
Katie McKoy
Hospitals across the country say they are being overwhelmed by an early surge in respiratory infections including RSV

By Brenda Goodman, CNN

Parents who need to take a child to the emergency room are facing agonizing waits in many parts of the United States because of a shortage of hospital beds.

Hospitals across the country say they are being overwhelmed by an early surge in respiratory infections including RSV, influenza and enterovirus. As a result, pediatric hospital beds are more full now than they have been in the past two years, according to a CNN analysis of data from the US Department of Health and Human Services.

This crush of young patients filling hospitals now means those with less urgent illnesses may face long waits and sometimes days-long stays in the ER while they wait to be admitted. It also means kids who need cancer treatment or surgery may be sent home to wait until hospitals have beds.

Pediatric beds are so full in San Antonio that Elena Mikalsen drove her 17-year-old daughter to an emergency room 45 minutes away in the hopes that she could be seen more quickly there. She knew hospitals closer to home were already full.

Her daughter hasn’t been able to eat or drink since Thursday because of a sharp pain in her abdomen that gets worse after she eats. Last week, she began vomiting and having chills.

After blood tests and an ultrasound in the ER, doctors determined that she needed to have her gallbladder removed. It was full of gallstones.

“What’s happened with my daughter is, she should have been admitted last night, as someone who can’t eat or drink and is in pain and is a child,” Mikalsen said Monday.

Normally in a case like this, the hospital would put the person on the surgery schedule and keep her hydrated and comfortable until the procedure. But there aren’t any available beds, so her daughter is waiting at home.

Mikalsen knows this process intimately because in addition to being a worried mom, she works in health care.

She asked CNN not to name her employer because she wasn’t authorized to speak on their behalf. She also asked not to use her daughter’s name to protect her privacy.

“We don’t want to take a bed away from a baby, because that’s what’s really happening right now,” Mikalsen said. “Very little ones coming in who are suffocating, so they need all the beds.”

For now, her daughter is resting at home and taking medication to relieve the pain.

There are risks involved with delaying the surgery. Gallstones can block the the tiny tubes that carry the digestive juices that are made by the gallbladder to the small intestine. That may lead to an swelling, intense pain and an infection, which can trigger sepsis.

“It is nerve-wracking,” Mikalsen said. “We had the surgeon on the phone last night and the doctor. They ran all kinds of tests on her in the ER and they were like, ‘well, she’s not dying. We’re not going to prioritize a bed for her.’ “

Mikalsen even tried to get her daughter an adult bed at local hospitals, but they were told she still needs pediatric care. She has a list of symptoms to keep an eye on — signs that her daughter’s condition could be worsening. And they have an upcoming appointment to see a doctor for a consultation, but no promise of upcoming surgery.

“My instructions are strict bed rest, no food, just fluids and pain medication, so that’s what we have to do. She misses school and I miss work until we get this figured out,” Mikalsen said.

Unprecedented numbers of cases

Texas isn’t the only state being impacted. A spokesperson for Hasbro Children’s Hospital in Rhode Island told CNN the hospital is at 125% capacity and has been having issues with bed space for about a month.

Seattle Children’s Hospital says it is seeing double the number patients they would normally see in October. On any given day, for most of the day, it’s at about 200% of its physical capacity in the emergency department.

“RSV is on the rise, and last week 30% of respiratory viral tests in Seattle Children’s Emergency Department were positive for RSV. In the past, when we’ve reached 30-40% positivity, we are at peak, which typically lasts for 2 months,” said Emergency Services Dr. Russell Migita, in a statement to CNN.

The Illinois Department of Health alerted hospital systems in the state that they are running out of pediatric intensive care beds. As of Friday, just 6% of the 289 PICU beds remained open statewide.

“That’s actually an optimistic number,” says Dr. Deanna Behrens, a pediatric critical care specialist at a children’s hospital in Chicago. She asked that CNN not identify the hospital because she didn’t have permission from her employer to talk about the shortage.

Behrens says that 289 refers to the number of licensed intensive care beds available, but because of staff shortages, hospitals may not have enough nurses to keep that many beds open for patients.

“It’s like nothing that I’ve ever seen before in the decade that I’ve been doing this in terms of the amount of kids that we have with all these respiratory illnesses,” she said. “The number of kids we are seeing is very unusual.”

Behrens says her hospital has sent children as far as St. Louis for intensive care when it didn’t have available beds.

It’s the same story in Minneapolis.

“Our total ER volumes are the highest they’ve ever been in our emergency department right now. So our overall number of patients per day,” said Dr. Marissa Hendrickson, a pediatric emergency medicine physician at M Health Fairview Masonic Children’s Hospital in Minneapolis.

Nearly all the kids seen there are sick with respiratory viruses, especially RSV.

“We still do our best to get people who are more ill and need more immediate attention back to rooms as quickly as possible,” Hendrickson said. “But sometimes, when things are busy enough, we aren’t even able to do that.

“And then we ended up caring for people in non-traditional spaces like hallways or trying to start their care actually physically in the waiting room. So we’re squeezing people in as best we can,” she said.

‘These hospitals are overwhelmed’

In Atlanta, Katie McKoy says she recently waited nearly three weeks to get cancer scans for her 14-year-old son, Matthew, who goes by Mattie.

Mattie has a rare genetic condition called spinal variant neurofibromatosis type one, which causes tumors to grow on his spinal cord and compress his nerves. Because of where they’re growing, the tumors have paralyzed his diaphragm, the muscle that sits underneath the rib cage and controls breathing. He breathes with the help of a tube in his windpipe and machines.

Mattie’s condition will shorten his life, but McKoy says he could live five or 10 more years with good care. He takes an oral chemotherapy drug to slow the growth of his tumors and to space out his surgeries.

When he recently got weaker, his doctors decided it was time for another round of scans.

“We’re using these scans to decide, when is it time for hospice? When is it time for surgery? And to make those really gut-wrenching decisions,” McKoy said.

Mattie has to be admitted to the hospital when he goes for imaging. He has autism and can’t stay in the machines without sedation. Because his medical needs are so complex, he needs intensive care during each trip.

McKoy said Mattie’s most recent set of scans was originally scheduled for September 26, but that appointment was canceled for lack of space.

Children’s Healthcare of Atlanta has been using surge tents for emergency room overflow since August, when respiratory illnesses began an out-of-season climb. Children’s says the tents are for mild injury and illness, not only RSV patients. Wait times in the emergency department vary through the day but average around three hours or more.

The doctors started making calls and eventually secured a spot in a hospital bed that would normally have been reserved for someone who needed rehabilitation. The McKoys took it because nursing coverage was better for those beds, but it wasn’t the same level of attention he would have gotten in the intensive care unit.

Mattie finally got his scans on October 18.

Alhough his family says they are grateful for the incredible medical team at Children’s, the level of care he needs is very difficult to get right now.

“Other pediatric hospitals are in just as bad of a situation. It’s a nationwide crisis,” McKoy said. “These hospitals are overwhelmed.”

Allyson Wright, a spokesperson for Children’s Healthcare of Atlanta, said that because of patient privacy laws, the hospital can’t comment on the specifics of this case, and “decisions about transferring patients are reassessed daily both within Children’s and with our partner hospitals as needed to ensure that care is provided expeditiously and safely.

If Mattie’s health suddenly declines, his mom says, she’ll have no choice but to take him to the emergency room for care. His immunity is low because of his underlying health conditions and his cancer treatment, so if he catches an infection while waiting in the ER, it could kill him.

“Honestly, I’m terrified,” McKoy said. “I’m afraid of him dying this flu season because he gets sick and the infrastructure of the hospital system in general isn’t able to care for him because there are so many other sick kids and there’s no bed available for him. That’s my deepest fear.”

What parents can do

To make the most of hospital capacity for kids, public health officials are urging parents to protect their children from respiratory infections by making sure children have recently been vaccinated against Covid-19 and influenza and being cautious to prevent sharing germs.

Doctors who care for kids in the hospital ask parents to seek out their pediatrician, when possible, before heading to a packed ER.

Some children shouldn’t wait. Respiratory symptoms that require urgent medical attention include fast or labored breathing. In a baby, that might mean that their nostrils flare with every breath, or their head may bob as they try to breathe.

“When children are having trouble breathing, they pull in the muscles so that you can see their ribs outline with every breath or you can see their stomach sucking in and out in a way that it doesn’t normally do. Or the muscles in the neck and that go up by their shoulders over the collarbone can pull in with their breath,” said Hendrickson, the pediatric emergency medicine physician in Minneapolis.

“The other thing would be to watch for dehydration. So sometimes, little kids — even a baby with a stuffy nose — can sometimes have trouble drinking. It’s hard to drink a bottle if your nose is stuffy. And so sometimes, they just sort of give up, and they don’t drink enough,” she said.

It’s OK if they’re not eating, she said, as long as they’re still getting enough fluids. Keep an eye on the number of wet diapers a baby has every day.

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