Fast-spreading viral infections have pushed pediatric hospitalizations and daily emergency room visits to record highs in Orange County, prompting authorities to declare a health emergency.
The county, like the rest of California, is facing a viral triple whammy: continued circulation of the coronavirus, seasonal increase in influenza, and increased spread of respiratory syncytial virus, or RSV, a respiratory disease that can be dangerous for young children. .
Children’s hospitals can quickly become strained when viruses increase, as relatively few beds are available to begin with. Orange County, for example, has only two hospitals dedicated to child care, and both are “operating at or beyond their capacity to support pediatric care.” [patients] with a respiratory illness,” county health officer Dr. Regina Chinsio-Kwong said Tuesday.
Issuing an emergency declaration – which Chinsio-Kwong did on Monday evening – offers the government the option of requiring hospitals that do not usually treat children “to take care of them if and when we need it,” she said. This flexibility could prove useful in the coming months, when many officials expect the coronavirus and the flu to become more active.
“I’m concerned about what the future holds,” Chinsio-Kwong said. If influenza and RSV cases increase simultaneously, “we are in trouble. And generally, these two viruses affect our young children. And there are only a limited number of beds in a pediatric hospital to care for very sick people.
Children’s Health of Orange County, which operates a main hospital in Orange and a smaller facility in Mission Viejo, is experiencing “unprecedented volumes,” both in inpatient units and in the emergency room, for all reasons, according to Melanie. Patterson, vice president of patient care services and chief nursing officer.
At the CHOC hospital in Orange, more than 400 pediatric patients are seen every day in the emergency room. About 15% of children seen in the emergency room are admitted.
On Tuesday, there were 285 patients admitted to the 334-bed CHOC hospital in Orange; a year ago, there were 188.
“So that’s a gigantic increase for us,” Patterson said.
At CHOC’s 54-bed Mission Viejo Hospital, 43 patients were admitted on Tuesday, up from 28 on the same day a year ago.
Other California hospitals are also reporting that an early season RSV surge is getting worse. Dr. Daisy Dodd, pediatric infectious disease specialist for Kaiser Permanente in Orange County, said “the influx has been large and it has been much earlier” than usual, although the health care system health continues to be able to meet demand.
So far, Los Angeles County public health officials said they haven’t seen any major increases in pediatric hospital bed occupancy.
Still, some hospitals report being very busy. Dr. James Stein, chief medical officer at Children’s Hospital Los Angeles, said in a statement that the facility was able to admit children from its emergency room. But the emergency department is so busy and its available capacity is so large that the ACCH cannot always accept transfers from other hospitals.
Children are increasingly testing positive for RSV at the Los Angeles hospital, with a positivity rate of 38%, up from 31% the previous week. Both figures exceed the peak of all of last winter, which was 24%, according to Marisa Glucoft, the hospital’s executive director for quality and safety.
Dr. Christina Ghaly, director of LA County’s Department of Health Services, said many hospitals don’t have large numbers of pediatric beds, which means even small increases can have a major impact.
For example, if a hospital has 12 pediatric intensive care beds and six are already occupied, she said, “you can very quickly reach 100% capacity just by admitting six patients. And then, based on their rotation and how long they’ve been in the hospital, you can see how quickly you find yourself in a tight spot.
“Fortunately, at the moment we don’t have a serious problem, but realize how quickly this can change,” she told the County Supervisory Board on Tuesday.
RSV is highly transmissible, but for generally healthy adults and older children, it is more of a nuisance than a serious threat. However, babies are particularly vulnerable because the virus attacks the very small airways that lead to their lungs, causing inflammation.
Heavy production of mucus can block the airways. While adults and older children may just cough, babies may need extra help with breathing. Those most at risk are newborns and infants in their first year of life, especially those younger than 6 months.
Premature infants, babies with underlying heart disease or chronic lung problems, and children with weakened immune systems are also at higher risk, as are the elderly.
Specific warning signs that a baby needs urgent medical attention include:
- breathing faster than normal, with their chest folding inward and their nostrils dilated
- dehydration, including to the point of crying but not shedding tears
- not producing a wet diaper within seven or eight hours
- refuse to eat
- turning blue around the mouth due to lack of oxygen
For children 3 or 4 years old, warning signs may include wheezing and rapid breathing. Critically ill children may need oxygen or other support in a hospital to help them breathe, including being put on a ventilator.
“It’s not just the little kids. We have 5, 6 year olds in the hospital right now,” Dodd said.
Each year, approximately 58,000 children under the age of 5 are hospitalized with RSV nationwide, resulting in 100 to 500 deaths. Among people aged 65 and over, an estimated 177,000 are hospitalized each year, with 14,000 deaths.
“Our best shot at protecting ourselves and our children from respiratory disease continues to be the same things we have practiced throughout the pandemic, including using masks indoors around others and stay home when you’re sick,” Chinsio-Kwong said.
RSV is hitting many parts of the country particularly hard, perhaps because transmission has been relatively latent for two years and many young children have low immunity to the virus. Dr. Ashish Jha, the White House’s COVID-19 response coordinator, estimated last week that about 90% of children end up contracting RSV at least once by age 2. But “because of the pandemic, some of the standard pattern types have been disrupted, so we’re seeing a lot of RSV at once,” he said.
The percentage of respiratory samples testing positive for RSV in LA County is also at its highest level in the past five years. About 12% of samples test positive for RSV, up from about 6% to 7% last October and less than 1% in the previous three October months.
In children under 5, 7% of emergency room visits are related to RSV or acute bronchiolitis, swelling of the airways usually caused by RSV. That’s higher than at any time in the past three years.
“As with influenza, we cannot predict whether this is an early peak or the start of a severe season. But we do know RSV activity is unusually high for this time of year. and warrants caution,” Ferrer said.
A “triple whammy from the three viruses circulating at once could strain the already overstretched medical system,” San Diego County health officials wrote in a statement late last week.
“As we see a sharp increase in influenza and RSV cases, I urge San Diegans to do their part to prevent the spread of disease,” said county public health officer Dr. Wilma Wooten. “Although there is no vaccine for RSV, many vaccines are available for influenza and COVID-19.”
Either way, Wooten noted that the vaccines “take two weeks to become fully effective, so people should get both shots as soon as possible.”