Colorado children’s hospitals, which were largely spared the worst of COVID-19, are now facing their own crush of patients as respiratory syncytial virus and other common bugs return — and the possibility of a severe flu season looms.
Hospitalizations for RSV in Colorado already are higher than their peak in 2021, which came in late December. Since Oct. 1, 292 people have been hospitalized for RSV, and 95% are children, which is “putting a strain” on pediatric units, according to the Colorado Department of Public Health and Environment.
At times, Children’s Hospital Colorado’s pediatric intensive care unit and general inpatient units are at “maximum capacity,” and staff are considering how to best use the available space and beds, spokeswoman Rachael Fowler said Tuesday.
The data only comes from hospitals in Denver, Adams, Arapahoe, Douglas and Jefferson counties. It’s difficult to compare the current hospitalizations to pre-pandemic levels, as only two hospitals reported their RSV numbers before 2020.
Over the summer, hospitalizations started increasing from rhinoviruses and enteroviruses — two families of viruses that typically cause cold-like symptoms, but can lead to complications in younger kids.
Once that started to die down, RSV infections took off, said Dr. Kevin Messacar, an infectious disease specialist at Children’s Hospital Colorado. If a difficult flu season follows that, pediatric hospitals and units will be stretched in the way that adult hospitals were during COVID-19 surges, he said.
“This has kept us extraordinarily busy,” Messacar said. “One wave was just overcome by the next.”
On Friday, the state health department announced it was taking steps to help hospitals coordinate if they continue to see increasing numbers of patients with RSV. It stopped short of reactivating the transfer center used to help find beds for patients during the worst COVID-19 surges.
Children’s Hospital has tried to hire additional staff and encouraged those already working there to take extra shifts, Messacar said. They’re also going through contingency plans, such as how they might ask the state for permission to convert regular beds to provide intensive care, if needed, he said.
Similar conversations are taking place around the country, and about three-quarters of hospital beds for children nationwide are full.
“We are very busy, not just in our hospital, but across the country,” Messacar said.
“We need everyone to do their part”
The state health department also sent a note to health care providers urging them to tell parents to keep their children home when they have respiratory illnesses, to try to slow the spread of viruses. Since the start of October, 42 child care centers and schools statewide have reported RSV outbreaks. (The state stopped publicizing COVID-19 outbreaks in those settings, so it’s difficult to compare how different viruses are spreading there.)
Dr. Eric France, chief medical officer for the state health department, advised parents to consult their child’s primary provider if they develop symptoms like wheezing, poor feeding or dehydration.
“The increase in RSV-related hospitalizations in Colorado in recent weeks is very concerning. Fortunately, there are steps we can take individually through frequently washing your hands, disinfecting hard surfaces and staying home when sick,” he said in a statement. “We have learned a lot about how to respond effectively and coordinate as a state, but we need everyone to do their part.”
For most people, RSV causes a cold, but some younger children develop severe breathing problems, and about 500 die from it in the U.S. in a typical year. Older adults and people with compromised immune systems also can have serious cases, and RSV kills about 14,000 people over 65 in a normal year.
No RSV deaths have been reported this year in Colorado, according to state data.
What’s unusual is the number of kids who are sick now, and that the virus is spreading widely months earlier than it normally would, Messacar said. It’s not clear how much of the increase is because cases were essentially pushed back, with children who would have gotten sick in infancy avoiding exposure for a year or two. That’s not a bad thing, since older children tend to not to become as severely ill, he said.
Another factor is that precautions against COVID-19 meant pregnant women were exposed to fewer viruses, and may have passed fewer antibodies to their babies, Messacar said. That could leave infants more vulnerable to severe cases when the viruses started circulating widely again.
The Centers for Disease Control and Prevention estimated about one in 500 babies who are 6 months or younger has been hospitalized with RSV since the start of October.
RSV can spread efficiently on surfaces, unlike COVID-19. That means the major lines of defense are handwashing, sanitizing frequently touched objects, covering coughs and sneezes, and staying home if you’re sick. Generally, children shouldn’t return to school or daycare until they’ve gone at least 24 hours without a fever (without the use of fever-reducing medication) and their other symptoms have been improving for at least one day, according to the state health department.
There’s no available vaccine for RSV now, though two shots undergoing trials appear to significantly reduce the odds of hospitalization in older people. On Tuesday, Pfizer announced its shot, given during pregnancy, reduced the odds that infants would be hospitalized with RSV by about 82%.
There is a monoclonal antibody to prevent infection, called palivizumab, but the American Academy of Pediatrics only recommends it for babies who were born very prematurely or with severe heart or lung defects, and for children younger than two with compromised immune systems.
While many children recover from RSV without any specific treatment, parents should promptly seek help if their children can’t keep fluids down or are showing signs of respiratory distress, Messacar said. For babies, those signs may include a faster breathing rate, nostrils flaring or the ribs and belly moving more than usual as the child breathes.
“We don’t want people to delay at home,” he said.
Unclear what flu season may bring
So far, flu hospitalizations for the entire Colorado population aren’t substantially different from previous years at this point, and the CDC still considers influenza activity in the state to be low.
Nationwide, it’s a different story, with unusually high spread in the South for this time of year.
The last time that the flu was this severe nationwide this early was 2009, when H1N1 swine flu caused a pandemic. As of Friday, there had been 6,900 flu hospitalizations and 360 deaths nationwide, according to the CDC.
At the same time, fewer people have gotten vaccinated against the flu than had at this point in 2020 and 2021, and the strain that’s circulating tends to cause more complications. That strain is a good match for this year’s flu shot, however, and getting vaccinated cut the risk of hospitalization in half in the Southern Hemisphere.
It’s possible, however, that the flu season just shifted forward, and won’t be more severe than was typical before the pandemic. Australia had an early flu season and a high number of cases, but didn’t have more hospitalizations or deaths than usual. Something similar happened in Chile, where the season started early, but hospitalizations were actually lower than usual, because an estimated 93% of high-risk people were vaccinated.
It’s particularly difficult to predict what the flu might do because viruses have been behaving strangely this year. Over the summer, a virus considered the most likely culprit in cases of sudden paralysis in young children started making the rounds again after two years with little activity. Despite the increase in cases of the enterovirus EV-D68, however, there was no corresponding jump in paralysis cases. No one knows exactly why, but it’s a welcome development for now, Messacar said.
Viruses will most likely return to their normal seasonal patterns eventually, but until then, children’s hospitals need to be prepared for more unexpected twists and the possibility that the next few months will be difficult, Messacar said.
“I think it’s better to prepare than to predict,” he said.
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