By Caroline Kee

As respiratory viruses like RSV (respiratory syncytial virus) surge among young kids across the United States, many children's hospitals are overwhelmed by a deluge of patients filling up emergency rooms and hospital beds.

“There’s no space anywhere,” said Dr. Sage Myers, a pediatric emergency medicine physician at the Children’s Hospital of Philadelphia.

The Children's Hospital of Philadelphia (also known as CHOP) is the oldest children's hospital in the country and one of the largest with 594 beds. The hospital has been at or above capacity for three weeks, and unprecedented patient volumes are causing wait times and capacity issues far beyond what staff could've imagined.

"I've been working in pediatric emergency medicine at CHOP for over 15 years now, and this is definitely the most patients that I've ever seen coming into the emergency department and the fullest our hospitals have ever been," said Myers.

Last week, Myers took to Twitter to share what she was seeing in the pediatric emergency department. Her comments went viral.

"Just finished an overnight shift in the peds emergency department. Whatever you are imagining when you hear the news about RSV, and increased viral illnesses, and high pediatric volumes…it’s 1000 times worse." — Sage Myers, MD MSCE (@Redsoxma) November 2, 2022

“We’re seeing a lot of respiratory viruses circulating right now, which have come much earlier than we normally see,” said Myers, adding that RSV is more of a late fall or winter virus, but cases started ramping up in the summer.

Cases of RSV have skyrocketed in Philadelphia since September, according to data from the City of Philadelphia Department of Public Health. Nationally, weekly RSV hospitalization rates have reached levels typically seen in December, according to data from the U.S. Centers for Disease Control and Prevention.

The surge of RSV is coinciding with an early flu season, said Myers, and activity is already surging full force in parts of the South. Last week, the U.S. reported the highest rate of flu hospitalizations for this time of year in a decade, with young children among the hardest hit groups.

Rhinovirus and enterovirus, common viruses that cause respiratory illness, are also circulating at higher levels than usual, Myers said, and COVID-19 is not gone either.

Children’s immunity to these viruses may have waned over the last two years due to lack of exposures during the pandemic, which may explain why these seasonal respiratory viruses are hitting harder and earlier than expected.

Experts have warned about a potential “tripledemic” of RSV, flu and COVID-19 this winter, which could strain health systems and stretch medical resources.

Most children who get RSV will recover on their own, but Myers said she's seeing an increasing number kids show up to the emergency department struggling to breathe. Children who are hospitalized with RSV usually need supportive care, like fluids and oxygen, but some require prolonged care or to be put on a ventilator. Some kids may develop complications, like pneumonia or bronchiolitis.

“Younger children in general are more likely to have difficulty with respiratory illnesses, especially RSV, in part because we build up immunity over time ... so the older you are, the more immunity you have, and the easier you fight it off,” said Myers.

"There are just no beds that are available."

The sheer volume of sick kids in the emergency room and hospitalized patients is creating delays and bottlenecks to care, according to Myers. “We have wait times for children in the emergency department that are way longer than we ever would have thought possible before, despite us doing everything we possibly can to see children quickly.”

So many children are coming into the emergency department at CHOP at once that there's a wait to be checked in and triaged when patients first walk in, said Myers. The wait times in the actual waiting room to see a physician are also long, and even children who need to be hospitalized are having to wait until space opens up.

“There are just no beds that are available, and a lot of children are sitting in the emergency department waiting ... which decreases the space that we have to see new children,” said Myers. This includes children coming into the emergency room for RSV or any other reason. “Obviously we also still see all of the kids with appendicitis and broken arms and those things,” said Myers.

This isn't only a problem in the Philadelphia area, said Myers, and CHOP has been inundated with requests for transfers of patients from hospitals in other states as far as Virginia. "It's not typical at all. ... They're reaching out as far as they can to try and find places to send their children," Myers added.

A growing problem for already-strained hospitals

What’s happening at CHOP is just a snapshot of what's unfolding at many children’s hospitals around the country. The crisis comes on the heels of many community hospitals in the U.S. closing pediatric units to make space for influxes of adult patients due to COVID-19.

"Very few children were getting sick ... so some hospitals closed their pediatric floors altogether ... and it's created less space in the community for children to be taken care of," said Myers.

Health worker shortages and burnout are exacerbating the problem. "We (at CHOP) are fortunate that we're still able to operate all of our bed capacity," said Myers. "There are hospitals that may have an actual bed sitting there open, but they can't use it because they don't have enough staff to be able to safely do that."

A severe flu season could make things a lot worse, Myers warned, stressing that "flu is more likely to cause pediatric deaths than RSV."

It's unclear how the winter will pan out, but Myers said she anticipates that "it’s just going to be longer and longer waits for children. ... There’s literally nowhere else to send them.”

How parents can help keep kids safe

“Generally children are amazingly resilient. ... Most of the time, they will recover,” said Myers. But it’s important for parents to learn how to differentiate between a mild case that can be treated at home and a case that requires extra care or an emergency room visit.

“Pediatricians can be a great help,” said Myers, adding that parents should not hesitate to reach out if their chid is sick.

Signs of severe illness include, but are not limited to, trouble breathing or wheezing, and discoloration of the skin or lips.

Parents can also protect their children by making sure they are up to date on their vaccines, said Myers. Every child age 6 months and older should get their seasonal flu shot and primary COVID-19 vaccine series, and children ages 5 and older should get a COVID-19 booster. Some children may need two flu shots.

“The more we can blunt the spread of flu and the less sick children can get, the better,” said Myers.

Adults should get vaccinated as well, Myers added, because they will be less likely to become infected and transmit the virus to children. Immunizations are "a good priority if you're trying to avoid being in waiting rooms for hours and hours," said Myers.