RSV surge stretching Chicago-area children's hospitals

RSV surge stretching Chicago-area children’s hospitals

Children with the respiratory illness RSV are filling Chicago-area children’s hospitals, leading to longer ER waits, occasionally delayed surgeries and difficulty transferring pediatric patients between hospitals.

RSV, which stands for respiratory syncytial virus, can cause a runny nose, coughing and fever, and in most people is mild and resolves within a week or two. But sometimes it can be more serious, especially among babies, causing pneumonia and inflammation of the small airways in the lung. Each year, about 1% to 2% of babies younger than 6 months old who catch RSV may need hospitalization, according to the Centers for Disease Control and Prevention.

RSV often surges during the late fall and winter, but this year, it has arrived early and is making some older children sick as well. It comes on top of an early swell of other respiratory illnesses that have kept Chicago-area children’s hospitals packed for months.

“We are in a major crisis and we absolutely need all hands on deck for our children!!!,” Dr. Frank Belmonte, chief medical officer at Advocate Children’s Hospital, posted Thursday on Twitter in response to a tweet about similar surges in other parts of the country.

In Chicago, the percentage of emergency department visits by children younger than 5 for RSV is about 10 times higher now than at the same time in 2019, according to the Chicago Department of Public Health.

“We’re coming out of a pandemic where a lot of kids weren’t exposed because we were socially isolated and trying to protect ourselves,” said Dr. Marcelo Malakooti, associate chief medical officer at Lurie Children’s Hospital. “There was this preponderance of children who may not have been exposed to the virus before and this was perhaps the first time.”

Some doctors have compared this RSV surge to what adult hospitals faced in March 2020.

University of Chicago Medicine Comer Children’s Hospital has been full for 53 days in a row. Since Sept. 1, Comer has been able to accept more than 670 sick children transferred from other hospitals, but has had to say no to about 500 other transfer requests because it had no more available beds, Comer leaders said in an email sent to all Chicago Medicine staff and faculty Oct. 27.

In recent years, many Chicago-area community hospitals have closed their pediatric inpatient units, meaning when they get very sick children, they must often transfer them elsewhere.

“Unfortunately, some of these children wound up being transferred to hospitals as far away as St. Louis,” Comer leaders said in the all-staff email, of children it couldn’t take from other hospitals.

Comer is also seeing about 150% more patients in its emergency department than it saw at this time last year. In just one month, from September to October of this year, Comer saw the number of patients visiting its ER shoot up by about 32%.

“It’s very severe,” said Dr. John Cunningham, physician-in-chief at Comer. He noted that in the past, many children with severe cases of RSV were 1 or 2 years old. Now, the hospital is seeing 4 and 5 year olds. “Children have been cocooned in the last couple years (and) are now getting RSV late.”

Lurie Children’s Hospital is also running at capacity, meaning all of its beds are generally fully, Malakooti said. So far, Lurie has had two RSV deaths this season, he said. Each year in the U.S., about 100 to 300 children younger than 5 die of RSV.

Lurie has had to turn away more transfer requests from other hospitals than usual.

Both Comer and Lurie have delayed some surgeries to keep more beds open. The hospitals have also had to board some children in ERs, meaning keep them in ER beds until beds elsewhere in the hospitals open.

“It’s obviously overloading the pediatric health systems,” Malakooti said.

RSV rates are high in other areas of the country as well, with some hospitals in other states reportedly setting up tents outside their ERs, doubling up children in rooms and considering calling in the National Guard for support.

Doctors at Lurie and Comer say they haven’t had to take any of those steps at this point. They are, however, trying to get creative.

University of Chicago Medicine is asking medical staff who normally care for adults to volunteer for overtime shifts working with children at Comer.

In the late afternoons and evenings, Comer is trying to use part of its fourth floor as a “fast track” space for children who arrive at the ER with less serious illnesses, to help take pressure off the ER. It’s also transferring some older pediatric patients into adult beds at University of Chicago Medical Center.

Comer is also looking at changing some of its regular beds into intensive care beds.

Despite the high numbers of kids with RSV, Malakooti said cases have not yet peaked, and the situation might get worse before it gets better.

Children’s hospitals are also bracing for the flu season, which some are predicting will be the worst in years. The risk of flu infection remained low in Chicago for the week ending Oct. 22, though it was increasing, according to the Chicago Department of Public Health.

Pediatricians are urging parents to make sure their children get flu shots. Doctors say parents should keep their kids home if they’re sick, make sure they’re washing their hands, call their pediatricians if their children are sick, and bring them to ERs if there’s an emergency.

“We’re very concerned, and we’re preparing for it as best we can,” Cunningham said.

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