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CT children’s hospitals, swamped with RSV, brace for flu cases

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The emergency department entrance at Connecticut Children's Medical Center in Hartford.

Connecticut’s two children’s hospitals, already dealing with a deluge of respiratory syncytial virus cases among young kids, are bracing for flu cases to swell as the colder weather sets in and a surge in patients tests capacity.

“We remain at full capacity, and we have been pretty much at full capacity for the last three months with rare exceptions,” said Dr. Juan Salazar, physician-in-chief at Connecticut Children’s Medical Center. “The emergency department has been bursting at the seams, and our critical care unit has been almost always filled to capacity.”

“For the last six weeks, we have been over capacity, which means we’ve had an average of 15 to 20 children who require admission … but they haven’t been able to be brought up to one of our inpatient beds,” he said. “So they’re remaining in our emergency department bays, awaiting a bed to open to be able to move them upstairs.”

RSV cases remain high, but flu cases are also on the rise. Throughout October, Connecticut Children’s had 42 flu cases. During the first two weeks of November, the hospital saw 216 flu cases.

Connecticut Children’s had 355 RSV cases in October and had seen 232 as of Nov. 15.

“We’re seeing a shift toward influenza,” Salazar said. “Predictive models would suggest that over the next four to six weeks, influenza is going to be the major player.”

At Yale New Haven Children’s Hospital, RSV and flu cases are climbing. In early October, the hospital had a week with RSV cases in the low 20s and another in the mid 40s, said Dr. Tom Murray, associate medical director for infection prevention at Yale. But recently, cases have ticked up, with 89 recorded the week ending Nov. 12 and 79 reported the week before that.

Yale had three flu cases the first week of November and nine during the second week, Murray said.

“Far and away, the biggest concern is that influenza is going to accelerate rapidly and RSV will not decrease as rapidly,” he said. “The next few weeks, it’s very possible we will have a lot of RSV and a lot of flu, which will push our capacity. We’re having active surge meetings to try to decide how we’re going to handle it.”

Officials at Yale have met with leaders at Connecticut Children’s to discuss regional efforts.

“Looking for active spaces, thinking about physicians and nursing staff who can do extra shifts, really doing everything we can to increase our capacity to the best of our ability,” Murray said.

In an email, Public Health Commissioner Manisha Juthani did not offer specifics but said, “the Connecticut Department of Public Health has been working with hospitals to address the number of pediatric inpatients with respiratory viral illnesses.”

“There have been a slightly lower number of children admitted with respiratory syncytial virus within the past two weeks. We are hoping that these cases have plateaued,” she wrote. “Flu cases have been rising in the southern states for the last several weeks, so that now flu also has high activity in Connecticut as well.”

Under strain a month ago, Salazar and others at Connecticut Children’s asked the state Department of Public Health to explore the logistics of opening a field hospital with the help of the National Guard. They considered erecting a tent outside Connecticut Children’s but decided instead to expand capacity within the hospital.

“They came, they surveyed; they said if we wanted the field hospital tent that we could have it,” Salazar said. “But we evaluated [it], and we felt it was probably best to work within our walls. It’s getting cold, and while it’s very useful under a severe emergency, it’s really not a useful location to keep pediatric patients.”

Connecticut Children’s typically has 45 beds in the emergency department, but officials have utilized patient rooms, hallways and other areas to scale up to 80 beds or more when needed.

“We’ve added up to 10 flex beds … and then we’ve set up additional beds throughout the first floor in different units,” Salazar said. “At any one time, between fast track and the behavioral health unit, our main emergency room and the expansion, it can flex up to even 90 beds. It’s fluid.”

Although RSV is usually characterized by mild cold symptoms such as cough, fever and runny nose, it can be serious in infants, young children and older adults. It is the most common cause of bronchiolitis — inflammation of the small airways in the lungs — and pneumonia in children younger than 1, according to the Centers for Disease Control and Prevention.

Most of the patients admitted to Connecticut’s children’s hospitals are 2 or younger, officials said, and many are 6 months and younger.

Salazar cited three possible reasons for the increase in serious RSV cases this year. Isolation and precautions taken during the last two winters meant children weren’t exposed to the typical seasonal viruses (mask mandates in schools were dropped in March of this year) and lacked immunity. Pregnant people also were not exposed to as many viruses.

“A certain level of protection is afforded by the mother’s exposure to RSV or influenza or adenovirus or enteroviruses. Maternal antibodies have an effect on the baby and probably have a protective effect on those babies under the age of six months,” Salazar said.

Many children have also been infected with COVID, he said, and even mild cases could reduce their ability to fight off other illnesses.

“We know that about 85% of kids got infected with COVID,” he said. “Most of them were mild [cases], but that mild disease had an immunologic effect that dampens or diminishes the ability of those kids to respond to a new infection with a different virus. We’re studying that right now, trying to understand post-COVID immune suppression.”

The RSV strain spreading this year may also be more transmissible and virulent than previous strains, he added.

Physicians and public health officials are urging parents to get their kids vaccinated against the flu and COVID. Though COVID has not posed a large problem for children’s hospitals in recently, cases could also go up in the approaching winter months.

“We are keen for all parents to get those two vaccines up to date,” said Dr. Sten Vermund, professor of pediatrics at the Yale School of Public Health. “A lot of us are not masking these days because COVID incidence is low and because we’re vaccinated, but if there are vulnerable children who have severe asthma … or immune suppression, they can continue to mask, physically distance and avoid groups to keep risk to a minimum.

“Everything we learned to do with COVID can be applied to reducing the risk of other respiratory viruses.”

The state has commissioned television and radio commercials and created online notifications about COVID boosters and flu vaccines. Juthani said officials are also running advertisements on billboards throughout the state and on CT Transit buses.

There is no vaccine for RSV, though development of the shot is underway.

“This increased hospital census should remind parents to get their children vaccinated against influenza and COVID-19,” Juthani wrote in an email. “Both vaccines are effective at preventing severe illness, hospitalization and death.”

Children who are sick should stay home, she said. If they must leave the house and are exhibiting respiratory symptoms, masking is recommended.

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