Washington's children's hospitals 'in crisis mode' amid surge of respiratory viruses

A surge in RSV, a contagious respiratory virus, is straining pediatric hospitals across Washington state.

As flu cases also begin to rise, and hospital officials look toward another potential Covid-19 wave, they’re sounding the alarm about hospital capacity for the state’s youngest patients.

“We are in crisis mode,” said Dr. Tony Woodward, medical director of emergency medicine at Seattle Children’s hospital during a media briefing Monday, “and bordering, if not already in, disaster mode in our emergency departments across the state.”

Woodward said Seattle Children’s emergency room is at 100 percent capacity essentially 24 hours a day and goes up to 200 and 300 percent capacity at points.

People with urgent needs are still being seen, but pressure in the system is resulting in long wait times for those who are not in an active emergency.

Wait times exceeded 12 hours for some kids at the Mary Bridge Children’s Hospital in Tacoma this weekend, according to Ben Whitworth, the hospital’s chief operating officer. And it can take more than a day for children who need to be admitted to the hospital to make it from the emergency room to an inpatient bed, he said.

Whitworth said more than 60 percent of emergency department visits for the hospital are respiratory-related, and he said they’re seeing the hospital’s highest ever admissions for RSV.

At Seattle Children’s, RSV cases have soared compared to levels in 2020.

Children’s hospitals prepare for respiratory virus season each year, but face masks, social distancing and other mitigation efforts during the pandemic resulted in milder seasons the past couple of years.

This year, RSV infections surged early. Flu cases are also starting to tick up.

“Respiratory viruses are a major driver of pediatric Emergency Department (ED) volumes. The fact that so many children are getting their first RSV infection now is driving the volumes. By comparison, in 2020, we saw about ¼ of patients that we are seeing now. In October of 2022, Seattle Children’s saw about double the number of patients in the [Emergency Department] that we normally would. It is likely to get worse when influenza peaks,” Dr. Russell Migita, an emergency physician at Seattle Children’s, said in a statement.

Respiratory syncytial virus, known as RSV, is a respiratory illness that can affect people of any age, but it’s most serious in young children and older adults.

For many people, RSV presents like a cold. But some people can get very sick, developing pneumonia or bronchiolitis, and requiring hospitalization.

The surge in respiratory illnesses in kids is putting strain on a system already stressed by staff shortages and financial issues. Delays in care throughout the pandemic also mean that many patients are also sicker when they make it to the hospital.

“This is our Covid,” said Dr. Mary Alice King, medical director of Harborview Medical Center’s pediatric intensive care unit (ICU). “Right now, that is the stress in our pediatric hospitals. We’re terrified that we won’t be able to take care of all the kids.”

King said hospitals across the state are working together to make sure kids don’t go without care, and they’re looking at creative solutions like admitting older kids to adult hospital beds, and treating kids wherever they can, even in hallways and lobbies.

The issue facing pediatric hospitals is familiar to their counterparts across the state serving adult populations.

During the pandemic, hospitals had to work together in a delicate balancing act to move patients around in order to make sure everyone got the care they needed, and no single hospital was overwhelmed.

The Washington Medical Coordination Center is the group that shepherded that balancing act, taking calls from hospitals that were out of options and finding beds for the patients they could not serve.

This group is now gearing up to be able to help pediatric hospitals in the same way.

Health officials are also asking the public for help, urging families to utilize the kinds of precautions that have become familiar throughout the pandemic.

Hand washing, masking and staying home when sick can help to decrease spread.

King and others also stressed the importance of keeping kids up to date with flu vaccines, even if they’ve recently been ill. Although, King conceded that getting a flu vaccine can be a logistical nightmare for working parents.

Still, she said it’s vital that families do everything they can to help decrease the spread this winter.

“I think people are so tired from Covid and they don’t get the urgency of what we’re talking about,” King said. “We need to flatten this RSV curve and we need to think proactively about flattening the influenza curve because we are out of beds… I’m actually terrified about what this can look like a month from now.”

Hospital leaders stress that people should still go to the emergency room if their child is having a medical emergency.

But they warn that patients will be seen based on the severity of their condition, not based on what time they arrive.

They’re asking families to call a nurse’s line or a primary care provider if their child is ill but they don’t need hospital attention.

If a child is having a hard time breathing and showing signs of respiratory distress they should get medical help, King said.

Signs of respiratory distress can include things like nasal flaring, breathing hard and fast, and a blue tinge around the mouth or nail beds. A persistent nighttime cough that’s getting worse can also be a warning sign, King said.

For little ones, not eating or drinking properly and showing signs of fatigue can also be a sign that it’s time to talk to a medical provider.

As the holidays approach, health workers say families may have to make some tough choices. If family members are sick, they may need to skip gatherings, they say.