Children with respiratory viruses overwhelm Maryland hospitals, which are running out of beds

A surge of young children with respiratory illnesses is overwhelming the state’s hospitals, leaving some seriously sick kids in emergency departments for hours or being transferred to other facilities, including out of state.

Many have respiratory syncytial virus, or RSV, a common respiratory virus in young children causing cold-like symptoms. But there are other viruses circulating, and doctors fear a wave of flu and COVID-19 cases in coming weeks because people are again inside mixing at school and other occasions and taking few precautions such as wearing masks.

“It’s a crisis,” said Dr. Theresa T. Nguyen, interim chair of pediatrics at Greater Baltimore Medical Center in Towson and a pediatrician with GBMC Health Partners. “We saw RSV in the last few years but not in significant numbers. It’s novel all over again, and it’s really impacting the infants and the under-5 age group pretty tremendously.”

Doctors grew concerned about the respiratory viruses this summer, when they began seeing an unusual number of warm-weather cases. But in the last two weeks, the viruses began swamping hospital emergency departments.

Several hospitals report that all pediatric beds and intensive care beds are full. To find space they are turning to other hospitals within their systems, in the state and to those in neighboring states and beyond.

That’s coordinated through a statewide emergency management agency called the Maryland Institute for Emergency Medical Services Systems, or MIEMSS, also used to ensure safe care for the waves of COVID-19 patients.

MIEMSS and state health officials couldn’t say Friday how many beds are currently available in the state.

The Maryland Hospital Association said a fifth of the state’s available beds are without staff, and officials there encouraged families with children who have less urgent medical needs to seek care first from their pediatrician or in an urgent care setting to preserve limited hospital resources for those needing advanced care.

Chase Cook, spokesman for the Maryland Department of Health, said the state is working with MIEMSS, the hospitals and others and is “encouraging all of our hospitals to coordinate their efforts and to ensure that pediatric beds are fully staffed.”

Staffing is a nationwide issue, with the most acute problem being a lack of nurses and respiratory therapists nationwide. In Maryland, one in four nursing positions is vacant.

That’s posing a challenge in caring for the rise in RSV, which has become a significant hospital issue in the Mid-Atlantic and Northeast states, followed by the Upper Midwest, said Nancy Foster, vice president for quality and patient safety for the American Hospital Association.

She said most of the country can expect a significant uptick, and all the hospitals will work to provide care, as well as share what they learn about the specific viruses.

Foster said the national public health emergency, renewed until January by the Biden administration, continues to give hospitals some flexibility in what jobs different medical providers are allowed to perform. For now, some hospitals are postponing non-emergent procedures, as they did when COVID-19 cases spiked, she said.

“Most general acute care hospitals have a relatively limited number of pediatric beds, but during COVID we learned how to expand our capacity and deliver care,” she said. “This time we need doctors, nurses and respiratory therapists experienced with kids.”

Nguyen said pediatricians have been expecting other viruses to make a comeback. Kids haven’t been getting that sick in the past couple of years during the coronavirus pandemic and their systems aren’t primed.

RSV is sickening older kids who never had the virus. Others have gotten enteroviruses. Hospitals already are getting a few influenza cases.

COVID-19 cases among children remain low, with just 13 kids in the hospital statewide with the infections, including three in intensive care, out of 447 total hospitalized with the coronavirus, state figures show.

With colder weather coming, the coronavirus and influenza could pile on to the burden. Doctors note Australia, a bellwether continent for the United States, just had a tough flu season.

Doctors say parents ought to treat kids at home if possible, since most recover from these maladies in several days and it’s not necessary to know exactly which one to treat it. They suggest acetaminophen or ibuprofen for fevers and other comfort care, and calling primary care doctors with concerns or visiting urgent care centers.

Keep kids home from school or day care if they are really coughing a lot or feeling unwell, the doctors say. For minor issues, put them in a mask when leaving home.

Children do need emergency care if they are having trouble breathing. In young children, look out for trouble eating, drinking, sleeping or peeing, doctors said.

About a dozen hospitals in the University of Maryland Medical System are taking a page from their pandemic playbook and coordinating among facilities to ensure children with RSV are getting care, but also tapping the MIEMSS system, said Dr. Jason Custer, chief of critical care at the University of Maryland Children’s Hospital and an associate professor of pediatrics at the University of Maryland School of Medicine.

Custer said there just wasn’t a lot of other viruses circulating during the last couple of years of the pandemic. Now the viruses are making a comeback earlier in the season, and finding children vulnerable because they were never infected. There also now are more coronavirus variants on the horizon and those could infect or re-infect people.

He and other doctors urged parents to vaccinate their children against viruses when there is a vaccine. Children as young as age 5 are now eligible for the relatively new bivalent vaccine against COVID-19 that includes omicron variants and could provide more protection. There is no RSV vaccine yet.

Most children recover from all of these viruses, though they can spend some extremely unpleasant days on the sofa or in the hospital on oxygen or with a secondary infection, Custer said. He said they also can pass the viruses to people who have underlying health conditions or are very young or old and not as able to fend off infections.

“Good hand-washing, staying out of school and day care with illnesses, getting immunity from vaccines, these are all things people can do,” said Custer. “We did a good job during COVID with this, but we’ve drifted away.”

That’s frustrating to Dr. Susan Lipton, head of infectious diseases at the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore.

She said parents and everyone ought to reconsider precautions from masking to vaccinations to keep illnesses to a minimum and prevent spread, particularly as the holidays approach. That protects the kids and everyone around them.

It also will keep kids out of the emergency room. She said when the hospitals are overwhelmed with respiratory infections they have less space for those coming to the hospitals for other reasons.

Lipton said now about half the people coming to Sinai’s emergency room have respiratory symptoms.

RSV can be more sinister than a regular cold, as it reaches the lungs and causes inflammation and pneumonia.

There are so many cases in Maryland, some days the closest open beds have been in Delaware and even North Carolina and New York, she said, “and no parent wants to send their children that far away.”

“We have a perfect storm,” Lipton said. “Kids back at school and day care, parents resuming work in person, there are all these infectious diseases and we’re become sloppy about precautions. Viruses were not spreading when everyone was masked. We’ve broken the dam.”