‘Crisis mode’: Washington health leaders warn that hospitals are overcapacity as RSV cases rise in children

OLYMPIA – Pediatric hospitals across Washington are swamped with children infected by a respiratory virus.

“We are in crisis mode, bordering – if not already – on disaster mode in the state,” Dr. Tony Woodward, medical director of emergency medicine at Seattle Children’s Hospital, told reporters Monday.

The high case count of children with respiratory syncytial virus, or RSV, is driving the hospitals well above their patient capacities, state health officials said Monday.

The surge in RSV follows trends nationwide as hospitals prepare for a trifecta of diseases this fall and winter that also includes influenza and COVID-19. Severe cases of RSV and the flu have been affecting mostly children.

The Department of Health only has voluntary data on RSV, but trends from the Centers for Disease Control and Prevention show that cases have more than tripled in the last three weeks.

Washington is among states with the fewest acute care beds for children in the country, with about 500 pediatric beds and 122 pediatric intensive care unit beds, said Dr. Alice King, medical director of the pediatric trauma ICU at Harborview Medical Center. With numbers surging as they are now, those beds can fill up fast.

Half of all admissions are respiratory-related, and most are due to RSV, said Dr. Mike Barsotti, chief administrative officer for Providence Sacred Heart Children’s Hospital and president of the Washington Chapter of the American Academy of Pediatrics. Half of all pediatric ICU patients have a respiratory illness.

Currently, hospitals on the West Side are well above 100% capacity, sometimes up to 300% capacity in the evenings, Woodward said.

Though the surge is worse on the West Side for now, it also is growing in Eastern Washington and hospital leaders expect cases to worsen in the coming weeks. Barsotti said the hospital is currently operating at 110 to 120% capacity with the emergency department taking most of it.

“We are definitely in a surge, but we are just building to the level being described on the West Side,” Barsotti said.

The surge is especially affecting pediatric emergency rooms where wait times can be up to 24 hours for patients who need to be admitted.

At Sacred Heart, Barsotti said they are working to find ways to see more patients more efficiently in the emergency rooms and to focus their efforts on seeing the sickest kids first. That will require finding the right mix of staffing and other hospital resources.

For example, Sacred Heart has been able to pull extra beds from the adult hospital to use for kids, Barsotti said. The hospital also is working with other hospital systems across the state or in Idaho to use their pediatric resources when needed.

Hospitals are looking at hiring more traveling nurses and specialists to help with the surge, but the cost and availability of such health care workers do not always make it possible, said Ben Whitworth, chief operating officer for Mary Bridge Children’s Hospital and Health Network.

Factors contributing to the lack of available pediatric hospital beds include the increase in severe respiratory illnesses, patients seeking care delayed due to the COVID-19 pandemic, as well as problems discharging some pediatric patients because their behavioral health or social services needs can’t be met, hospital leaders said.

King also pointed to trends on the East Coast where the RSV surge hit first. The severity in disease is rising in kids, she said. Part of that is because of how few resources are available for pediatrics in the state. On a regular day, only 6% of ICU resources are for children, who make up about 25% of the population, King said.

Another factor is that more kids are getting sicker and spreading it faster than in previous years, King said. Part of that could be due to more vulnerability and less herd immunity in younger children who did not live during previous respiratory seasons when the COVID-19 pandemic kept many children isolated or wearing masks and social distancing around others.

As RSV spreads, hospitals are anticipating influenza cases also will rise.

“We need to flatten this RSV curve, and we need to think proactively of flattening the influenza curve,” King said.

Looking at the East Coast, Barsotti said there were a number of patients who came in with both influenza and RSV, so hospitals are trying to prepare for that.

Almost all kids will get RSV at least once before the age of 2, Whitworth said, but parents should be on the lookout for worsening symptoms that may require immediate medical treatment.

RSV is mostly respiratory, meaning its symptoms could include a runny nose, coughing, sneezing or fever. Most of those are normal and do not require such emergency care, King said.

Some signs to look out for include increased work in breathing or respiratory distress. That could mean breathing hard and fast or having a persistent nighttime cough, she said. Not eating, drinking or feeding as well could also be a sign to get medical help.

Despite the emergency room surge, hospital leaders encourage parents whose children are having such difficulties to get treated immediately. Hospitals will work to treat the sickest kids first.

“If you have an emergency, come to the ER,” said Taya Briley, executive vice president at the Washington State Hospital Association.