With no room at the pediatric ICU, or no pediatric ICU
A friend is a retired neonatal ICU doctor. It’s a tough gig watching premies struggle for life. Even tougher when she lost one. Tougher still for the parents.
Alexander Stockton and Lucy King produced a video diary for the New York Times about how COVID, RSV and flu are hitting young kids especially hard this winter. My connection to RSV (respiratory syncytial virus) is modest but memorable. So when it pops up in the news I notice. This year it’s a tripledemic (Yale Medicine):
“What we are seeing is record levels of RSV in young children. Usually, we see a spike in December or January, but it’s earlier this year,” says Scott Roberts, MD, a Yale Medicine infectious diseases specialist.
Meanwhile, as of early December, RSV cases reported by Yale were beginning to go down and COVID-19 and flu cases were increasing. A big part of the flu increase, he explains, is our lack of immunity from having not been exposed to the virus for several seasons due to masking and other precautions, many of which have fallen to the wayside.
[…]
RSV is a common and highly contagious respiratory virus that causes cold-like symptoms. Most kids are exposed to the virus by their second birthday and therefore develop a degree of immunity that makes future cases less troublesome.
But for the very young it can be deadly. Even more so because the flood of young patients has hospitals streched thin. The number of hospitals properly equipped to treat very young children is also limited. Especially in rural America.
Scientific American from November:
In California, the Orange County health department declared a state of emergency in early November 2022 due to record numbers of pediatric hospitalizations for respiratory infections. In Maryland, emergency rooms have run out of beds because of the unusually high number of severe respiratory syncytial virus, or RSV, infections. So emergency departments there are having to refer patients across state lines for care.
In the U.S., the winter respiratory virus season started earlier than usual this year. Since peak infections usually occur in late December or January, this uncharacteristic early wave suggests that the situation could get much worse for people of all ages, particularly children.
The New York Times examines the problem:
As the Opinion video above argues, this crisis is not simply the result of a sharp rise in case numbers. The wave of respiratory illnesses in recent months has revealed a health care industry ill equipped to care for critically ill children.
Profit-driven management has eroded pediatric health care in America. Health care providers make more money treating adults than they do children. As a result, the number of hospitals offering pediatric care has decreased dramatically over the past two decades.
So when the number of R.S.V. cases skyrocketed in late 2022, the American health care system wasn’t prepared. Hospitals were overwhelmed, and families struggled to find appropriate care. And once again, the nation’s health care workers have shouldered much of the burden, going to extraordinary lengths to care for society’s most vulnerable.
The “world’s finest” system is a mess. A recent study by the American Hospital Association examined rural hospital closings:
1. Seventy-four percent of rural closures between 2010 and 2021 occurred in states where Medicaid expansion was not in place or had been so for less than a year.
2. Nineteen rural hospitals closed in 2020 — the most of any year in the past decade.
3. Ten percent of U.S. physicians practice in rural areas dispute those areas accounting for 14 percent of the country’s population.
4. Hospitals accounted for one in every 12 rural jobs in 2020.
5. About half of the hospitals that closed between 2010 and 2020 were independent.
6. AHA said rural hospitals require increased attention from state and federal governments to address barriers and invest in new resources. It called on Congress to extend the Medicare-dependent Hospital program and the Low-Volume Hospital program, which are set to expire Oct. 1.
“This is our pediatric pandemic,” says Erika Setzer, pediatric critical care provider. “The floodgates have opened. They’re coming. They’re coming in droves.”
Pray your child or grandchild can get needed care without going begging.