“It was 11:30 pm. I was answering a text from a nurse on one of the two cell phones I carried. Then I got a call on the other cell from an outside ER wanting to transfer a patient to us. While I was on the phone, I got two more texts: come see a patient with trouble breathing; a family is asking for an update. It went on like that all night.”
That’s how my husband, hospital-based pediatrician Don Williams, described one of his recent overnight shifts at the Texas pediatric hospital where he works. Don has been in the thick of the struggle to provide care for sick children this fall. Pediatric hospitals, in particular, are challenged to cope with increasing rates of respiratory viruses, busy emergency rooms and doctors and nurses leaving the field.
On Nov. 14, the American Academy of Pediatrics and the Children’s Hospital Association sent a joint letter to the Biden administration asking for an emergency declaration that would free up resources and give hospitals greater flexibility to address the “alarming” number of pediatric respiratory illnesses. Nationwide, more than three-quarters of pediatric hospital beds are full, the letter said. Many states have surpassed 90% of their hospital capacity for young patients. But the U.S. Department of Health and Human Services has said an emergency declaration isn’t needed.
Case rates have continued to climb. Influenza-related hospitalizations have reached their highest level in over a decade for this time of year, according to Rochelle Walensky, director of the Centers for Disease Control and Prevention. As the hospitals have filled up, doctors like Don have been overwhelmed, too. I asked him to share his perspective.
You’ve been working in a children’s hospital for 20 years now. You and I both know that the hospital gets busier in the fall and winter. What’s different this year?
Normally, there’s a predictable spike of RSV [respiratory syncytial virus] and influenza infections between December and February. The COVID pandemic really seems to have knocked that pattern off its axis. For about a year, we saw very few respiratory infections in kids. But in 2021, we were surprised by RSV coming in the summer and not really surging in the winter. For the last few months, though, we’ve seen multiple viral infections all happening at once: RSV, influenza, a smattering of COVID and also adenovirus, parainfluenza, rhinovirus/enterovirus.
Those are other respiratory viruses.
Right. And we’re getting calls from emergency rooms all over the state – Laredo, even Dallas [three hours away] – to admit kids because closer hospitals are at capacity. Sometimes we can’t take them because we’re full. It’s a numbers issue. My group is caring for about 50% more children than usual. There are only so many hospital beds and people available to take care of sick patients.
When did you notice the shift, and what did that look like?
Early in the pandemic, kids were staying home from school and not passing around other viral infections. While it was a scary time for us, it was thankfully pretty slow in the pediatric hospital world. But after a few months, caseloads returned to normal. By early 2021, patient volume was higher than before the pandemic. We were seeing many more kids with mental health crises, which continue to be a big concern. Then, in late August, our census – the number of sick children admitted to the hospital – skyrocketed. We were all surprised to see so much RSV and flu at such an unusual time.
Describe what it’s like for you to experience this surge in patients.
Typically, when I come for a day-call shift, there’s maybe two children in the mental health unit needing physicals and two general pediatric patients that the residents [doctors in training] want to staff with me. Now, it’s not unusual to walk through the hospital doors and have eight patients on my immediate radar, including some waiting in the ER.
I’ve been in rooms with families trying to get a good history, and I’ll get texted five or 10 times within 15 minutes. A resident says they have an admission in ER Room 30. Two minutes later, a different resident texts the same for ER Room 8, then another for a patient who’s already made it to their hospital bed. More than ever, I’ll get called by our transfer center for outside ER physicians asking to admit a child to our hospital. I have to step out of the room to take those calls. And nurses text frequently to clarify orders and give updates on patients already admitted.
It’s not a perfect analogy, but it’s like trying to cook eight entrees at once on a four-burner stove.
I know a lot of health-care workers have left their positions in the last few years. Is your hospital experiencing staff shortages, and, if so, how is that contributing to hospital capacity problems?
I know doctors and other health-care workers are leaving the field. Luckily, my group hasn’t had any attrition, but we all worry that the current level of stress is unsustainable.
The pediatric workforce was largely shielded from some of the worst impacts from COVID because kids were much less likely than adults to get seriously ill. But now, many pediatric hospital doctors feel like this is our “COVID in March 2020” moment.
And it’s obviously not easy to hire and train more doctors.
Right. It takes months or years to hire a new doctor. Every day, one of us serves as “backup attending” to help when all the teams are full. That person used to get called in about once a month. Now they are called in about 80% of the time. These are supposed to be our days off, so you can imagine it’s wearing a bit thin.
What are the consequences to patients when the hospitals are full?
Many times, they have to wait in the emergency room, in less comfortable conditions, because there are no beds in the hospital. In the past, we might have one or two kids waiting in the ER. This month, sometimes we’ve had 20 kids waiting.
Our hospital is well-equipped to take care of pediatric patients, but often kids are seen in adult ERs, where the staff may not have expertise in pediatrics. This is especially difficult when there is nowhere to transfer care, and children need to stay in the ER for many hours or even days. Several times I’ve coached doctors on the phone on how to provide inpatient pediatric care in their ER. I’m happy to do it, and I kind of like it, but again, it takes time. And often we don’t have any time.
What can people do to help?
A lot of what is happening is out of our control, but there are some things that will help: vaccines, especially COVID and flu; staying home when we’re sick; and the common-sense things we did during the pandemic – washing hands, considering wearing a mask, just being aware of our susceptibility to infections.
Of course, when children are struggling to breathe, they need to go to the ER. But when it’s not an emergency, they should see their primary care physician.
We all wonder if this is a temporary anomaly or the new normal after the pandemic. It’s unclear how long this wave will last. But it’s been three months and it’s not slowing down.
Lisa Doggett, senior medical director of Sagility, is a columnist for Public Health Watch, a nonprofit investigative news organization based in Austin. Her memoir, Up the Down Escalator, will be published in August 2023 by Health Communications, Inc.The views expressed in her column do not necessarily reflect the official policy or position of Public Health Watch.