Photo Credit PHL (Public Health Image Library)
#17,160
A year ago, prompted by the severity of the the Delta COVID wave, and the rapid spread of the incoming Omicron Variant, many hospitals around the country found themselves swamped, and forced to operate under `Crisis Standards of Care'.
While Delta is gone, and Omicron - while plentiful - isn't producing huge numbers of severe hospital admissions, the addition of an out-of-season RSV epidemic, and an early and robust seasonal flu, has once again stretched health care delivery resources very thin across the nation.
We've explored the impact of these protocols often during the pandemic (see The Realities Of Crisis Standards Of Care), but in short it can mean hospitals are allowed - under certain dire circumstances - to ration care (including access to ventilators, ICU beds, etc.) and even turn some patients away.
Most of the time, however, it means that some elective procedures may be postponed, and some patients may endure longer waits to be seen at the Emergency Room (or for an ambulance), or to be admitted to a hospital bed.
Given the recent trajectory of flu, RSV, and COVID, this winter respiratory surge is only expected to worsen over the next few weeks. The headline from Oregon's KATU-TV website, dated yesterday, illustrates the situation nicely:
Oregon's hospitals surpass capacity issues seen during COVID-19 pandemic surges
A week ago, Oregon's Public Broadcasting system published:
Providence NICU enters crisis mode amid RSV surge, joining pediatric intensive care units
By April Ehrlich (OPB)
Dec. 3, 2022 5:32 p.m.
All three of Oregon’s pediatric care ICUs adjusted care standards last week to accommodate an overwhelming surge of critically ill infants and children.
Providence announced late Friday that its neonatal intensive care unit at the Portland Medical Center may need to take emergency steps to treat critically ill infants.
The medical center filed paperwork with the Oregon Health Authority to adjust care standards so health workers can treat more patients amid a statewide surge of children and infants seriously ill with respiratory syncytial virus, known as RSV.
The state’s crisis of care standards provide hospitals greater flexibility; for instance, by allowing more patients for each nurse. The guidelines also allow hospitals to triage patients, wherein they prioritize patients who have a higher probability of survival. All Oregon hospital units that have entered into crisis care standards in recent weeks say they aren’t triaging patients.
Providence’s announcement comes about a week after all three of Oregon’s pediatric ICUs initiated crisis care standards — Oregon Health and Science University’s Doernbecher Children’s Hospital, Legacy’s Randall Children’s Hospital and Providence’s St. Vincent Medical Center.
Providence’s Portland Medical Center doesn’t have a pediatric ICU, so infants and children who need intensive pediatric care would need to be transferred to other hospitals. Neonatal care units can sometimes be used to treat very young infants who need intensive care, but they’re typically reserved for premature newborns.
Meanwhile, in New Mexico this week, Department of Health officials issued the following statement on their medical crisis.
Department of Health issues public health emergency order to help hospitals address rise in respiratory viruses
Dec 5, 2022 | Press Room
SANTA FE – The New Mexico Department of Health has issued a public health emergency order in response to a surge of pediatric cases and hospitalizations of respiratory viruses, including respiratory syncytial virus, commonly known as RSV. The order requires all New Mexico hospitals to work cooperatively to reactivate and participate in a “hub and spoke” model of resource management to ensure patients are transferred to appropriate levels of care.
“We expand our social networks during the holidays, which is an important part of nurturing ourselves as human beings living in a complex world. However, at the same time we create more opportunities for respiratory viruses to spread,” said Acting Department of Health Secretary David R. Scrase, M.D. “It’s important to take steps to reduce the risk for respiratory viruses by practicing the good health and hygiene habits we’ve learned over the past few years as New Mexico nurses, doctors and hospital staff are facing another surge.”
This public health emergency order is necessary now as hospitals and emergency rooms are operating above their licensed capacity due to a surge in respiratory viruses and are now experiencing an unsustainable strain on healthcare providers. According to the U.S. Centers for Disease Control and Prevention, the United States is experiencing an early, elevated onset of respiratory disease incidence, as the result of RSV, influenza, COVID-19, and other respiratory viruses. Respiratory disease caused by RSV and other viruses is placing severe strain on pediatric hospital capacity in New Mexico, and evaluations show that the state is nearing a level of capacity strain that would necessitate activating crisis standards of care.
RSV is a common respiratory virus that spreads through virus-containing respiratory droplets produced from coughing and sneezing. For most children, RSV produces mild illness. However, young children are especially susceptible to RSV – according to the CDC, RSV can be dangerous for some infants and young children, with children under the age of two are at increased risk of severe disease and hospitalization. Each year in the United States, an estimated 58,000-80,000 children younger than 5 years old are hospitalized due to RSV infection. Learn more about how young children and infants are impacted by RSV here.
New Mexico saw a significant increase in RSV cases during the months of October and November 2022, in addition to an increase in cases associated with COVID-19, influenza, and other respiratory illnesses. According to the CDC weekly Influenza Surveillance Report prepared by their Influenza Division New Mexico, Texas and Tennessee are seeing the highest rates of in Influenza in the country.
“In light of the increasing numbers of children being hospitalized with RSV, and the number of children presenting to the Emergency Departments statewide, it is really important at this time to take these precautions recommended by the New Mexico Department of Health, especially not exposing our children to others that are currently experiencing respiratory symptoms.” said David Gonzales, MD and Chief Medical Officer at CHRISTUS St. Vincent.
“As health care providers in New Mexico, we will continue to work closely to support children across the state who need care at this challenging time,” said Dr. Jason Mitchell, chief medical and clinical transformation officer at Presbyterian Healthcare Services. “We encourage families to prevent the spread of RSV and other respiratory illnesses and to seek care if it is needed.”
State health experts encourage all individuals at increased risk of severe disease (and their caregivers) to take steps to prevent RSV and other respiratory infections this flu season.
Stay up to date on flu and COVID-19 vaccinations.
Stay home if you or your child is sick.
Wash hands thoroughly and frequently.
Keep common, high touch surface areas clean and regularly disinfected.
If you have a child needing medical evaluation, call your healthcare provider or visit an urgent care center. At this time, hospital emergency departments are strained. Only visit the hospital if your child shows signs of severe illness, such as significant trouble breathing.
A copy of the Dec. 1, 2022 public health emergency order is available here.
Similar reports are coming from across the country, including:
L.A. hospitals feel strain from COVID surge, bad flu season
Winter Triple-Demic of Flu, RSV and COVID Pushes NY Hospitals to Brink, Hochul Warns
‘Tripledemic' impacts Texas hospitals amid ongoing staffing crisis
While we don't have a vaccine against RSV, and the flu vaccine provides (most years) only moderate protection against infection, we do have a perfectly good - and well proven - NPI (Non-pharmaceutical Intervention) that can significantly reduce your risk of infection from all respiratory viruses.
But sadly - judging by my last trip to the grocery store - very few people are inclined to wear them.
