WVU in the News: Hospitals brace for a possible ‘tridemic’ of RSV, flu and COVID

With people suffering from respiratory illnesses crowding hospital emergency rooms nationwide, experts at West Virginia University and elsewhere are warning of the possibility of a “tridemic,” with simultaneous outbreaks of influenza, COVID-19 and respiratory syncytial virus or RSV.

Already, the burden on the health care system caused by RSV has filled pediatric beds at WVU Medicine in Morgantown, W.Va., said Dr. Lisa Costello, a pediatrician and assistant professor in the School of Medicine Department of Pediatrics.

Just as “at the beginning of COVID we saw hospitals limited elective procedures, we are having to make case-by-case decisions on what elective procedures can take place because of the constraints on beds,” she said this week.

“We don’t have beds for patients. We had a waitlist of over 20 patients [Wednesday morning] waiting to get a hospital bed.”

The situation remained the same Friday, she said.

"WVU Medicine Children's continues to have a long wait list of multiple patients for admission, as do other children's hospitals in West Virginia and the region."

According to the Hospital and Healthsystem Association of Pennsylvania, as of Thursday morning, 92% of all pediatric intensive care unit beds in the state were occupied. 

Among the state’s larger, regional pediatric centers or children’s hospitals, 91% of beds were occupied and two-thirds were at 90% capacity or higher.

“UPMC Children’s has the capacity to care for any child needing care,” the hospital said in a statement. “We are still seeing a steady uptick in RSV and other respiratory illnesses here in Pittsburgh.”

Chris Chamberlain, HHAP vice president of emergency management, said: “The challenge nearly all pediatric specialty hospitals are facing is that they are receiving more requests to transfer patients from community and outlying hospitals that aren’t really equipped to handle pediatric intensive care patients.”

On Wednesday, HHAP hosted a statewide call with member hospitals to help them to work together to handle the burden. One of the strategies discussed was to offer resources and expertise “to bolster some of the capacity of the local hospitals to care for children, to allow them to keep the child there,” Mr. Chamberlain said.

“We know that the COVID-19 pandemic really changed the overall approach to infection control — we had social distancing, we had mask-wearing,” he said. “One of the other side effects may have been a change in course in some of our more annual seasonal outbreaks like RSV and flu.”

In a briefing with reporters Friday, Dr. José R. Romero, director of the National Center for Immunization and Respiratory Diseases, said, “What we’re seeing is a cycling of infections,” with RSV surging in some parts of the country while in others it is fading and being replaced by a spike in flu cases.

Estimated illnesses from flu this season roughly doubled over the week ending Oct. 28 to about 1.6 million, according to the Centers for Disease Control and Prevention, and there were 730 deaths reported.

And the cumulative hospitalization rate in its influenza hospitalization surveillance network was higher than the rate at this point in previous seasons, going back to 2010-2011.

With new variants, especially BQ.1 and BQ.1.1, COVID-19 remains a concern.

And RSV has been in the news for several weeks, turning waits at children’s hospital emergency rooms into ordeals of eight or 10 hours.

For adults, RSV is like a cold, but it can be dangerous for younger children, especially babies under a year old. Symptoms include coughing, nasal secretions, wheezing and often a fever.

“There’s no doubt that we will face some challenges this winter,” said Dawn O’Connell, assistant secretary for preparedness and response for the federal Administration for Strategic Preparedness and Response.

“We are monitoring capacity across the country,” she said, “and standing by to deploy additional personnel and supplies as needed.”

Medical supplies are available from the national stockpile, but “to date no state has requested this level of support,” she said.

“We know what levers we need to pull should things continue to increase in this way.”

While recent attention has focused on RSV and flu, “It’s important to note that COVID-19 is not gone,” Dr. Romero said.

Of the three illnesses, Dr. Costello of WVU said, “right now, certainly, RSV in the pediatric population is the one we are seeing the most.”

Although it is normally seen later in the winter, in January, February and March, it has shifted earlier since the start of the COVID-19 pandemic.

“In October, we started to see an uptick,” Dr. Costello said. “That could continue or worsen into the winter months.”

“Symptoms of RSV that we are seeing in children are secretion, a lot of congestion and some may have a fever,” she said.

She recommends a trip to a health care provider if children exhibit fast breathing, flaring nostrils, head bobbing while breathing, grunting when breathing and rib cage caving with each breath.

At UPMC Children’s, estimated emergency department wait times are constantly updated on a tracker. At 10:15 a.m. Friday, the tracker said the wait was 166 to 181 minutes, or about three hours.

By 1:20 p.m., it was up to 278 to 293 minutes, or nearly five hours.

Dr. Michael Petrosky, lead physician at AHN Pediatrics, Arcadia Division, a practice in McCandless, said, “RSV is out there every year. I’m not seeing as much COVID. What I’m seeing is more flu.”

The risk with RSV is primarily for very young babies who can’t clear their airways, he said. When their breathing becomes so labored that they cannot nurse or drink from a bottle, it can lead to dehydration.

Dr. Petrosky said AHN is “trying to do a big push on vaccines,” especially the new bivalent COVID-19 booster that was recently approved for children 5 and up, as well as flu and the original COVID vaccine for children 6 months and older.

For those under 6 months, he recommended “cocooning” — ensuring that everyone in contact with the infant is vaccinated.

Dr. Costello agreed with the emphasis on vaccinations, especially because there is not yet a vaccine for RSV.

To reduce the burden on the health care system, she encourages “using all the tools in your toolbox, whether that’s flu, COVID, or other vaccine-preventable disease.”

She also advised people to wash their hands frequently and to stay home if feeling ill.

As for the warning signs that an infant is ill enough to need emergency care, Dr. Petrosky said “hydration’s a big key for me. If they’re having a wet diaper at least every eight hours, that’s a good sign.”

And for children under 2 or 3 months, a temperature of 100.4 or above, taken rectally, is a concern.

“I have a soon-to-be 9-month-old,” Dr. Costello said. “I have been doing all that I can to protect her. As a new mom, it certainly causes that increased worry.”