‘The onslaught just keeps coming’: Hospitals scramble to respond to a surge in children sick with RSV

A room in the new cardiac intensive care unit at Boston Children’s Hospital. Jesse Costa/WBUR photo

Dr. Tim Gibson was working a shift at Winchester Hospital when he saw a 7-week-old baby with RSV struggling to breathe. The child needed intensive care. But these days, pediatric ICUs in Massachusetts are usually full. “We called every hospital within 200 miles, and they all said, ‘We don’t have a bed, do your best.’ And it was a real, real sick kid,” Gibson said.

Eventually, UMass Memorial Medical Center, where Gibson also works as chief of pediatric hospital medicine, found space for that baby, an another child would have to wait a little longer to receive treatment. These are the types of choices doctors are making as a spike in cases of respiratory syncytial virus, or RSV, strains hospitals across Massachusetts and forces them to employ new strategies to cope with the wave of young patients.

Hospitals are canceling surgeries to make room for kids with respiratory illness. They’re repurposing some spaces to accommodate more patients. And they’re asking tired doctors and nurses to pick up extra shifts.

As they scramble to respond to RSV, they’re also bracing for an uptick in flu. And Covid continues to spread. RSV is an old virus, but it’s hitting with new force this year — at least partly because fewer people are wearing masks than during the previous two winters.

The virus is usually mild. But it can be serious for children with heart or lung disease, and for newborn babies with tiny airways. Some patients are just a few days old. “The onslaught just keeps coming,” Gibson said. “It’s been the worst I’ve ever seen.”

Sometimes, there are no ICU beds for kids anywhere in Massachusetts, and they need to be transferred to another New England state. Other children wait in crowded emergency departments for hours until hospital staff can find them a bed.

State officials have loosened some regulations to help hospitals free up space for more patients. At hospitals in the Mass General Brigham system, some teenage patients are staying in adult units. And some older babies are being treated in ICUs typically reserved for newborns in their first days of life.

Boston Children’s Hospital is keeping some patients overnight in rooms normally used for short-term recovery from surgery. And the pediatric wing at UMass Memorial is borrowing a few beds from a nearby unit for adults.

The Worcester hospital is also increasing capacity to treat the sickest patients by offering at least one element of ICU care outside the ICU. The treatment, called high-flow nasal cannula, blows humidified oxygen through prongs placed in a child’s nose.

“Our census — it fluctuates minute to minute, hour to hour, but we’ve been full,” said Dr. Larry Rhein, chair of pediatrics at UMass Memorial. “It’s a revolving door of who it is, but it’s always full.”

Children who develop the lung infection pneumonia or inflammation known as bronchiolitis from RSV usually improve after several days of treatment with oxygen and fluids.

Rhein said the staff are trying to treat patients quickly, send them home and make room for more.

One way they plan to do this is by moving certain patients who recover into a playroom filled with books, toys, and games. Children can play here — with supervision — until their families are ready to bring them home.

“That will free up their bed space for the next young infant to come in, who does need the monitoring, and does need nursing attention,” Rhein said.

Each day at UMass Memorial, about a dozen children in the emergency department typically wait for a bed.

For pediatricians, this crisis feels eerily like the early pandemic days of 2020, when hospitals were flooded with Covid patients. Now, it’s RSV patients.

But hospitals are under more pressure today, said Dr. Paul Biddinger, who leads emergency preparedness for Mass General Brigham. They’re grappling with a shortage of health care workers and an increase in sick patients.

“All of this is occurring in the context of an extraordinarily overcrowded health care system at baseline,” Biddinger said. “This is very different than when we went into the pandemic in March of 2020 with a busy health care system — but one that did not have levels of crowding that we see today.”

Massachusetts has about 1,000 hospital beds for children, and fewer than 150 of them are for kids who need intensive care, according to the state Department of Public Health. Those ICU beds are spread across just five hospitals — three of them in Boston.

Tufts Medical Center closed all of its pediatric beds this summer, including 10 ICU beds. Boston Children’s, meanwhile, opened a new inpatient tower.

At Children’s, the biggest pediatric hospital in Massachusetts, staff in the command center make calls throughout the day to help manage the flow of patients across the region.

Dr. Sara Toomey, the hospital’s chief safety and quality officer, said doctors and nurses are working to triage the sickest kids and see them quickly. “We are really trying our best to make sure that every kid is getting the care they need,” she said. “Admittedly, it might take a little longer.”

Boston Children’s expanded its emergency department to accommodate the influx of patients, by borrowing space from a day clinic. “We’re over capacity on many days and are using every possible space we have,” Toomey said.

Doctors have noticed a dip in RSV cases in recent days. But the capacity crunch has not eased. And even as RSV declines, flu is likely to rise.

“We’re anticipating this to go on, probably, realistically, until the spring,” Toomey said. “So [we’re] thinking and planning actively to make sure we can support our community up through the end of April.”

There is no approved vaccine for RSV, but doctors are urging people to stay up to date on flu and Covid vaccinations to reduce the spread of other respiratory illness through the rest of fall and winter.

And while medical groups are not pushing for mask mandates, they are asking people to consider wearing masks, at least in crowded indoor spaces. “Anything that people can do — washing their hands, wearing masks, getting vaccinated — will help,” said Rhein, of UMass Memorial.

“We really are working incredibly hard, and we want to be available. And we are. But it will take everyone’s help.”

This article was originally published by WBUR 90.9FM on Nov. 23. The Reporter and WBUR share content through a media partnership.

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