CDC, the flu, RSV, and Covid are taking a toll on health care systems in the last few years: How the US hospital system is dealing with the epidemic
The problem goes beyond making everyone feel sluggish and icky. CDC director Rochelle Walensky has confirmed that the flu, RSV, and Covid are putting stress on US hospital systems. Measures to save lives, including social distance and mask-wearing, curbed the spread of flu and other respiratory illnesses in 2020. (Although there was a warning sign in 2021, when RSV cases in the US had an out-of-season uptick over the summer, an indicator that things were shifting in the wake of Covid.) Now these viruses are roaring back, and hitting a burned-out health care system that’s spent three years treating Covid infections.
Temperatures are dropping and the risk of COVID-19 and influenza are up. Respiratory syncytial virus patients have been overwhelming hospitals for the last few months. Public health officials are concerned that there could be a “Tripledemic” during the winter.
Hensley says that this is because the population “is more immunologically naive than what we would expect in most years”. The children get infections by their second birthday. Now you are going to have kids who have never seen the movie, which will be three, four, year olds.
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“We’ve been strapped, and hospitals have sort of been functioning at the edge of how they can function. We’re seeing more people requiring help and fewer beds available, largely due to staffing needs,” explained Kalu. This combination is going to cause a lot of problems.
In the advisory, hospitals were guided to keep heightened awareness for these more severe infections when treating pediatric patients, and parents were instructed to keep an eye out for specific symptoms, like difficulty breathing and the sudden onset of limb weakness.
She said it’s good for you to speak with your provider about your symptoms. If a child has breathing issues, or can’t drink or eat food, you need to make sure they see a doctor to assess the situation, and if they need help.
When Amber Sizemore and her family went out of state to celebrate her birthday last week, she had hoped her toddler daughter, Raegan, would try swimming. The 15-month-old was not herself on Saturday.
Sizemore took her to urgent care after she didn’t feel better and he told them that she was going to work at Raegan’s day care.
As soon as they saw her vitals, the staff at UH Rainbow Babies & Children’s Hospital in Cleveland knew they had to admit Raegan, her mom said. She needed oxygen.
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An infected person can pass on RSV through a cough or sneeze. Respiratory droplets can land on the surface of a desk or a doorknob, and if someone else touches it they can get sick.
The US Department of Health and Human Services does not specify the reason for hospitalization, but about three-quarters of pediatric hospital beds available nationwide are being used now. By comparison, pediatric hospital beds were about two-thirds full on an average day over the past two years.
With the RSV surge, UH Rainbow Babies has had so many patients, it went on diversion for a couple of days in early October, meaning it couldn’t take external emergency admissions. Its still taking patients, even though it’s still slammed with RSV cases.
There has been such such a dramatic increase in cases in Connecticut that Connecticut Children’s Hospital has been coordinating with the governor and public health commissioner to determine whether it should bring the National Guard in to expand its capacity to care for these young patients.
Zoey Green said that she couldn’t figure out how she slept with ice packs on top of her. She said they’re trying to keep her hydrated so she doesn’t have to go back on an IV.
She said that the community is very full and that they are working through how to accommodate sick kids.
Staff at the UH Rainbow Babies are hoping things don’t get worse. “I mean, I hope we’re peaking right now, because if we’re not, then holy hell,” said Dr. Amy Edwards, associate medical director for pediatric infection control.
What do parents feel about the recent outbreaks of the coronavirus in Grand Rapids, Mich., on November 14 – 23rd
When everyone stayed home in 2020 and 2021 to prevent the spread of the coronavirus, it seemed to change the typical RSV season. There was an immunity gap because case counts were low.
Adults tend to think it is nothing more than a cold or allergies when they have it, or they think it is simply a mild illness and just go on with their lives.
“It’s not a fatiguing virus the way influenza or Covid is, so you really do feel fine,” Edwards said. “And then what happens is, your neighbor has that beautiful baby, and you bring over a casserole, and you kiss that little baby because you feel fine. You don’t feel sick. Sometimes they end up at the hospital because you pass it on to them.
Davis, the head of the children’s hospital in Grand Rapids, said hand hygiene is the most important thing to keep ourselves and others safe. She told people to not touch their faces until they washed their hands.
She said that if you are sick, you should stay home and not spread the illness.
“I would like other parents to know they shouldn’t watch their child’s cough lightly and take symptoms seriously,” she said. If we didn’t have Raegan help, this could have been a lot worse.
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Van Sorge says that the hope is that this surge will return to their normal seasonal pattern once community levels of immunity are strengthened. “I would sincerely hope that after this surge, kids will have been exposed again, they will build up immunity — and that’s it.”
“And now we’ve seen a rapid decline (in RSV),” said Smith. The Covid rise, which happened a little bit later and a little bit slower, has been superimposed on by the very rapid rise in influenza.
Madhavan said on Friday that he hoped this was not the new normal. “But for this year, it is concerning because it’s still only late October and we don’t know what we’re going to see as we head deeper into fall and especially this winter.”
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The problem is that their small lungs and muscles can’t muster up the power to cough up or sneeze out the increased secretions and mucus caused in their airways.
“They have trouble breathing because they don’t have enough fluid to get out, and that causes them problems in eating and drinking,” Madhavan said.
Keeping hands away from the face, staying hydrated, and washing your hands are some of the things the health officials say help prevent the spread of the disease.
She suggested not being shy about grilling others about how they’ve been feeling. The other person on the other end don’t think to say if they have had a minor cold because they don’t think of it as a serious problem. But that could become a serious case of RSV for an infant or a toddler, she added.
The easiest way to stay healthy during the fall and winter months is to get your updated COVID booster vaccine, according to Madhavan.
Anyone over six months old can get the flu vaccine. It takes a few weeks for the shot’s full protection to take effect. She said a child needs two shots one month apart before they get the full protection from the vaccine.
The COVID bivalent boosters for people 5 and older became available in September. Children over six months can get the three available COVID-19 vaccines. “Don’t wait to get the booster until we’re in the middle of another COVID wave,” says Madhavan.
There is, however, a treatment called palivizumab that is available to high-risk infants. It is an injection that can be given to premies and other babies born with certain lung or heart conditions who are at high risk for severe RSV disease. It is administered once a month throughout the RSV season.
There are vaccines for both the flu and Covid, but not forRSV. All three of the viruses present the same symptoms, so testing is required to determine which is more likely to cause disease and recommend treatment.
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Some children are not routinely given palivizumab. Part of that is due to the possible, more serious side effects associated with the drug, which include swelling of the throat, difficult or rapid breathing, muscle weakness, and unresponsiveness.
It is best to call your doctor or nurse if you are unsure whether the disease is serious or not, rather than going to the hospital, where the risks of being exposed to other infections may be greater.
Madhavan said that in most cases, health care professionals can go through a checklist of warning signs and make suggestions for potential at-home treatments.
“Based on that information they can recommend that you start doing nasal saline drops, use a humidifier or shower, or do other things to help loosen up mucus and decrease congestion,” she said. “If it’s a child older than one, they may say try honey to help with a cough or give suggestions on how to bring down a fever.”
But, Madhavan warns, it may be time to seek more intensive care when an infant or young child is working extra-hard to breath. The skin between or below the ribs and collarbone can pull into and out of the nostrils and other area of the body.
Seventeen states, Washington, DC, and New York City, are reporting high or very high respiratory illness activity amid a flu season that’s hitting harder and earlier than usual, according to data published Friday by the US Centers for Disease Control and Prevention.
It has been more than a decade – since the H1N1 swine flu pandemic – since flu hospitalization rates have been this high at this point in the season. The latest CDC update tracks data through October 29.
There are more than one in five available beds in seventeen states. The five that are full are Rhode Island, Arizona, Maine, Minnesota and Delaware.
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We are more vulnerable to these viruses since COVID-19 restrictions. What’s behind the current surge in the Northern Hemisphere, and what will the new normal be?
He said it was hard to know what was going to happen now that both of these may have peaked.
In August 2021, researchers in France coined the term ‘immunity debt’ to describe this reduction in population-level immunity. On Twitter, the term has taken on a life of its own. Matthew Miller, an immunologist at the University of Hamilton, Canada, calls the idea that a lack of exposure to infections such as theRSV andInfluenza has irrevocably damaged the immune system nonsense.
Another open question is how these viruses compete and interfere with one another. It is possible for an innate immune response to prevent the spread of another virus if you are bitten by a single virus. Hensley points out that last year’s first wave of influenza declined soon after the Omicron surge began. Maybe Omicron provided short-lived protection against flu. Or maybe the Omicron surge simply convinced people to mask up and keep their distance.
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Pitzer expects that next year’s peaks and valleys might look much more like those that occurred before the pandemic. She isn’t placing any bets. She thinks this winter is going to be the last unusual one.
One theory is that lack of exposure to group A Streptococcus (strep A) during lockdowns at the height of the COVID-19 pandemic means that young children lack immunity against the bacteria. But it is too early to say for certain if this is behind the strep A surge, says molecular microbiologist Claire Turner at the University of Sheffield, UK.
Sriskandan says that this is the first time in decades that a peak like this has ever happened at this time of year.
In rare instances, strep A can lead to a more serious condition called invasive group A streptococcal infection, particularly in people with compromised immune systems. This can cause conditions including meningitis, toxic shock syndrome and necrotizing fasciitis, a swiftly progressing infection of the tissue under the skin that is sometimes called flesh-eating disease.
Social mixing and scarletfever have increased in 2022, but they were already there. Rates did not fall as expected this year. There were brief lulls when schools were closed for holidays, but the number of cases still went up.
Those numbers don’t show the true extent of strep A infections in the country, says Sriskandan. She says that scarlet infectious disease is the starting point of the whole problem of sore throats. This is a very clear sign of what is happening in the community.
Turner and her team are hoping to use tonsil cells grown in the laboratory to evaluate samples from the surge. They are hoping to learn more about the different strains and how they interact with one another.
Across the country, overflow health care workers are struggling to catch their breath as hospitals fill with sick patients battling a trifecta of respiratory illnesses – Covid-19, RSV and the flu.
The situation at UC San Diego Health is so bad the hospital had to set up tents in parking lots for patients to be taken to other hospitals. The hallways in the emergency department are also full of temporary beds for patients who were admitted but are awaiting hospital beds.
“We have not had to reconfigure conference room space to care for patients even during the Covid pandemic,” said Longhurst, who explained that UC San Diego Health has experienced an equal number of Covid patients as patients with other respiratory viruses. These are not normal times.
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The cumulative number of immunity we all have is the most powerful factor according to Dr. Edward Jones-Lopez, infectious disease specialist at the University of Southern California.
He said that despite evidence of safety and efficacy, there are still many people who are not getting their vaccinations.
“I’ve seen one case of three infections occurring at the same time,” said Jones-Lopez. “These are independent viruses that can infect the same individual and, obviously, the more viruses, the more infections you have … the higher the risk of one of them leading to more serious disease.”
Health departments in New York, Los Angeles and Seattle have advised people to wear masks due to the spike in the number of viruses.
Smith said that if you have an illness that makes you particularly susceptible to infections, it’s a good idea to wear a mask. “It’s the best protection that we have for anyone else who is concerned about transmission.”
For Americans across the country preparing to gather and socialize with family and friends during the end-of-year holiday season, the White House has a clear warning: Covid-19 is not over, and you had better protect yourself.
The White House is launching a public campaign on Thursday to prepare Americans for a rise in Covid-19 cases this winter, according to an interview with CNN.
The Biden administration’s renewed push to encourage people to use all of the necessary tools available to keep Covid-19 at bay – getting vaccinated and boosted, making use of tests and treatments and masking up when necessary – are all part of achieving what Jha said is the White House’s ultimate goal: preventing serious illness, hospitalizations and death.
Each American household is able to order up to four free Covid-19 tests this winter as a result of the administration restarting the free at- home test program. It is also offering federal resources to local health departments, putting an extra focus on high-risk individuals including by providing a winter playbook for nursing homes and other long-term care facilities, and permitting nursing home staff to administer vaccinations.
Jha declined to predict how many Covid-19 cases there might be this winter, but said data from the past few weeks make clear that numbers have been on the rise, likely driven in part by indoor gatherings during the Thanksgiving holiday and the beginning of the winter holiday season.
Dr. Leana Wen: It’s always important to stay healthy, and particularly so before the holidays. Even though people aren’t so worried about getting sick, they want to miss events for fear of beinginfecting elderly loved ones and spreading diseases to other family and friends.
There are currently specific and more conservative guidelines from the CDC for what an individual should do if they test positive for Covid-19, including isolating from others, than for if one catches the flu or RSV. Jha said that has to do with the fact that the spread of RSV and the flu largely happens when a person is symptomatic, whereas Covid-19 can be transmitted a lot more even when a person is asymptomatic.
He is encouraging Americans to follow the simple rule of thumb when it comes to sickness: if you are sick, stay home.
If you do believe you have Covid-19, it is not wise to cough your way through the family holiday dinner unless you are sure you have it.
To prevent an increase of flu and Covid-19 cases over the next few weeks, health care workers want families to take precautions including wearing masks in crowded indoor settings and washing their hands frequently.
To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
You should identify which gatherings are most important to you. The first events need to be counted backward. For about five days to a week before that first event, try to reduce your risk of catching respiratory viruses as much as possible.
After touching frequently used surfaces, there should be frequent hand washing. Wear a high-quality N95 or equivalent mask in all indoor crowded settings. Try to reduce the number of social gatherings during this time.
Wen: Many respiratory infections like influenza, RSV and the common cold are primarily spread through droplets. Droplets are expelled when someone coughs or sneezes. Good hand hygiene is important, as is encouraging people not to attend if they are sick.
The coronaviruses are found in the air and spread through aerosols. Good ventilating can help to reduce the spread of respiratory viruses. If you live in a warm weather environment, consider hosting your gathering outdoors — that will be lower risk than indoors.
If outdoors is not possible, consider your setting. Can you find a larger space where people are not required to cluster close together? Is it possible to keep windows and doors open and use the same type of filters for better air quality?
For Covid-19, having everyone take a quick home test the same day can be used to reduce risk. You may choose to provide the tests at the door to better ensure that everyone takes one.
Wen: Expect that airports, train stations and bus depots will be quite crowded during the holidays and plan ahead to reduce your risk in these crowds. I strongly recommend masking in these settings if you want to be safe during the holidays. If you have returned to normal activity after taking a break, it’s a good idea to get your mask out again so you can attend holiday celebrations.
High-quality respiratory masks, such as N95, KN95 or KF94, are very protective against droplets. Have you already figured out which masks you can wear during transit? If one of them gets bent out of shape, you should bring several with you.
You should wear masks the entire time as you travel around a lot of people. For those who find masks uncomfortable, wear them at the highest risk settings, for example, when packed with other people waiting to board the plane.
The calculation may be different for people who are vulnerable. These people may need to gauge the events on their own. If a crowd of people are gathered for a New Year’s Eve party, it is riskier than if a few people are taking a Covid-19 test at the door.
People who are particularly vulnerable should clarify the precautions in advance with the hosts. If the event turns out to be more risky than they expected, they should be free to leave.
Wen: This is a very important point. Everyone should have a plan for what happens if they develop a viral illness while traveling. The US Centers for Disease Control and Prevention has a list of things that a Covid-19 plan looks like. If you have enough home tests and have a plan for treatment, then you should be able to get Paxlovid, as well as speaking with your doctor about your high-risk status.
There are possible signs of relief. The week after Thanksgiving, the worst of the season that hit post-Thanksgiving, the number of flu hospitalizations improved as test positivity rates declined and new hospitalizations started to fall.
The Colorado Hospital Association said it was deactivating the combined hospital transfer center because cases have stopped, which makes it less likely that young patients will be transferred to other hospitals.
“Colorado hospitals are prepared to employ our capacity management tools, including the CHTC, if we face another surge,” Jeff Tieman, the Colorado Hospital Association president and CEO, said in a statement.
Group A Strep infection as a virus complication of a viral infection and the Covid-19 pandemic, O’Leary said
“You can get an invasive group A strep infection without having an underlying viral infection, but often they also happen as a complication of a viral infection,” O’Leary said.
Our health system is not prepared for big epidemics because of how it operates. That was what we witnessed during the Covid-19 Pandemic. And further investment, of course, in public health is always something that’s a good idea, and we see that with emergencies, like the pandemic, but as you’ve probably seen, as the emergency abates, that funding dries up pretty quickly, and then we wait till the next time that something happens,” he said.
All staff and clinic physicians are included in that, as well as a lot of people who are also working at other places. “So people are really stepping up to the plate to meet the need right now, but yeah, we could certainly use a breather.”