As the nation grapples with an increase in respiratory illnesses that sicken very young children and infants, the high demand for inpatient and pediatric intensive care unit beds means that children are spending days and weeks in emergency rooms designed for short-term evaluation and treatment. .
The surge has hit states in the East and Southeast particularly hard, with DC, Maryland and Virginia reporting the highest incidence of flu-like illnesses, including RSV, according to Centers for Disease Control and Prevention data.
Pediatricians last week asked President Biden and Xavier Becerra, the secretary of the Department of Health and Human Services, to declare an emergency to give health care providers and hospitals more flexibility to care for sick children.
The letter from the heads of the Children’s Hospital Association and the American Academy of Pediatrics says that in some states, more than 90 percent of children’s beds are full, meaning more kids like Jordan will languish in emergency departments and makeshift rooms.
A spokeswoman for the CHA said talks with the administration and Congress are continuing, but no further action has been taken yet.
Experts say the high demand for pediatric ICU beds is due to the early onset of RSV making children sicker than usual, along with the start of flu season and the continued spread of the new coronavirus on top of an overall decline in pediatric beds and chronic labor shortages.
“It’s not fair that an ER doctor has to decide which child I’m going to put to bed,” Maeng, 42, said. “The system is not working.”
Theodore R. Delbridge, the governor-appointed chief of a Maryland state agency responsible for coordinating emergency management systems statewide, saw this coming. A year ago, clinicians reported an increase in RSV, or off-season respiratory syncytial virus, and feared flu and covid spikes could overwhelm the system.
He expanded C4, the government-funded Critical Care Coordinating Center, which was established in December 2020 to find intensive care beds for adults with covid, into a pediatric call center called C4 Pediatrics. Two physicians with pediatric expertise and two clinical coordinators with a bird’s-eye view of pediatric inpatient and intensive care bed capacity across the region are on call at all times from physicians seeking transfers for their critically ill patients.
The pediatric unit was staffed in October 2021, but to his surprise, Delbridge said, it wasn’t very busy, with only about 20 calls per month, peaking at 64 calls in June.
“That all changed in September,” he said.
Children’s hospitals in the DC area have reached capacity
The center handled 194 pediatric requests that month and more than triple that — 639 — in October, including nearly 600 for respiratory illnesses, Delbridge said. The center is also on track for a busy November, with 359 calls as of Tuesday afternoon.
“The last few weeks have been constant calls,” said Jennifer Anders, medical director for C4 Pediatrics and a pediatric emergency physician at Johns Hopkins Children’s Center. “As soon as one ends, the other starts for a 12-hour shift. It’s pretty unrelenting.”
Calls typically come from emergency department physicians at community hospitals who may be treating RSV patients with intravenous fluids and high-flow oxygen to support open lungs, interventions that require the constant monitoring available in an intensive care unit at the best of times department .
Patients are usually very young, with most being less than 5 years old, Anders said. They struggle to breathe and cannot interrupt the struggle for breath long enough to drink, leaving them dehydrated. Most recover with treatment, but they may get worse before they improve, or their condition may deteriorate rapidly.
Doctors are advocating calling call center employees who categorize patients by low, medium and high severity and repeatedly calling hospitals in Maryland, DC and Virginia, as well as Delaware, West Virginia and Pennsylvania, seeking beds. In the meantime, doctors offer treatment guidance, knowing that patients may never end up in ICU beds.
“The system is overwhelmed,” Anders said. Sometimes with a patient in dire need, a doctor will activate a pediatric transport team or call a colleague’s cell phone — whatever it takes, she said.
“They all look sick; they all need ICs,” she said. “My goal with C4 Pediatrics is that no child dies in a community hospital while waiting for an intensive care bed.”
In September, when a seemingly simple cold caused Jordan’s oxygen saturation to plummet, paramedics rushed him by ambulance to Adventist HealthCare Shady Grove Medical Center in Rockville. It took doctors all night to find the boy in a pediatric intensive care unit. At 3 a.m., he was transported to Sinai Hospital in Baltimore, where he remained for the next four days.
Then, on October 11, his oxygen levels dropped again and his mother rushed him to the nearest emergency room, Holy Cross Hospital in Silver Spring. He was diagnosed with RSV and assigned an emergency room with a small bed for him and later a small recliner where Maeng slept, and did not leave until her husband could relieve her after his day at work.
“It was miserable,” she said. “I have never seen my son look so down, sad and depressed. You’re in this tiny room, different doctors coming in all the time. Only visits from his siblings Katelin, 7, and Michael, 4, seemed to cheer up the boy, who goes by “JoJo”.
Holley Meers, the chief of emergency medicine at Holy Cross Hospital, declined to speak about a specific case, including that of the Maeng family, but said her staff are making adjustments, such as setting aside drugs that are measured by the weight of a child, pediatric gowns and oxygen supply tube, to care for children awaiting transfer.
“We are going to care for patients as long as they need care – if that means in our hospital, [then] that’s what we’re going to do,” she said. “If there are no beds available, the care continues.”
The ER was not an ideal place for Jordan, who turned 6 after this stay. In addition to the discomfort and small groups, the constant comings and goings of several doctors and nurses meant that his mother had to constantly explain his situation and unique needs.
Friends, relatives, and their church community came by with gift cards for hot meals, allowing the family to skip meals in the ER.
Maeng saw doctors first move a child who was even sicker than her son to a PICU bed, a decision she said she understands given the condition of the other child. She said a doctor explained to her that “there is literally no pediatric intensive care bed to be found in the entire DMV area.”
Doctors eventually found a bed for Jordan in Baltimore’s Sinai, where he stayed for a second time for another four days. Once home, his face was rubbed raw by the high-flow oxygen cannula used to assist his breathing, and being confined to a hospital bed affected his gait; he walked like a penguin for a few days, Maeng said. Now he takes a daily steroid to keep his lungs open and avoid another ER visit.
Maeng said their Christian faith helped her family see a higher purpose in the suffering her middle child was going through.
“Even though it was a crazy stay, seven days, I’m grateful,” she said. “I can share our story and bring light to the situation right now.”