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2022 pediatric care crisis

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2022 pediatric care crisis
Electron micrograph of Respiratory Syncytial Virus (RSV), one of the primary drivers of the 2022 pediatric care crisis.

In the waning months of 2022, the first northern hemisphere autumn with the nearly full relaxation of public health precautions related to the COVID-19 pandemic, hospitals in the United States and Canada^[1] began to see overwhelming numbers of pediatric care patients, primarily driven by a massive upswing in Respiratory Syncytial Virus (RSV) cases, but also flu, rhinovirus, enterovirus, and SARS-CoV-2.^[2] As of November 7, the United States is facing epidemics of flu, RSV, and COVID-19 in children;^[3] the Public Health Agency of Canada's FluWatch surveillance program declared the flu an epidemic November 14, noting a spike in pediatric flu hospitalizations above expected levels.^[4]

With high levels of hand-washing, masking, and social isolation during the early years of the pandemic, children born during this period had particularly low levels of exposure to the RSV and other seasonal viruses, with public health professionals reporting extremely low levels of RSV transmission in 2020 and 2021. In contrast, 2022 evidenced a dramatic reversal.^[5]

Starting in September 2022, many emergency departments and intensive-care units in the United States have been either at-capacity or over-capacity, with a variety of hospitals resorting to extreme measures which have included the use of a makeshift tent outside Johns Hopkins Children's Center in Maryland and the proposed deployment of the National Guard in Connecticut.^[2]

Additionally, with cases of RSV at 300% more than would be expected in a normal season and rising numbers of adult infections together with increased COVID-19 hospitalizations, some public health professionals have expressed alarm at the potential for spillover into a widespread medical crisis, not confined solely to pediatric care.^[6][7] Medical professionals have also posited that, since most children have had one or more SARS-CoV-2 infections by late 2022, COVID-19 may have affected children's immune systems in yet-to-be-determined ways.^[8]

Timeline[edit]

The crisis had no clear start date, as multiple disease outbreaks occurred over the course of 2022, with cascading effects on healthcare systems already burdened by the ongoing pandemic. Notably, staffing shortages led commentators in the US to say that the system was "crumbling" in August.^[9] While authorities at one health region in Ontario spoke of "serious" and "unprecedented" challenges in September.^[10] In Canada, warning signs appeared as early as July with a spike in enterovirus ("hand foot and mouth disease") cases^[11] which continued into August.^[12]

The pediatric care crisis in the United States began to be visible in statistics with high late-summer, August 2022 hospitalization numbers of children infected with rhinovirus and enterovirus, which are both acute respiratory illnesses and often indistinguishable without molecular sequencing or via a specific rRT-PCR assay.^[13]

RSV then began to see its exponential rise to the top of pediatric infections in September and October 2022, with mid and late-autumn SARS-CoV-2 and seasonal flu infections increasing the pediatric care burden later into the year. By mid-autumn, flu cases had already shuttered schools and reactivated remote learning in parts of the American South and mid-Atlantic.^[2]

On October 26, the Government of Canada issued an advisory that Canada was experiencing a shortage of children's acetaminophen and ibuprofen due to the spike in infections.^[14] By late October, staff infections with respiratory illnesses had compounded the previous staffing shortages in Ontario causing many emergency rooms and other departments at multiple hospitals to close.^[15] In the USA staffing shortages and the spike in infections saw 80% of pediatric beds full nationally, with the worst numbers being in Rhode Island where beds were 99% full, causing some hospitals to set up field tents.^[16]

As of early November, 75% of beds in US children's hospitals were full and the crisis had spread to eastern Canada, with a children's hospital in Ottawa reporting over 130% capacity for both intensive care and inpatient beds. On November 1, 2022, California's Orange County declared a pediatric health emergency after seeing record-breaking numbers of children enter emergency rooms in the county's hospitals.^[8] At the same time over fourteen thousand students were out of school due to illness in the Edmonton region of Alberta.^[17] By November 5, Emily Gruenwold, president and CEO of Children's Healthcare Canada said that "across the country, almost without exception, our children's hospitals are all running at 100 percent occupancy or more" in part because the shortage of over-the-counter painkillers that could suppress fevers lead more parents to bring their sick children to hospitals.^[18]

On November 14, the Children's Hospital Association and the American Academy of Pediatrics wrote a joint letter to President Biden and Health Secretary Xavier Becerra, asking that the administration declare an emergency that would unlock funding and regulatory flexibilities akin to the ongoing COVID-19 emergency. This request came as RSV hospitalizations reached seven times pre-pandemic levels among infants 6 months and younger and flu hospitalizations were the highest in a decade.^[19] One US state, Oregon, had already declared a public health emergency related to the pediatric care crisis several days prior to the national appeal.^[20] The US Department of Health and Human Services decided against a national emergency declaration at the time, deciding to instead support struggling communities on a case-by-case basis.^[21]

Coinfections[edit]

While coinfections have always been a possibility in pediatric medicine, SARS-CoV-2 has made coinfection with multiple viruses much more common, with doctors reporting back-to-back hospitalizations and children presenting with upwards of four distinct respiratory viruses in the span of a single month.^[2]

References[edit]

1. ^ Shingler, Benjamin. "What to know about RSV, a virus surging among young children in Canada". CBC News.
2. ^ Jump up to:^a b c d Wu, Katherine (31 October 2022). "The Worst Pediatric-Care Crisis in Decades". The Atlantic. Archived from the original on 31 October 2022. Retrieved 1 November 2022.
3. ^ Tanne, Janice Hopkins (2022-11-07). "US faces triple epidemic of flu, RSV, and covid". BMJ. BMJ: o2681. doi:10.1136/bmj.o2681. ISSN 1756-1833.
4. ^ "FluWatch report: October 30 to November 5, 2022 (week 44)". Public Health Agency of Canada. 2022-11-14. Retrieved 2022-11-14.
5. ^ Roth, Clare (27 October 2022). "Doctors say respiratory infection RSV may surge this winter". Deutsche Welle. Archived from the original on 31 October 2022. Retrieved 1 November 2022.
6. ^ Ponder, A’Leeyah (31 October 2022). "RSV cases surging in adults". WFIE 14 News. Archived from the original on 1 November 2022. Retrieved 1 November 2022.
7. ^ Gawthrop, Elisabeth; Clary, Benjamin (28 October 2022). "Uptick in COVID-19 hospitalizations and a surge in RSV cases in Minnesota". MPR News. Archived from the original on 31 October 2022. Retrieved 1 November 2022.
8. ^ Jump up to:^a b Prater, Erin (1 November 2022). "Viral infections like RSV, the flu, and COVID have one Southern California county declaring a pediatric health emergency. It's far from alone". Fortune. Archived from the original on 2 November 2022. Retrieved 2 November 2022.
9. ^ J.D, Sai Balasubramanian, M. D. "The Healthcare Industry Is Crumbling Due To Staffing Shortages". Forbes. Retrieved 2022-11-02.
10. ^ "Health-care worker shortage presenting serious challenge to Niagara hospital system - Niagara Health News, Updates & Publications | Niagara Health System | Système De Santé De Niagara". www.niagarahealth.on.ca. Retrieved 2022-11-02.
11. ^ "Hand-foot-and-mouth disease outbreaks higher than in years past: AHS - Edmonton | Globalnews.ca". Global News. Retrieved 2022-11-02.
12. ^ Sweet, Jennifer. "Doctors see hand, foot and mouth disease make comeback in N.B." CBC News.
13. ^ "Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68 – Multistate, 2022". CDC Health Alert Network. Centers for Disease Control and Prevention. 9 September 2022. Archived from the original on 31 October 2022. Retrieved 1 November 2022.
14. ^ "Infant and children's acetaminophen and ibuprofen shortage". www.canada.ca. 2022-10-26. Retrieved 2022-11-02.
15. ^ "Ontario hospitals continue to deal with significant staffing shortages | Globalnews.ca". Global News. Retrieved 2022-11-02.
16. ^ Christensen, Jen (2022-10-28). "Staff shortages make patient surges harder for children's hospitals -- and the situation won't get better soon". CNN. Retrieved 2022-11-02.
17. ^ "14K+ Edmonton students off sick as respiratory illnesses spike in region | Globalnews.ca". Global News. Retrieved 2022-11-07.
18. ^ "'We are so overwhelmed': Children's hospitals across Canada stretched as RSV cases, flu-like illnesses spike". CTVNews. 2022-11-05. Retrieved 2022-11-07.
19. ^ Kimball, Spencer (18 November 2022). "Children's hospitals call on Biden to declare emergency in response to 'unprecedented' RSV surge". CNBC. Archived from the original on 21 November 2022. Retrieved 21 November 2022.
20. ^ Rideout, Nicole (15 November 2022). "Oregon governor declares RSV in children a public health emergency". OHSU News. Archived from the original on 19 November 2022. Retrieved 21 November 2022.
21. ^ Weixel, Nathaniel (25 November 2022). "White House resists declaring emergency as flu, viruses surge in children". The Hill. Archived from the original on 25 November 2022. Retrieved 26 November 2022.