Connecticut’s two children’s hospitals, already grappling with a spate of respiratory syncytial virus cases in young children, are bracing for flu cases to surge as colder weather arrives and patient testing capacity increases.
“We remain at full capacity, and with rare exceptions, we’ve been pretty much at full capacity for the last three months,” said Dr. Juan Salazar, chief medical officer at Connecticut Children’s Medical Center. “The emergency room was bursting at the seams, and our intensive care unit was almost always full.”
“In the last six weeks we’ve been overwhelmed, which means we’ve had an average of 15 to 20 children who needed to be admitted … but they couldn’t be placed in one of our inpatient beds,” he said. “So they stay in our ER bays and wait for a bed to open to take them upstairs.”
RSV cases remain high, but flu cases are also on the rise. In October, Connecticut Children’s had 42 cases of the flu. In the first two weeks of November, the hospital recorded 216 flu cases.
Connecticut Children’s had 355 RSV cases in October and had seen 232 as of November 15.
“We’re seeing a shift toward influenza,” Salazar said. “Predictive models suggest that influenza will be the major player over the next four to six weeks.”
Cases of RSV and influenza are on the rise at Yale New Haven Children’s Hospital. In early October, the hospital had a week with RSV cases in the low 20s and another in the mid-40s, Dr. Tom Murray, associate medical director for infection prevention at Yale. But recently cases have been on the rise, with 89 recorded in the week ending November 12 and 79 reported the week before.
Yale had three cases of flu in the first week of November and nine in the second week, Murray said.
“By far the biggest concern is that influenza will accelerate rapidly and RSV will not decrease as quickly,” he said. “In the next few weeks it is very possible that we will have a lot of RSV and a lot of flu, which will strain our capacities. We have active surge meetings to try and decide how to handle this.”
Officials at Yale have met with Connecticut Children’s leaders to discuss regional efforts.
“Looking for active spaces, thinking of doctors and nurses who can do extra shifts, really doing everything we can to increase our capacity as much as possible,” Murray said.
In an email, Commissioner of Public Health Manisha Juthani did not provide details, but said, “The Connecticut Department of Health has been working with hospitals to address the number of pediatric inpatients with respiratory viral diseases.”
“A slightly smaller number of children with respiratory syncytial virus have been admitted in the past two weeks. We hope these cases have plateaued,” she wrote. “Flu cases have been increasing in the southern states in recent weeks, so the flu is now showing high activity in Connecticut as well.”
A month ago, under pressure, Salazar and others at Connecticut Children’s asked the state Department of Public Health to investigate the logistics of opening a field hospital with help from the National Guard. They considered setting up a tent outside of Connecticut Children’s, but instead decided to expand capacity inside the hospital.
“They came, they questioned; They said if we wanted the field hospital tent, we could have it,” Salazar said. “But we evaluated [it], and we thought it might be best to work within our walls. It gets cold, and while it’s very useful in a major emergency, it’s really not a useful place to keep pediatric patients.”
Connecticut Children’s typically has 45 emergency department beds, but officials have used patient rooms, hallways, and other areas to expand to 80 beds or more when needed.
“We added up to 10 flex beds … and then we placed additional beds throughout the ground floor in different units,” Salazar said. “Between the fast lane and the behavioral health unit, our main emergency department and the extension can even accommodate up to 90 beds at any time. It’s liquid.”
Although RSV is usually characterized by mild cold symptoms such as cough, fever, and runny nose, it can be severe in infants, young children, and older adults. It’s the leading cause of bronchiolitis — inflammation of the small airways in the lungs — and pneumonia in children under the age of 1, according to the Centers for Disease Control and Prevention.
Most patients admitted to Connecticut Children’s Hospitals are 2 or younger, officials said, and many are 6 months and younger.
Salazar identified three possible reasons for the increase in severe RSV cases this year. Isolation and precautions taken over the past two winters meant children were not exposed to typical seasonal viruses (mask requirements in schools were lifted in March this year) and lacked immunity. Pregnant women were also not exposed to as many viruses.
“A certain level of protection is afforded by maternal exposure to RSV or influenza or adenovirus or enteroviruses. Maternal antibodies affect the baby and are likely to have a protective effect on babies younger than six months,” Salazar said.
Many children have also been infected with COVID, he said, and even mild cases could affect their ability to fight off other illnesses.
“We know that about 85% of children have been infected with COVID,” he said. “Most of them were mild [cases], but this mild illness had an immunological effect that dampened or decreased these children’s ability to respond to a new infection with another virus. We’re investigating this right now, trying to understand post-COVID immunosuppression.”
The RSV strain spreading this year could also be more transmissible and virulent than previous strains, he added.
Doctors and public health officials are urging parents to get their children vaccinated against the flu and COVID. Though COVID hasn’t been a major concern for children’s hospitals lately, cases could also increase in the upcoming winter months.
“We are very keen for all parents to get these two vaccines up to date,” said Dr. Sten Vermund, Professor of Pediatrics at the Yale School of Public Health. “Many of us today don’t mask because the COVID incidence is low and because we’re vaccinated, but if there are children at risk who have severe asthma … or immunosuppression, they can continue to mask, physically distancing and avoiding groups, to keep them risk to a minimum.
“Everything we’ve learned with COVID can be applied to reduce the risk of other respiratory viruses.”
The state has commissioned TV and radio advertisements and created online alerts about COVID boosters and flu vaccines. Juthani said officials are also placing advertisements on billboards across the state and on CT Transit buses.
There is no vaccine against RSV, although vaccine development is ongoing.
“This increased hospital count should remind parents to get their children vaccinated against influenza and COVID-19,” Juthani wrote in an email. “Both vaccines are effective in preventing serious illness, hospitalization and death.”
Sick children should stay at home, she said. If they have to leave the house and have difficulty breathing, a mask is recommended.