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 required intensive care. But these days, Massachusetts pediatric intensive care units 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 really, really sick kid,” Gibson said.
Eventually, the UMass Memorial Medical Center, where Gibson also serves as Chief Physician of Children’s Hospital Medicine, found a place for this baby.
“We called every hospital within 200 miles and they all said, ‘We don’t have a bed.’ “
dr Tim Gibson, UMass Memorial Hospital
Another child would have to wait a little longer for treatment. These are the kinds of decisions doctors are making as a surge in respiratory syncytial virus (RSV) cases is straining hospitals across Massachusetts, forcing them to adopt new strategies to cope with the surge in young patients.
Hospitals are canceling surgeries to make room for children with respiratory illnesses. Some rooms will be repurposed to accommodate more patients. And they ask tired doctors and nurses to work extra shifts.
As they struggle to respond to RSV, they are also preparing for a surge in the flu. And COVID continues to spread.
RSV is an old virus, but it’s hitting with renewed vigor this year — at least in part because fewer people are wearing masks than the previous two winters.
The virus is usually mild. But it can be serious for children with heart or lung disease and for newborns with tiny airways. Some patients are only a few days old.
“The rush just keeps coming,” Gibson said. “It was the worst thing I’ve ever seen.”
Sometimes there are no pediatric intensive care unit beds anywhere in Massachusetts and they have to be moved to another New England state. Other children wait hours in crowded emergency rooms for hospital staff to find a bed for them.
State officials have relaxed some regulations to help hospitals free up space for more patients.
In hospitals in the Mass General Brigham system, some juvenile patients remain in adult wards. And some older babies are treated in intensive care units, normally reserved for newborns, for the first few days of life.
Boston Children’s Hospital keeps some patients overnight in rooms typically used for short-term recovery from surgery.
And the UMass Memorial’s pediatric wing borrows a few beds from a nearby adult unit.
Worcester Hospital is also increasing the capacity to treat the sickest of patients by offering at least one element of critical care outside of the ICU. The treatment, called high-flow nasal cannula, blows humidified oxygen through tines that are inserted into a child’s nose.
“Our census — it fluctuates by the minute, by the hour, by the hour, but we were full,” said Dr. Larry Rhein, Chair of Pediatrics at UMass Memorial. “It’s a revolving door who it is, but it’s always packed.”
Children who develop a lung infection, pneumonia, or inflammation known as bronchiolitis from RSV usually improve after a few days of treatment with oxygen and fluids.
Rhein said staff are trying to treat patients quickly, send them home and make room for more.
One way to do this is to take certain recovering patients to a playroom filled with books, toys, and games. Children can play here – under supervision – until their families are ready to take them home.
“That will free up their bed space for the next little infant that needs to come in, that needs to be monitored and cared for,” Rhein said.
“All of this is happening in the context of what was initially an extraordinarily overcrowded healthcare system.”
dr Paul Biddinger, Mass General Brigham
Each day at UMass Memorial, there are typically about a dozen children waiting for a bed in the emergency room.
For pediatricians, this crisis feels eerily like the early pandemic days of 2020, when hospitals were flooded with COVID patients. Now they are RSV patients.
But hospitals are under greater pressure today, said Dr. Paul Biddinger, who directs emergency preparedness for Mass General Brigham. They are struggling with a shortage of medical staff and an increase in sick patients.
“All of this is happening in the context of an extraordinarily overcrowded healthcare system at the outset,” Biddinger said. “This is very different from when we went into the pandemic in March 2020 with a stretched healthcare system – but one that didn’t have the levels of overcrowding we see today.”
Massachusetts has about 1,000 children’s hospital beds, and fewer than 150 of those are for children who need critical care, according to the state Department of Health. Those intensive care 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 intensive care unit beds. Boston Children’s, meanwhile, opened a new stationary tower.
At Boston Children’s, the largest children’s hospital in Massachusetts, command center staff are on the phone throughout the day to manage the flow of patients in the area.
dr Sara Toomey, the hospital’s chief safety and quality officer, said doctors and nurses are working to screen for the sickest children and see them quickly.
“We really try our best to make sure every child gets the care they need,” she said. “Admittedly, it could take a little longer.”
Boston Children’s expanded its emergency department to accommodate the influx of patients by leasing space from a day clinic.
“We’re overloaded a lot of the days and we’re using every possible space we have,” Toomey said.
Doctors have noticed a drop in RSV cases in recent days. But the capacity crisis has not eased.
And even if the RSV decreases, the flu will likely increase.
“We anticipate that this will probably continue realistically into the spring,” Toomey said. “So [we’re] Think and plan actively to ensure we can support our community by the end of April.”
There is no approved vaccine against RSV. But doctors are urging people to stay up to date on flu and COVID vaccinations to help reduce the spread of other respiratory illnesses throughout the rest of the fall and winter.
And while medical groups aren’t pushing for mask requirements, they are urging people to at least consider wearing masks in crowded indoor spaces.
“Anything people can do — wash their hands, wear masks, get vaccinated — will help,” said UMass Memorial’s Rhein.
“We work really incredibly hard and want to be available. And we are. But it will need everyone’s help.”