'Hospitals are bursting at the seams': 5 physicians on the effects of the respiratory virus surge

About three years into the COVID-19 pandemic, and the word "surge" may fall on deaf ears. 

While COVID-19 alone isn't straining hospitals and staff to the same degree it was during earlier waves, capacity issues, workforce shortages and the nation's ongoing surge of respiratory viruses are now placing unprecedented pressure on the nation's healthcare system. 

For months, news of a respiratory syncytial virus surge — which mostly affected children — dominated headlines. Then came influenza's early arrival, which went on to become the worst flu outbreak in more than a decade. While both of those respiratory viruses have likely peaked, hospitals may see subsequent surges in the aftermath of holiday gatherings. Meanwhile, COVID-19 is still keeping an average of about 40,000 people hospitalized daily, according to HHS data tracked by The New York Times. And earlier this month, hospital bed use in the U.S. hit a high, with more than 80 percent of beds in use. It had only reached that level at one other point during the pandemic, which was at the height of the omicron surge in January. 

To get a better grasp on how the nation's ongoing respiratory virus suge compares to the height of the COVID-19 pandemic, Becker's asked five physicians for their perspective. Their responses challenge the notion that the reality within hospitals today isn't "as bad" as it was during the worst of the pandemic. 

Editor's note: Responses were collected between Dec. 13 and Dec. 20 and are presented in alphabetical order. 

Allison Bartlett, MD. Pediatric infectious disease specialist at the University of Chicago Medicine Comer Children's Hospital: Speaking specifically to what it's like in a children's hospital … It's more appropriate to compare this to our usual winter respiratory viral surge. We definitely have days during a typical respiratory season when we are at capacity or over capacity, but what we have never seen before was the numbers of requests for transfers of patients and the number of consecutive days where we were not just at capacity, but overflowing and having to turn away hundreds of transfer requests, which is the same [thing] all of the other children's hospitals were having to do. The height and the duration of the crisis that we have been seeing is what is unprecedented. 

Fortunately RSV has peaked and come down. And that was one of the big drivers especially for the younger kids. We are 95 days into being near capacity and the first sort of 65 days of that was being absolutely overflowing and overwhelmed with both patients coming to see us for care and then requests for us to care for additional patients. During that time … we got creative like many other institutions did, and have now permanently added an emergency room fast track up in our clinic space that's staffed by additional people to help move through some of the lower acuity, less sick patients so that our ER has time and space to see the more critically ill children. We've got extra staffing on the inpatient sides from all levels of healthcare workers to help cope with the extra capacity and needs that we have. 

Raed Dweik, MD. Chair of the Respiratory Institute at Cleveland Clinic: 

At Cleveland Clinic, we have had a challenging fall due to the prevalence of respiratory viruses. We experienced an early RSV season, particularly affecting our pediatric patients. At times, our positivity rate for RSV in children 5 years old and under was near 50 percent. RSV is now beginning to decline, but influenza admissions have increased significantly in the past several weeks. This has been combined with a more gradual increase in COVID-19 hospitalizations. We are concerned that we could see additional spikes in admissions after holiday get-togethers. 

While the overall volumes of respiratory virus patients are lower than they were at the height of the COVID-19 pandemic, our hospitals and emergency rooms have remained extremely busy with high volumes of patients. However, we are fortunate to be a large system, and while we may be experiencing high levels of patients, we are still able to care for them. 

We are encouraging everyone to take basic steps to protect themselves and others such as vaccination for flu and COVID-19, hand washing and masking in certain situations, particularly if you are at higher risk for severe illness or around people who are at higher risk. We also are working to educate patients on the many ways to access our care and encouraging them to choose the most appropriate option based on their symptoms and individual risk.  

Eric Perez, MD. Chief medical officer at Chilton Medical Center in Pompton Plains, N.J., at  Atlantic Health System: They say history doesn’t repeat – it rhymes. That’s definitely been the case as the last few weeks and months have seen a steep increase in both patient volumes and the percentage of patients needing care for respiratory viruses, predominantly RSV, Influenza, Rhinovirus/Enterovirus and COVID-19. The nature of what we are currently seeing is similar in some ways to the height of the COVID-19 pandemic but different in others. In 2020, the COVID-19 pandemic featured a typically adult population, requiring us to shift team members, capacity and resources from areas such as pediatrics to allow for increased adult volumes. Now, healthcare teams find themselves mostly in the opposite position, taking care of an unprecedented number of children while adult volumes remain high. Similarly in the areas of supply shortages, in 2020 high flow oxygen, ventilators and PPE were in short supply nationally. This time around it's cribs. At Chilton Medical Center and across Atlantic Health System, lessons learned from prior waves of the pandemic have paid off, keeping us well prepared and capable of flexing our capacity to meet these changing needs. Some things remain the same, the steps patients can take to protect themselves. Get vaccinated and boosted, get your flu shots, and stay home if you are sick!

Megan Ranney, MD. Emergency physician and academic dean of Brown University School of Public Health in Providence, R.I.: Although there are far fewer COVID-19 patients, the hospitals are bursting at the seams, emergency department wait times are through the roof, and nurses and doctors are — simply — exhausted. Three years in, and we're still unable to provide timely and empathetic care. Although quantitatively, patient loads are similar, qualitatively, it's much worse, simply because we're so understaffed and overworked. 

Paul Thottingal, MD. Senior medical director of communicable diseases & organizational preparedness for Kaiser Permanente Washington: 

Washington state has one of the lowest per capita hospital bed rates in the nation and experienced reduced hospital capacity even before the pandemic. Bed capacity is even worse in pediatrics. Burnout and staffing challenges have made recovery to our pre-pandemic levels even more difficult. Then you factor in pandemic-related diversions of care and a surge of respiratory infections at a scale that we haven’t seen in 10 years, and that combination of factors has made this crisis feel continual. The pressure never eased.

A surge like we’re currently experiencing coming at us this fast, this high, this hard, is a big deal. It's frightening that we might not have enough capacity to take care of sick kids and adults with serious illness. We know that staying home when sick, masking in indoor spaces, and handwashing all work very well to reduce transmission.

It is particularly noteworthy that all county-level public health agencies in the state have returned to strong recommendations for masking, which we know reduces transmission of all respiratory viruses, while in an indoor public space. Kaiser Permanente and nearly all other healthcare systems in the state signed on to a joint letter of support for this public health recommendation, and that's the kind of unity we need to be effective at reducing the levels of transmission that we're seeing.


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