Like playing football with no pads: 6 leaders contextualize the 'tripledemic'

With many children's hospitals facing unprecedented capacity issues amid a surge in  respiratory syncytial virus, flu season admissions at the highest level in 13 years and highly transmissible omicron subvariants gaining prevalence nationwide, hospitals are bracing for a difficult winter. 

Becker's asked clinical leaders and virology experts from health systems across the country what analogy they would use to explain the capacity issues at children's hospitals and the looming threat of a "tripledemic" this winter. Their responses are below in alphabetical order.

Editor's note: Responses have been lightly edited for length and clarity. 

Kenneth Alexander, MD, PhD. Chief of Infectious Diseases at Nemours Children's Hospital (Orlando, Fla.): This [so called "tripledemic"] is actual proof that masking works because what we have done is in the course of protecting ourselves against COVID-19 is we have also protected ourselves against influenza and RSV. Now that masking has disappeared, we have not only the return of COVID-19 but also the acquired risk of RSV and influenza.

Matt Binnicker, PhD. Director of Mayo Clinic's Clinical Virology Laboratory (Rochester, Minn.): We send our football players out onto the field with layers of protective gear — helmets and shoulder pads — intended to prevent injury. If we were to send the players out onto the field without that protective gear, they would almost certainly get injured and need to go on to the sideline to be tended to by the trainer. One or two trainers can handle a few players at a time, but if all those players went out onto the field without protective gear, the trainers on the sideline would be overwhelmed and wouldn't be able to keep up that capacity.

That's really what our children's hospitals are facing right now; we have a large population of young children in the country who don't have the layers of protection either from routine annual flu vaccinations or just normal routine exposures to respiratory viruses like RSV. The viruses are spreading because of relaxed precautionary measures, and we're having a lot of kids come down sick, so children's hospitals are just getting flooded with young kids who are coming in in need of care and hospitalization.

I was talking with a colleague in Texas who directs a lab in a children's hospital. They've had to refer patients as [far] north as Missouri because their beds in their hospitals in Texas are full. That's the situation we're in. It's definitely something that we're keeping a close eye on, and the best thing that we're promoting and asking families to do is if your child is eligible for a flu and COVID vaccine to get that done, because that will help protect them from more moderate to severe illness that might require them to go into the evaluated at the hospital.

Aaron George, DO. Chief Medical Officer of Meritus Health (Hagerstown, Md.): One way to think about this fall season is almost like an airplane. Just like our hospitals, airlines run data based on past experience and demand to determine the number of seats and flights available. 

As a result, airlines will often oversell seats because they are taking a chance that people won't show up — but what happens when everyone does? It's a disaster. It's the same thing with risky behaviors, lack of masking and not taking precautions when it comes to RSV. 

Hospitals are running out of beds in a similar way as airplanes run out of seats. When all the other airplanes are full or all the hospital beds are in use, there's no space for everyone no matter how desperate the need. And just as we can't build planes or train pilots overnight, our hospitals face the same strain with identifying new beds and training enough staff to care for patients.

Tom Murray, MD, PhD. Associate Medical Director for Infection Prevention at Yale New Haven (Conn.) Children's Hospital: This is not the equivalent of COVID-19 in early 2020 and is the respiratory surge children's hospitals have been anticipating. Preparations involve identifying additional spaces and staff to see sick children and facilitate timely discharges, regional coordination of intensive care unit beds, coordination with the department of health on bed capacity, increased access to COVID-19 and influenza testing, and promoting the COVID-19 and influenza vaccines. Yale New Haven Children's Hospital had planning meetings back in 2020 and 2021 to address respiratory surge. We didn't know exactly when or how many children would be affected, but we knew the viruses and what would be needed to take care of them. The surge has arrived and dedicated groups of pediatric health care providers are working around the country to ensure every child receives the required care.

Michael Ritchey, MD. Chief Medical Officer at Phoenix Children's: What we're seeing now in terms of multiple respiratory viruses is not uncharted water. The difference is that we typically see these spikes in the winter season, but due to the pandemic we have experienced this earlier in the year. It is hard to predict how the situation will evolve this season. However, we are used to seeing busy respiratory virus seasons and have plans in place to care for children facing these illnesses.

Jim Versalovic, MD, PhD. Pathologist-in-Chief at Texas Children's Hospital (Houston): Current respiratory virus challenges are like tornadoes that appear rapidly, have severe impact and are so unpredictable. The "big three" respiratory viruses for children — COVID-19, influenza and RSV — are actively circulating and causing hospitalizations among children right now. Influenza A and RSV A are the headlines and the concern is whether we must handle all three viruses at the same time with even larger numbers of children hospitalized for pneumonia or lower respiratory tract infections. Fortunately, my colleagues including those here at Texas Children's Hospital know how to diagnose, treat and prevent these infections, but we must remain vigilant.


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