Yakima Valley hospitals among those with surge in pediatric ER visits due to RSV, flu outbreak

YAKIMA – While the number of COVID cases statewide remains low, a fall surge in respiratory viruses, especially among children, is causing a similar overflow of Washington’s emergency department and hospital rooms as was seen during the peak of the pandemic.

Local and statewide health care officials say respiratory syncytial virus, or RSV, infections are the primary reason pediatric hospitals and other facilities are often filled beyond capacity.

“There’s a lot of sick kids out there,” said Tara Briley, executive vice president of the Washington State Hospital Association, during a Monday Zoom call with media and health care officials.

“Hospital ERs across Washington are extremely strained right now,” Briley said. “Many are exceeding 100% of capacity, and this is especially true for our pediatric facilities …

“The RSV surge is putting extreme pressure on an already stressed system.”

The surge in young patients has been noticeable at Yakima Valley hospitals.

Jody Shively, emergency department director at Astria Sunnyside Hospital, said her facility has seen an increase in RSV patients in recent weeks.

“We are admitting more (pediatric patients) and transferring them when beds are not available,” Shively said. “We are not seeing many COVID cases at this time, but we’re seeing an increase in influenza A & B.”

A Yakima Valley Memorial spokesperson said while they do not have specific numbers, the hospital is seeing increases in both RSV and flu cases.

Symptoms, effects of RSV

RSV is a respiratory virus with symptoms similar to influenza and the common cold, but it can produce severe breathing difficulties, particularly in infants and toddlers, said Dr. Ana Garcia, a pediatrician with Astria Health.

“RSV hits children who are older more like a cold, but it hits harder for children 2 and younger,” Garcia said.

“Infants will have a lot of wheezing, a lot of phlegm. Babies are usually admitted (to the hospital) and they often need supplemental oxygen.”

Older children with RSV will develop symptoms such as fever, a runny nose and coughing, Garcia said. Additional symptoms parents should watch for with infants to 2-year-olds include irritability, a lack of eating or drinking, a persistent cough and breathing harder or faster than usual, she said.

Part of the reason the RSV surge seems more severe this year is the lack of cases during 2020 and 2021 due to social distancing, masking and other COVID prevention measures, Garcia said.

“Are there more cases? It’s hard to say, because we didn’t see as many during the pandemic,” she added.

Preventing the spread of RSV and flu cases requires similar measures as slowing the transmission of COVID: washing hands; trying not to touch one’s eyes, nose and mouth; cleaning and disinfecting; and keeping children home when they are sick, Garcia said.

Pediatric ER visits

Dr. Michael Barsotti, chief administrative officer for Providence Sacred Heart Children’s Hospital in Spokane, said the national surge in RSV cases began on the East Coast, then was noticed in Western Washington, and is making its way over the Cascades.

“I feel we’re probably a step behind the west side of the state,” Barsotti said during Monday’s WSHA online conference call. “We’re definitely seeing a surge, but haven’t reached the (beyond capacity) levels of the west side yet.”

At Seattle Children’s Hospital and MultiCare’s Mary Bridge Children’s Hospital in Tacoma, the triaging of emergency department patients is necessary, with the most seriously sick or injured being seen first.

“We are in crisis mode and bordering on disaster mode in Washington state,” said Dr. Tony Woodward, emergency medicine director at Seattle Children’s Hospital.

Woodward said his hospital’s ER is at 100% capacity almost 24 hours a day, with levels of 200 or 300% capacity in the evenings. Patients are being seen in hallways and storerooms due to the lack of rooms and beds.

Ben Whitworth, chief operating officer at Mary Bridge, said as he addressed the teleconference Monday morning, there were 23 patients in the waiting room, including children who have been waiting with their parents since 10 p.m. Sunday .

“Over 60% of our ER visits are respiratory related,” Whitworth said. “At Mary Bridge we’re seeing our highest ever rates of RSV (among admissions).”

All the emergency department directors, including Shively, stress that parents with children who are severely injured or ill should continue to come to the ER.

If a patient is working hard to breathe, grunting, has nasal flaring, is wheezing, having reactions, turning color or sitting with arms resting on their knees or another surface, parents should bring them into the emergency department, Shively said.

“We have space to take care of RSV patients or any other patient that arrives,” Shively said.

Ideally, parents should turn to their child’s health care provider or an urgent care facility if there are not severe RSV symptoms, the WSHA’s Briley said.

She noted that the current situation is the opposite of the capacity crunch hospitals faced during the first surge of the COVID pandemic, when an overwhelming number or adult and senior citizen patients were forced to be housed in the pediatric areas of some Washington hospitals. Now, pediatric patients are going to adult hospital beds, Briley said.

Dr. Mary King, director of Harborview Medical Center’s pediatric intensive care unit, said even those measures may not be enough as Washington has only 500 pediatric beds, and 122 pediatric ICU beds, for a state with 1.5 million children.

“This is our COVID, this is our crisis moment in pediatrics,” King said. “We’re terrified that we won’t be able to take care of all the kids.”