Children's Hospitals are Overwhelmed
As pediatric nurses, we are in the thick of it right now. This week we wanted to share an article written last week showcasing the burden on pediatric hospitals right now. Thank you, Time Magazine!
“Aug. 20 was a good day in the pediatric intensive care unit at Children’s Hospital New Orleans. Carvase Perrilloux, a two-month-old baby who’d come in about a week earlier with respiratory syncytial virus and COVID-19, was finally ready to breathe without the ventilator keeping his tiny body alive. “You did it!” nurses in PPE cooed as they removed the tube from his airway and he took his first solo gasp, bare toes kicking.
Downstairs, Quintetta Edwards was preparing for her 17-year-old son, Nelson Alexis III, to be discharged after spending more than two weeks in the hospital with COVID-19—first in the ICU, then stabilizing on an acute-care floor. “Fortunately, he never regressed,” Edwards says from outside Nelson’s room, the door marked with signs warning of potential COVID-19 exposure inside. “He’s progressing, slowly but surely.”
The nurses and doctors who care for the sickest patients at Children’s Hospital New Orleans (CHNO) have to take the good where they can these days. On Aug. 6, Louisiana Governor John Bel Edwards announced that more than 3,000 children statewide had been diagnosed with COVID-19 over the course of just four days. That same week, about a quarter of Louisiana children tested for COVID-19 by the state’s largest health system turned out to have the virus.
Seventy young patients ended up in treatment at CHNO during the 30 days ending Aug. 23. Prior to this summer, the hospital had never had to care for more than seven COVID-19 patients at a time, and usually fewer than that; on any given day in August, that number has been at least in the mid-teens, enough that the facility had to call in a medical strike team from Rhode Island to help manage the surge.
CHNO isn’t alone. The extra-transmissible Delta variant has ushered in a new chapter of the pandemic. For the first time, pediatric hospitals are struggling to treat the number of young patients developing severe cases of COVID-19. A record high of more than 1,900 children were hospitalized nationwide on Aug. 14—and unlike during previous spikes, infections have so far been clustered largely in states with low vaccine coverage, meaning hospitals in undervaccinated states like Louisiana, Florida, Tennessee, Alabama and Texas are drowning. “Our hospital system across Alabama is beyond capacity. Last week we had net negative ICU beds, and that’s pediatric and adult together,” says Dr. David Kimberlin, co-director of the division of pediatric infectious diseases at Children’s of Alabama. “Doctors are doing CPR in the back of pickup trucks.”
This grim scenario may seem shocking, given one of the pandemic’s long-standing silver linings: that children, for the most part, are spared from the worst of COVID-19. About 400 children nationwide have died from COVID-19 since the pandemic began, and most pediatric hospitals have seen no more than a handful of patients at a time—which makes the current surge in the South and parts of the Midwest especially unnerving.
There is no evidence that the Delta variant is causing more severe disease than previous strains, says Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics (AAP) committee on infectious diseases. Less than 2% of children who have caught COVID-19 during this wave landed in the hospital—roughly the same percentage as during earlier phases of the pandemic, according to a TIME analysis of AAP and U.S. Department of Health and Human Services data. An even smaller percentage of children die from the disease, though some have gone on to develop complications like the inflammatory condition MIS-C.
The difference seems to be that the highly contagious Delta strain is tearing through all demographic groups at a furious clip, currently contributing to the more than 140,000 infections reported in the U.S. on any given day. It’s a depressing numbers game: If 100 children become infected, one or two might end up in the hospital. Push the caseload up to 180,000—the number of kids diagnosed with the virus nationwide during the week ending Aug. 19—and at least 1,800 are likely to get sick enough to need hospitalization.
Children have also drawn a short straw. Viruses are wily, seeking out and infecting vulnerable hosts at all costs. Without authorized vaccines for people younger than 12, any child who has not previously been infected has no immunity against SARS-CoV-2, meaning the virus effectively has free rein among America’s 50 million youngest residents. Even among older children who can get vaccinated, rates are low: just 35% of 12- to 15-year-olds and 45% of 16- and 17-year-olds are fully vaccinated, according to U.S. Centers for Disease Control and Prevention data.
While each individual child has a low chance of developing severe disease, the current pediatric surge, which has been compounded by an off-season spike in RSV and parainfluenza cases, has grave implications for health care networks. Even before the pandemic, health care access was a struggle in parts of the South and Midwest. In Arkansas, for example, there is only one pediatric hospital system to serve the state’s more than 3 million residents. A rural hospital could have fewer than 10 ICU beds, meaning even a small coronavirus surge could push it beyond its limits. “Down here in the deep South, we are getting slammed to the point where, honestly, our health systems may collapse,” Kimberlin says. “What that means is, if you have a stroke, you die at home.”
The hospital’s quiet atmosphere hides the work happening behind the scenes to keep pace with that increase. CHNO has implemented an incentive program to encourage current staff nurses to pick up extra shifts, and has hired about 150 new nurses to help manage the patient load.
The staff at CHNO makes a valiant effort to stay positive and keep smiling beneath their masks—a trait, perhaps, of choosing to work in pediatrics. But Blancaneaux admits it can be difficult this far into a pandemic, when the tools for ending it are in nearly every drugstore in the country. “Everyone is frustrated and worn out and upset,” he says. “You feel unsupported by the public because we keep fighting against it. And a large part of it is preventable.”
—With reporting by Emily Barone”
To see the full version of this article, please visit Time's website.
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-The Baby Whisperers