'Unprecedented' surge in RSV cases filling up pediatric ICU beds

At first, Logan Bentley had a low-grade fever and no other signs of illness.

But several days later, the Geneva toddler had trouble breathing. His mom noticed his nostrils were flaring.

“His symptoms, they didn't come on right away,” Cristy Bentley said. “And then, when they hit, they hit, and it escalated pretty quickly.”

Now 15 months old, Logan ended up in the emergency room with respiratory syncytial virus, better known as RSV, in September.

Cases of RSV are surging earlier than usual, flooding pediatric hospitals with sick children.

Dr. Melissa Manrique, a pediatric hospitalist at Northwestern Medicine Central DuPage Hospital in Winfield, said she hasn't seen anything like the current surge in her 14-year career.

RSV season usually runs from October or November to March. But cases this year started rising around mid-September, Manrique said.

“We certainly have gone through surges in RSV and influenza in the past,” she said. “But this is really unprecedented, in that we really are having a lack of availability of beds both at Central DuPage and in the area for pediatric patients.”

The hospital's pediatric inpatient and intensive care units were running at full capacity last week. While doctors say they're seeing cases of enterovirus, rhinovirus and influenza, the dominant virus is RSV, causing 75% of respiratory-related pediatric hospitalizations at Central DuPage.

Statewide, only 6% of pediatric intensive care unit beds were available as of Oct. 25, the Illinois Department of Public Health reported.

“We have been operating at our maximum capacity for about the last five weeks and continue to see record volumes in our emergency room” as recently as last week, Manrique said.

Hospitals are bracing for a triple threat: an influx of RSV patients colliding with the onset of flu season and a potential winter surge in COVID-19 cases.

“I really do think that we need to have a high level of concern at this time, just given the limited bed availability of our pediatric hospitals and pediatric units,” Manrique said.

Why RSV is on the rise

Most kids end up getting RSV at least once by the time they're 2 years old. The virus often presents more like a cold in older children and some adults.

But some pediatricians say this year's RSV season has led to intense respiratory symptoms and prolonged hospital stays.

The majority of patients at Central DuPage are under age 1, with infants affected more severely. Doctors say they also have seen an increase in toddler and preschool children requiring hospitalization for RSV-related respiratory distress, likely as a result of them avoiding illnesses during more isolated pandemic times.

As kids stayed in their home environment, Manrique said, “there was just a lack of building that other natural immunity to viruses.”

The youngest patients “haven't been exposed to very much over the last two years,” said Dr. Michael Cappello, vice chairman of pediatrics at Advocate Children's Hospital in Park Ridge.

“They've been in isolation, behind masks,” he said. “And now we've opened things up a lot, and those same children who may have been exposed gradually over time - everyone's getting it at once.”

At the Park Ridge campus, nearly 40 patients had RSV last Wednesday, and five of them were in the pediatric intensive care unit, Cappello said.

“We're trying to figure out creative ways to find more space, to see if our adult partners can help with some of our older patients,” Cappello said.

Illinois Department of Public Health officials have advised health care facilities to consider cross-training non-pediatric staff members who may be able to provide patient care in pediatric areas to keep up with the surge in respiratory infections.

“The elevated visits and hospitalizations are creating a health system crisis in pediatric critical care access with an acute shortage in pediatric intensive care unit (PICU) beds, directly impacting the health system capacity heading into the fall/winter,” IDPH officials said in an Oct. 20 alert sent to hospitals.

Nationally, more than 5,000 laboratory tests came back positive for RSV the week of Oct. 22, according to the Centers for Disease Control and Prevention.

Cappello lauded the emergency room and inpatient physicians, nurses and respiratory therapists “who have really gone above and beyond” to manage the caseload.

“It's just coming at us in fast waves,” Cappello said. “There really hasn't been a break.”

Get your flu shot

There is no vaccine to prevent an RSV infection. Monthly injections of Synagis, an antibody medication, currently are available on a limited basis to boost immunity in certain high-risk and severely premature infants, said Dr. Nicholas Tapas, a pediatrician at Central DuPage Hospital.

With all these respiratory viruses circulating at once, experts are reminding parents to vaccinate children against flu and COVID-19.

“That takes two of the three issues off the table,” said Dr. Ashish Jha, the White House's COVID-19 response coordinator, in a briefing last week. “It also creates more capacity in the health care system.”

The CDC recommends everyone 6 months and older get a flu vaccine annually.

Tips for parents

Parents should seek emergency medical attention if their children have difficulty breathing.

“The child might be breathing faster than normal, might be using muscles in their ribs or in their belly to breathe out and in,” Manrique said.

Roughly 58,000 children younger than 5 years old are hospitalized each year due to an RSV infection, the CDC says. It can cause pneumonia and bronchiolitis, an inflammation of the small airways of the lung.

“It's spread by droplets, contact with people who are actively infected. If we minimize that, we're going to decrease the transmission to other people,” said Dr. Tom Oryszczak, chief medical officer and executive vice president at Northwest Community Healthcare in Arlington Heights.

Hospitalized patients receive mainly supportive care: oxygen, IV fluids and nasal suctioning to clear out secretions.

Frequent hand-washing helps prevent the spread of RSV.

“Unlike COVID, which is purely airborne, with RSV, a lot of it is surface transmission,” Jha said. “And therefore, washing hands turns out to be actually quite a good thing for RSV.”

A mom of three, Cristy Bentley urges parents to stay vigilant as the infection runs its course. Logan first was diagnosed with RSV at his pediatrician's office.

“It's so scary,” Bentley said of seeing her son experience breathing issues.

After a trip to the emergency room, he was sent home with a nebulizer.

“When he wanted to play with his siblings and keep up with them,” Bentley said, “that's when I kind of knew that he was on the road to recovery.”

Last week, his parents took Logan to the closest emergency room when he had another virus and an ear infection. It was more crowded, and the wait was much longer.