CT children’s hospitals full of respiratory illnesses arriving early in full force; one talking to FEMA about setting up auxiliary site

The state’s two children’s hospitals are full to overflowing with patients suffering from respiratory illnesses that have arrived earlier and are causing more serious illnesses than in past years.

“I’ve never seen this level of occupancy beyond our capacity for a sustained period of time as I’m seeing it right now,” said Dr. Juan Salazar, physician in chief at Connecticut Children’s Medical Center in Hartford, on Tuesday.

“We know historically in the past when, during the wintertime, during influenza peak, we might have a couple of weeks where we had to put kids in playrooms, things like that, obviously all with supervision. But this level for so long, every day — I’ve never seen it before in my 25 years here at Connecticut Children’s,” Salazar said.

The hospital is trying to hire pediatric nurses, in the midst of a nursing shortage, and is talking to the the National Guard and the Federal Emergency Management Agency about setting up a tent on the lawn, Salazar said.

Beginning in June, Salazar said, there has been a steady increase in children being admitted with respiratory illnesses, from rhinoviruses to flu. His best guess is that protecting children from COVID-19 has made them vulnerable to other viruses.

“Most of the children for the last 2½ years had been socially distanced, wearing masks not in their normal exposure environments, because of the things we have done to prevent COVID, which needed to be done,” Salazar said.

“Now, the school’s open; masks are gone. And then the viruses begin to circulate in a very susceptible population because they hadn’t seen any of these viruses before,” he said. “So they’re getting hit with something they’ve never seen in their young lives or at 2, 3 years of age.”

“Our hospital is full right now; all the beds are taken,” Salazar said. “And currently we have about 15 kids waiting to be admitted in the Emergency Department that don’t have a bed to go to” in the units.

“We can’t bring them in,” he said. “So we’ve created a new unit which we call M1 for kids that are boarding in the Emergency Department waiting to be admitted to the floors.”

Salazar said enterovirus was most common in June and July. That can be serious if it develops into acute flaccid myelitis, which in severe cases can cause paralysis.

“We got into August, September, and it shifted to rhinovirus, which is normally a common cold virus that shouldn’t give you anything except a snotty nose, but many of these kids actually ended up coming into the hospital with viral pneumonia,” he said.

Then RSV, respiratory syncytial virus, “which, normally historically, we see in the late winter months, trailing a little bit into the early spring,” began to increase.

“You never see it in September, and truly, September, October is just the wrong time for us to be seeing RSV. And it’s increasing exponentially,” Salazar said.

Dr. Thomas Murray, associate medical director for infection prevention at Yale New Haven Children’s Hospital, said RSV is common for children under 3, but that more are being hospitalized earlier than usual this year.

“Almost all children will get RSV at some point early in their childhood, and the majority of kids will get kind of a cold from it, but will not necessarily need to come to the hospital,” Murray said. “But sometimes younger children will have difficulty breathing and so they need to come to the hospital, usually for additional oxygen and respiratory support.

“Unfortunately, it’s very difficult to tell the difference between RSV and other respiratory viruses, like COVID and viruses that cause the common cold like rhinovirus, which we’re also seeing in the hospital,” he said.

RSV is the most common respiratory illness for children at Yale New Haven, Murray said, but “we’re seeing many different kinds and that’s a little bit unusual. And we’re certainly seeing many severe cases, not just from the RSV but also from the rhinovirus. So our intensive care unit has been very busy.”

While Yale New Haven has one to three children admitted with COVID each day, there are 30 admitted with RSV, Murray said. “So, big difference.” He said RSV cases seen in the Emergency Department jumped from 57 last week to 106 now, although not all were admitted.

Murray said the high number of rhinovirus cases could also be related to the strain of the virus.

“We are definitely seeing more children admitted to the hospital this year with rhinovirus than we’ve typically seen in past years,” Murray said. “And some of them can be quite sick and it could be related to the strain of the virus that’s circulating. It’s hard to say why.”

Murray said while COVID is spread through droplets in the air, several of the other viruses live on surfaces and can be spread that way. There needs to be “a renewed emphasis on hand washing, on clean … surfaces,” he said. “So shared toys for example, because a child will rub their nose, which may be running. They’ll then play with the toy. … Another kid comes and grabs the toy and then touches their nose. And there you go. You have spread of infection.”

Murray said RSV usually is not life-threatening. “Most kids who get RSV do just fine and come into the hospital and get some oxygen and get hydrated and stay a couple of days and then go home,” he said.

“There are a handful that will require escalating respiratory support and end up in our intensive care unit,” Murray said. “But we have great staff that worked really hard to help these kids recover. They tend to do well, so it’s very rare to have a death.”

“RSV will eventually begin to subside,” Salazar said. “But what’s going to happen is … that influenza is going to surface sometime in mid-November, and it’s going to peak all the way through December. And the flu will also affect children and it will challenge the system even more through the months of November and December.”

Salazar and Murray both said it is critical that everyone, especially children, get a flu vaccination.

Salazar continued, “Okay … I don’t have a crystal ball, but to cap it off, what follows influenza is, guess what? The resurgence of COVID-19 with the variants that are now beginning to circulate.”

Other viruses that are circulating, Murray said, are parainfluenza, adenovirus and human metapneumovirus.

The emergency is also occurring in Boston and Philadelphia, Salazar said. “It’s a children’s hospital phenomenon, primarily, throughout the country and certainly in the Northeast,” he said. “So we’re looking at … a very challenging time with having a sufficient number of beds, sufficient staff, especially for critical care and hospitalized kids that are severely affected, and so we are addressing it, obviously.”

Besides the lack of exposure to common viruses, another theory for why children are being hospitalized is that their immune systems have been compromised by COVID, Salazar said.

“We know from studies that have been done nationally, in the Northeast, that probably 85% of the pediatric population has been infected with COVID,” he said. “And that makes sense. I think we’ve had a surge last January, and we had a major surge in the spring, summer, and even recently, so I’m not surprised many of those kids had COVID, probably didn’t know they had COVID, probably had mild COVID.”

But that theory is not as likely as the first, he said.

Ed Stannard can be reached at estannard@courant.com.