Flu, RSV, COVID are hitting NJ children hard this fall. Will it get worse this winter?

Emergency rooms and hospital pediatric units across New Jersey have seen a surge in the number of children being brought in with respiratory illnesses including influenza, respiratory syncytial virus (RSV) and COVID in recent weeks, hospitals are reporting.

Having dubbed it a "tripledemic" for the three leading viruses that began spreading earlier than usual this year, experts expect the situation to get worse as Christmas, New Year's Eve and other holidays bring more indoor gatherings and travel, which typically increase the risk of transmission.

Both the number of sick children and the severity of their illnesses are greater this year, after two seasons during the height of the COVID pandemic when many kids were not getting as sick. Back then they were still wearing masks indoors and not socializing as much, and consequently they did not build up natural immunity, said Dr. Harpreet Pall, chair of pediatrics at Hackensack Meridian School of Medicine in Nutley.

"We're seeing a lot of younger kids who have never been exposed before to these viruses coming in very sick," he said.

The flu, which public health officials had warned would likely be highly transmissible this season, has been driving the surge in emergency room visits in recent weeks, according to a report released last week by the New Jersey Hospital Association.

RSV, a virus that can produce heavy cold-like symptoms, has been responsible for more hospitalizations of children than flu. Although children are still getting sick from COVID, the numbers are much lower compared with other viruses, Pall said.

The week after Thanksgiving saw a surge in emergency room visits by children sickened with flu, RSV or COVID, reaching a combined high of 943 on Nov. 29. That has led to more admissions, and about 70% of New Jersey’s pediatric beds were filled throughout November, the report said.

Nationwide, hospitalizations for flu nearly doubled during the week after Thanksgiving, compared with the prior week, and “are the highest we have seen at this time of year in a decade,” said Rochelle Walensky, director of the federal Centers for Disease Control and Prevention.

Many of New Jersey's 71 hospitals have already added beds to their pediatric units. The upcoming winter months will "test the health care system’s capacity and resiliency," said Cathy Bennett, CEO of the New Jersey Hospital Association.

Across the country, 14 children have died so far of flu this year. One child flu death in New Jersey was reported to the CDC on Dec. 10.

During the last two pandemic years in New Jersey, there were no pediatric flu deaths. But in the 2018 flu season, six children died, and in 2019 two died.

About 50% of New Jersey children have received a flu vaccine this season, a much higher rate than adults, at 25%, according to federal data. About 7% of New Jerseyans under 18 had gotten a bivalent COVID booster shot as of last week, said Nancy Kearney, a spokeswoman for the state Health Department.

“Flu vaccines can be lifesaving,” Walensky said. This year, the most vulnerable groups — children, those over 65 and pregnant women — have lower vaccination rates nationally than last year, she said.

This year’s flu vaccine appears to be a good match to the virus type that is circulating, said Dr. Sandra Fryhofer, board chair of the American Medical Association and an internal-medicine specialist in Atlanta. She urged people to get vaccinated, noting that it takes two weeks for antibodies to develop.

“Even if you’ve already had flu, you should still get vaccinated,” she said, explaining that people can be infected twice in the same season. Type A is the prevalent form of flu currently, she said.

While reports of RSV are still high nationally, Walensky said, the illness may be leveling off in the mid-Atlantic, New England and Midwest regions, and it has already peaked in some southern states.

Physicians remind parents and others to stick with basic prevention techniques: Get a flu shot, wash hands frequently, and if a child is sick, keep them home from school.

"We should be gathering for the holidays this year," Pall said. "The social contact you get from that is really important for everyone's well-being. We just have to do it safely."

Adding to the problem for children is a nationwide shortage of the powder used to make liquid amoxicillin, the pink-colored antibiotic prescribed by millions of pediatricians to treat strep throat and other bacterial infections.

The shortage, announced by the Food and Drug Administration on Oct. 28, is expected to last months, and it led the American Academy of Pediatrics to suggest alternatives in an advisory.

Contributing to the shortage is the rise in viral illnesses such as RSV and flu. Even though antibiotics are not effective against them, many doctors prescribe them. Amoxicillin is also a relatively low-cost generic drug, making it less likely for drug manufacturers to invest in sophisticated supply-chain management.

This article originally appeared on NorthJersey.com: Surge in flu, COVID and RSV among kids hits NJ hospitals