ICU full, kids waiting on treatment as RSV cases overwhelm Boston hospitals

Pediatric intensive care units are filled to capacity and many young children are waiting on emergency treatment as hospitals in Boston work to combat a surge in respiratory syncytial virus cases, or RSV, officials said Thursday.

They are calling it a ‘capacity disaster’ at Massachusetts General Hospital.

The Mass General Brigham hospital system was inundated with 2,000 RSV cases in the month of October alone, and already overcrowded emergency departments are facing significant issues as new cases continue to pile up, according to Brian Cummings, the medical director of the department of pediatrics at Mass General for Children.

There have been more than 1,000 reported cases so far in November.

Cummings estimates RSV cases are running 20 to 60 percent higher than an average fall -- keeping in mind, RSV is usually a winter phenomenon. He said most infections have been treated in the system’s urgent care centers or in Emergency Departments - but not all of them.

Boston Children’s reduces elective procedures - RSV is one of the reasons

“Even if just ten percent need hospitalization, it creates a lot of stress on healthcare facilities,” he said. “We’ve had over 250 hospitalizations for RSV alone on top of other circulating viruses.”

RSV is a common, contagious virus that causes infections of the respiratory tract. Mild RSV symptoms in children include stuffy and runny nose, headache, cough, fever, and sore throat. More serious symptoms include discoloration of skin, difficulty breathing, rapid breathing, wheezing, severe cough, and fever.

“The viruses are causing very severe respiratory illness in young children, leading to breathing difficulties or leading to asthma exacerbation,” Cummings said during a news conference on Thursday afternoon. “There are no available pediatric ICU beds, and we are operating over capacity. Today, we have seven patients that are outside the ICU that would normally be transferred into the ICU.”

Cummings noted that Mass General for Children is caring for small children and infants with severe respiratory illness, many requiring treatment in hospital acuity settings higher than normal, and a significant influx of pediatric patients is putting dire constraints on hospital bed availability.

“That really has ballooned through the entire month of October. That has created enormous stress on pediatric health care because the need for hospitalization has been increased,” Cummings explained. “What’s happened in the last two years with COVID, is that a lot of the pandemic mitigations have disrupted the normal viral transmission...A lot of RSV was not being spread in the previous two years.”

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The younger a child is, the more susceptible they are to a severe case of RSV, according to Cummings.

“Now that it’s circulating a little more, typically there are many more people susceptible to infection. The younger you are when you get infected, the more likely you have to have a more acute presentation,” Cummings explained. “The youngest patients are at the highest risk of needing hospitalization. Those are typically patients under the age of one. Usually, those hospitalizations are brief, but they can be very severe...Some patients may need breathing support.”

“All of this is occurring in the context of an extraordinarily overcrowded healthcare system at baseline,” said Paul Biddinger, MD, Director of the Center for Disaster Medicine and Vice-Chairman of Emergency Preparedness. “This is very different from when we went into the pandemic in March of 2020 with a busy healthcare system -- but one that did not have levels of crowding that we see today.”

But it’s hardly the only hospital with such issues. Recently, Tracie Charland’s 16-year-old daughter Emma was admitted to Boston Children’s Hospital for treatment of pneumonia.

“The capacity issue that they have within the ER and the hospital is unbelievable,” Charland said. “The ER is packed. The waiting room is just full of patients. In lines. I mean, patients are in the hallways being treated because there are not enough rooms.”

In a statement, the healthcare facility said, “Boston Children’s has been at or overcapacity on average for nearly six weeks due to RSV, seasonal illnesses and the ongoing behavioral health crisis. We anticipate the numbers will continue to climb as we shift into the winter months, so we are using alternative care spaces when necessary. These are spaces we have used many times before.”

Some scheduled, non-emergency procedures are now being put on hold as these hospitals work to treat those who in need of immediate care.

Thus, one of the messages to parents from Mass General Thursday: Know when things are serious enough to seek medical care for possible RSV and recognize it often can be treated at home.

“If they’re tired at rest, working harder to breathe or not drinking enough fluids -- that’s when you call your pediatric office,” said Alexy Aruaz Boudreau, MD, MPH, a community pediatrician at MGH. “For the most part, we can manage infections by staying at home, resting, drinking fluids, and controlling fever.”

Doctors are urging everyone to practice good hygiene and hand washing, in addition to masking up.

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