The novel coronavirus was a new and startling threat that scientists and doctors rushed to confront when it made its first appearance three years ago. But after two winters of COVID-19 spikes, this season, there’s an old virus behaving in new ways that’s causing problems for the health care field in Colorado and across the nation. And unlike COVID-19, it’s the youngest people who are most at risk.
Children’s Hospital Colorado is currently operating at full capacity due to a record number of pediatric patients with respiratory illnesses.
The increase is driven by a nationwide surge in RSV, a respiratory virus that primarily affects very young children, the immunocompromised and the elderly. The virus circulates every fall and winter, but began earlier than normal this year and has been unusually severe.
The increase has led Children’s Hospital to bring back surge tactics that it employed during peak times in the pandemic, and healthcare providers across the state are coordinating to try to increase resources for pediatric patients.
“We’re managing patient volumes like we’ve never seen before,” said associate chief medical officer Dr. Kevin Carney during a press conference last week hosted by Children’s and the Colorado Department of Health and Environment. “It’s truly like nothing we’ve ever seen before at Children’s Hospital Colorado.”
Carney said the hospital’s beds across the state are at or above capacity and that urgent care and emergency room visits are 30% higher than they have been on the busiest day of a normal flu season.
As of Nov. 18, 895 people have been hospitalized with RSV in the five-county Denver metro area since the beginning of October, according to data from state health department officials. The department only tracks the illness in the Denver metro area, where there have also been 255 reported outbreaks in school and childcare facilities. The overwhelming majority of those hospitalized are young children.
Dr. Lalit Bajaj, chief quality, equity and outcomes officer at Children’s Hospital Colorado, said that RSV is one of the main causes of a condition called bronchiolitis, which is what the hospital is seeing a steep rise in young patients needing treatment for.
RSV stands for respiratory syncytial virus, a common cause of mild cold-like symptoms such as runny nose, cough and fever. Nearly all U.S. children normally catch an RSV infection by age 2.
People infected are usually contagious for three to eight days. Babies and people with weakened immune systems can spread RSV for up to four weeks. There is no vaccine for it, though several candidates are in testing.
Everyone can get RSV. But it causes the most threat to infants, older adults and other vulnerable people, who can get serious airway and lung infections. Reinfections are not uncommon, and people can be reinfected more than once in a season, according to disease experts.
Among U.S. kids under age 5, RSV typically leads to 58,000 hospitalizations and up to 500 deaths in a year. For adults 65 and older, RSV causes 177,000 hospitalizations and 14,000 deaths yearly.
For babies, the struggle to breathe can interfere with eating. “And that’s really when we start to worry,” said Dr. Melanie Kitagawa of Texas Children’s Hospital in Houston, where more than 40 children have RSV.
“They’re breathing fast, breathing deep. We see them using muscles in their chest to help them breathe,” Kitagawa said. “These are kids who are having difficulty taking a bottle because their breathing is being impacted and they can’t coordinate both at once.”
RSV usually just shows up as a mild cold in older kids and adults, but it is extremely transmissible, Bajaj said. Unlike COVID-19, it can live for a number of hours on hard surfaces. It is also much more likely than COVID-19, which rarely sickened the very young, to require hospitalization for children. It mainly affects children below the age of 2, and can be especially dangerous for infants age zero to six months.
That’s because they have smaller airways and are more susceptible to respiratory distress, or difficulty breathing, Bajaj said. For the same reason, children who were born premature or have heart disease are also at higher risk because they have less lung capacity.
“The thing about RSV is healthy children over the age of two or three as well as adults handle it well, but adults act as a reservoir to transmit it,” he said.
Children’s is “very familiar” with the disease, which Bajaj said they usually track in a predictable pattern from December through April. The early and sudden influx has put a strain on the hospital system.
Similar situations are playing out across the country as the virus is encountering a highly vulnerable population of babies and children who were sheltered from common bugs during the pandemic lockdowns.
Immune systems might not be as prepared to fight the virus after more than two years of masking, which offered protection, according to Dr. Elizabeth Mack of Medical University of South Carolina. For babies, their mothers may not have been infected with RSV during pregnancy, which could have given the children some immunity.
“South Carolina is drowning in RSV,” Mack said in a news release.
U.S. health officials have noted a rise this month in national reports of respiratory illnesses, which they say is at least partly due to the early spread of flu in much of the South. Last week, more than 7,000 tests came back positive for RSV, according to CDC figures. That’s more than in previous surges.
At Children’s, the hospital has filled every single space on its inpatient side and is activating beds that aren’t usually used as inpatient beds, Bajaj said. Some days there are 30 to 40 patients waiting for an inpatient bed to open up.
“On any given night in our ED we will have full waiting rooms,” Carney said at the press conference.
Even more so than regular ICU beds, pediatric ICU beds are “an incredibly specialized resource,” Scott Bookman, the state’s COVID-19 incident commander, said at the conference.
On average, Bookman said there are 22 pediatric ICU beds available across Colorado but that number currently has been hovering between zero and five.
The hospital is falling back on contingency plans it has for when it reaches capacity, Bajaj said, including opening up alternative bed sites, asking employees to take on additional work and by working with other healthcare providers to transfer some patients to other facilities.
The hospital is also adding additional contract team members, including travel nurses and respiratory therapists, Carney said. Part of the hospital’s contingency plans include postponing some non-urgent surgeries and other treatments for children, which he acknowledged is “extremely stressful” for the families’ whose care is delayed.
During the peaks of COVID-19, which did not seriously affect children, Children’s helped other facilities that were at capacity to care for some of their patients. During this surge, Bajaj said those providers have reciprocated and some are lowering the minimum age of patients they will accept to their emergency departments to treat teenage patients.
“They’ve been really gracious to help us with some of the older kids,” he said, freeing up space at Children’s for the youngest patients.
The hospital has also brought back its medical tent that it set up outside its emergency department during the pandemic. During that time it mostly used the tent to isolate patients, and it is now using it to treat about eight patients at a time who have low acuity issues.
CDPHE is communicating with schools and childcare providers across the state to make sure they understand the potential danger, Bookman said. One of the most important things that can be done to reduce the spread is to have children and employees stay home if they are sick to avoid spreading disease.
“A mild cold for one person can be incredibly serious for someone else,” he said.
Aurora’s school district both said they are aware of the situation and like during the pandemic, school nurses continue to monitor symptoms in their schools. Both districts receive communications from CDPHE and the Tri-County Health Department.
Cherry Creek nurses are receiving training in recognizing signs and symptoms of RSV, spokesperson Lauren Snell said.
“We continue to have strong mitigation layers in place at schools including encouraging students to stay home when sick, washing hands frequently, thorough cleaning of surfaces, etc.” Aurora Public Schools spokesperson Patti Moon said in an email. “Also, nurses continue to work with families to track symptoms and illness reporting.”
Medical professionals say the increase in RSV is part of a several-year-long trend of the coronavirus disrupting the usual patterns of infectious disease but that the specific causal factors are not yet known.
Dr. Bernadette Albanese, is a pediatric infectious disease specialist with the Tri-County Health Department, said that rates of flu and RSV have been very low over the past few years when the coronavirus was more severe.
“We saw lots of things become uncommon during the two years of the pandemic when people were more separated,” she said.
The resurgence is likely a reflection of the fact that people are “kind of getting back to normal” this year and also have less immunity, Albanese said.
Bajaj concurred that a lack of immunity was likely a factor, but said there are still a lot of unknowns about how the pandemic is affecting disease transmission.
“It’s going to keep infectious disease experts busy for a while,” he said.
State epidemiologist Dr. Rachel Herlihy said that RSV is impacting children much more than flu or COVID-19, but that both other viruses are currently on the rise as well. She said she’s concerned about potentially seeing RSV, the flu and COVID-19 peak at the same time.
“It’s difficult to know how that’s all going to play out,” she said.
As of this week, Adams, Arapahoe and Douglas counties all have low transmission levels of COVID-19, according to the Tri-County Health Department. As of the most recent data, Adams and Arapahoe counties both had a percent positivity testing rate of just over 10%.
At the press conference, Herlihy and the other medical professionals urged Coloradans to get vaccinated for the flu and COVID-19, including the updated omicron booster, to wash your hands frequently and encourage young children to wash their hands and cover their coughs and sneezes as much as possible, to clean frequently-touched surfaces like counters and doorknobs and to stay home if they have symptoms of a disease.
“If I would say anything to the community, it’s please wash your hands and please clean your surfaces,” Bajaj said.
Medical professionals were more reticent when it came to recommending mask wearing, which at this point in the pandemic has become a personal decision as Colorado has not had a statewide mask mandate for over a year. However, multiple people said it would serve as an additional layer of protection.
Bajaj said that since he works in the emergency department and needs to stay healthy, he masks more than most people. Wearing a mask in indoor spaces will help protect the wearer from disease and will likely help the people around them as well, he said.
Unlike for COVID-19, there is currently no vaccine for RSV. There’s no specific treatment, so it’s a matter of managing symptoms and letting the virus run its course. Doctors may prescribe oral steroids or an inhaler to make breathing easier. In serious cases, patients in the hospital may get oxygen, a breathing tube or a ventilator.
Warning signs that children might be seriously ill include if they are having difficulty staying hydrated — diaper-aged children should have some urine output at least every eight hours, Bajaj said. Difficulty breathing is also a red flag. If children are wheezing, breathing quickly and shallowly or if their lips and fingernails are turning blue, seek medical attention.
Bajaj said that one major thing parents should do to be prepared is to know how to contact their primary care provider or pediatrician so that they can get ahold of them easily if something comes up. If their child starts to show symptoms of an illness, being able to get advice from their doctor about whether or not they need to go to the hospital can save them from hours of waiting in an emergency department.
He also said that the hospital’s freestanding urgent care in Wheat Ridge is a good option for parents to take their kids to if they need to get looked at but aren’t too sick.
“This is going to be a challenging winter,” Bajaj said. “But it will end.”
More information for parents and caretakers about RSV is available from Children’s Hospital Colorado at www.childrenscolorado.org/rsvinfo.
Information about where to get COVID-19 vaccines and boosters is available at covid19.colorado.gov.
— The Associated Press contributed to this report