RSV cases continue to surge in Texas, leaving children’s hospitals at capacity

Cases of respiratory syncytial virus are continuing to climb in Texas and across the U.S., leaving Dallas-Fort Worth children’s hospitals at capacity and with limited room to accept sick children.

There were seven pediatric ICU beds available across the Dallas-Fort Worth region on Sunday, according to data from the state health department.

At Cook Children’s, the children’s hospital in Tarrant County, all parts of the health system are at capacity, leaders said Thursday.

“We are full across the entire system,” Dr. Kara Starnes said. “Hospital beds, appointments at various clinics, emergency departments. All of these locations are completely full each day.”

The main culprit, according to state data, is respiratory syncytial virus, or RSV, a seasonal virus that is most worrisome in children under 5, and particularly in infants. RSV is the most common cause of pneumonia and inflammation of small airways in the lung for infants, according to the U.S. Centers for Disease Control and Prevention.

RSV season typically peaks in mid-December, but is spreading rapidly among young children earlier than might be expected in a normal year. The combination of an early and aggressive RSV season coupled with seasonal influenza is leaving children’s hospitals almost completely full.

“We’ve yet to reach peak flu season and we’re not sure if we’ve reached peak RSV season,” Starnes said.

The influx of sick kids is colliding with a need for more health care staff, said Dr. Dan Guzman, an emergency physician with Cook Children’s. Part of the reason for the overflow, he said, is that some of the sickest kids need longer term care and can’t vacate ER beds quickly.

“We have 78 beds in our emergency room,” Guzman said. “But when you don’t have kids leaving the hospital...they tend to stay in our ER. So that limits our ability to be able to move and see more patients.”

Cook Children’s hospital is so full that hospital leaders have activated an internal disaster protocol used when the hospital is at capacity. When that protocol is in place, Guzman said, doctors might work on days when they’re not scheduled to work, additional staff is called in to help, and patients are sometimes discharged more quickly than usual.

Some hospitalized children are testing positive for COVID-19 as well, according to state data. The number of hospitalized children with COVID-19 peaked at the end of August, about two weeks after the start of the school year for most Tarrant County school districts. Since then, the number of kids with COVID has gradually decreased, according to the data.

What is RSV, or respiratory syncytial virus?

Although RSV sometimes gets less attention than seasonal influenza and other viruses, it has long been a disease of concern among pediatricians.

In most healthy adults, respiratory syncytial virus will only cause a cold. But in children younger than 5, in adults 65 and older, and in people with compromised immune systems, the virus can cause a more serious disease. Some pediatricians say RSV is a more vexsome disease to treat in young children than other viruses because there is no specific treatment for the infection itself.

Doctors can provide supportive treatments, like additional oxygen, for bad infectious, and preventive treatments for infants who are born early or who have small airways.

In a typical year, several hundred infants will die from RSV. Researchers have estimated that RSV usually kills more infants than seasonal influenza, although both viruses are dangerous for older adults.

Is there an RSV vaccine?

The world got some promising news about a possible RSV vaccine on Tuesday. Pfizer published results of a phase 3 trial for its RSV vaccine, and said it had an efficacy of 82% against hospitalization in infants under 90 days old, according to the pharmaceutical company.

In the absence of an RSV vaccine, pediatricians recommend getting your children vaccinated against the diseases we do have protection for: seasonal influenza and COVID-19.

A plea for kindness and patience

Doctors with Cook Children’s urged parents to only bring their child to an urgent care clinic or the emergency room in the case of a true emergency because the system is so overwhelmed. They also cautioned that families who do go to urgent care clinics should expect to wait depending on how sick their child is.

They also asked for kindness, as health care workers continue to battle the latest surge after two years of the COVID-19 pandemic.

Staff “really need your kindness to be able to put one foot in front of another,” Starnes said.