Pediatric hospitals in the D.C.-area are operating at or near capacity as the respiratory virus RSV surges among children, leaving many affected parents anxious about available care. Children’s National Hospital in D.C., Inova Children’s Hospital in Fairfax, and the Johns Hopkins Children’s Center in Baltimore have all reported increased patient loads in recent weeks due to RSV. This common virus typically causes mild, cold-like symptoms but it can cause more severe problems, including pneumonia and the lung infection bronchiolitis, with infants at particular risk for more severe cases.

Brandon and Claire Vaidyanathan experienced the effects of the bed shortages firsthand two weeks ago when they noticed their four-year-old daughter had an elevated fever and some difficulty breathing. 

When they arrived at urgent care, the doctor told them they needed the emergency department. But as Claire and her daughter were whisked away to Children’s National in an ambulance, they were warned that the pediatric ICU might be full.

Due to the severe symptoms of what they soon found out was RSV, their daughter was expedited to a bed in spite of the shortages. She remained in the hospital for five harrowing days as doctors and nurses attempted different treatments.

“She was intubated,” Brandon says. “So the first day, she actually started getting a bit better. And then the second day she regressed and again had a lot of labored breathing. And so then they started to treat her pretty aggressively.”

Luckily, she began to improve after that, leaving the Vaidyanathans relieved that the hospital made space for her and that they sought treatment when they did. 

“I dread the thought of, what if I just didn’t, you know? “What if her breathing got a lot worse?” Brandon says of the possibility that he or Claire might not have taken her to get treatment when they did. “I felt miserable, I mean, this could have easily turned very wrong.”

RSV surges amongst children aren’t a new problem but this year, parents are navigating a healthcare system experiencing nursing shortages, decreased hospital capacity due to the pandemic, and years of reductions in pediatric beds nationwide. Experts also believe that children who have been shielded from viruses by COVID protection measures, such as masking and isolation, may have reduced immunity as a result.

Division Director of Pediatric Hospital Medicine at Johns Hopkins Children’s Center Dr. Eric Biondi says that this lowered immunity may be leading to more severe and complicated RSV cases.

“This feels like the sickest that I’ve seen kids coming in with these respiratory illnesses,” Biondi says.

Dr. Anita Patel, a pediatric critical care specialist at Children’s National, says it’s hard to say whether children are sicker this year as compared to previous years (she hasn’t noticed longer hospital stays than is typical for pediatric RSV cases) but that there seems to be a higher number of cases overall. 

“I believe that it is the sheer number of patients with the same percentage of severely ill kids. However, when you have a greater volume of illness, you will invariably see more severely ill kids,” Patel says.

The increase at Children’s National is modest so far but it is noticeable. According to the hospital, they’ve documented 1088 positive cases of RSV from July to mid-October compared to 923 during the same time last year.

“We’ve seen surges in the past but this one hasn’t died down. It’s created a challenging environment to work in,” Patel says. “The disease itself is not overwhelming. It’s the volume.” 

Despite ongoing questions about the severity of the virus, it is clear that recent closures of pediatric inpatient units are contributing to the lack of beds both locally and nationally.

“Most pediatric care in the country is not done at large children’s hospitals. It’s done at small community sites, which are often pediatric units within larger adult hospitals. And so those small units over the last couple of years, we’ve seen a lot of them close down as they needed more adult beds,” Biondi says. He estimates that 15% of pediatric beds have closed in Maryland alone.

In recent years, Henrico Doctors’ Hospital in Richmond closed some pediatric beds, as did MedStar Franklin Square Medical Center in Baltimore, according to the Washington Post.

A national study documenting closures of pediatric units between 2008 and 2018 found that possible causes included pediatric hospitalizations decreasing, pediatric units being less profitable (making them a target for budget cuts), and a short supply of specialized staff.

The closures have created a bottleneck at children’s hospitals nationwide, with parents and staff alike feeling the squeeze.

When Teresa Bippus’s two-week-old son Luke had difficulty breathing two weeks ago, she headed to Children’s National as soon as she got his negative COVID test. When she arrived, she was shocked at how crowded it was.

“I mean it was standing room only,” she says, adding that the waiting room had “pre-triage” where a nurse determined how fast patients needed to be seen, prioritizing kids who needed ventilators. “I have four kids, so I have been to the emergency room with the newborn five times for various things. This was the fifth time. I have never had to wait in the waiting room before.”

Patel says that while the waiting room has been crowded at times, similar to any surge year, waiting times are going to fluctuate. “Hour to hour, it can be really full, and then it can quiet down. The waiting room is dynamic,” Patel says, adding that any newborns with fevers over 100.4 degrees should go to the ER no matter what the issue is.

Infants, and particularly newborns, are more susceptible to complications from RSV, says Biondi.

“They can’t cough as strong, so they can’t clear it, and their airways are smaller. So a little bit of mucus goes a long way,” he says.

Luckily, Luke’s symptoms improved while they were waiting, and they didn’t need to be admitted for an overnight stay. They met with a doctor that kept him for observation for two hours to make sure he was fully recovered. Bippus says doctors even offered to keep him for a few hours longer in case things worsened.

But Bippus still wonders what the threshold is for prioritizing care. “It made me worry about the people that are in that sort of [category] where you need to be seen fast but it’s not immediately life-threatening,” she says. “What if he had been breathing a little worse, you know, and he hadn’t needed BiPap or a ventilator but he had needed oxygen, or something?”

Patel says that even as they deal with the pressure of rising cases, there’s a spectrum they use to safely prioritize, using primarily oxygen saturation levels and breathing difficulty to determine whether a patient needs to be admitted.

For some parents, fears about insurance coverage and the cost of care add to the stress of this surge.

“I did a panicked check of the hospital insurance coverage once she was admitted and was relieved to find out they accept our provider,” Brandon says. “But I wouldn’t be surprised if I receive a hefty bill with charges for the ambulance, etc. that are not fully covered by insurance.”

D.C. has a high rate of insured residents compared to other metro areas but racial disparities mean that while 97% of white residents are insured and 94% of Black residents are insured, just 87% of Latinx residents are covered. And insurance doesn’t always protect from large co-pays, out-of-pocket costs, or out of network care, as Brandon feared.

Patel says that the most important thing parents can do now is focus on prevention. She says that parents should keep their kids up to date on vaccines, especially the flu vaccine. The hospital reports they’ve had 80 cases as of mid-October – ten times the amount they saw last year. Patels says other basics include good hand hygiene, mouth covering when coughing, keeping kids home if they have a fever, and masking for children above two years of age. 

“Masking has prevented a lot of these surges. They’re not the norm right now, but are still a great tool,” Patel says. 

She also emphasized that if a child is having any breathing difficulty, the ER is there to help and that these circumstances shouldn’t discourage parents from seeking care.

“Even if we think we can’t make beds, we do. There are ways to be sure we’re handling things,” Patel says.

This story has been updated to reflect the correct temperature for when parents should take an infant with a fever to the emergency room.