While the most recent intense respiratory virus season may have peaked and experts predict future seasons will model pre-pandemic patterns, capacity and staffing challenges will likely persist in future seasons.
Respiratory syncytial virus began straining children's hospitals in early fall, with hospital leaders likening it to COVID-19's effect in March 2020. Then came influenza's early arrival, which went on to become the worst flu outbreak in 13 years. COVID-19 hospitalizations also increased through December and into January. The "tripledemic" pushed U.S. hospital bed use to a high in early December, with more than 80 percent of beds in use.
"We're expecting that the rates of infection and timing of infections to settle back down to their pre-pandemic cycles that we were seeing a few years ago," Dan Weinberger, PhD, associate professor in the epidemiology of microbial diseases at Yale School of Public Health in New Haven, Conn., told Becker's. He referenced RSV modeling he has worked on and trends from countries in the Southern Hemisphere.
The most recent virus season has been an anomaly of sorts, he said.
"People haven't seen a lot of these viruses for a couple of years, so there's maybe some waning of immunity and we're sort of playing catch up, but hopefully that will settle back down this year and we'll start to see a more normal pattern going forward," Dr. Weinberger said.
As the tripledemic winds down and healthcare workers grab a breath, many experts told Becker's they are focused on how to be better prepared for the next spike in infectious diseases.
Staffing and capacity issues
Hospital hiring and retention rates have been low for years, which have weighed heavily on care coordination issues. Alexandra Clark, MD, division chief of general pediatrics at Loma Linda (Calif.) University Children's Hospital, told Becker's health systems need to prioritize hiring and training this spring and summer.
"What we really need from our executive leadership is to ensure that we have the right number of pediatric trained nurses [and] therapists going into the next viral winter," Dr. Clark said.
The Emergency Medical Treatment and Labor Act is also creating setbacks, Dr. Clark said. EMTALA is a federal law designed to protect patients and ensure care equity by restricting hospitals from denying a potential patient if they have room. But because each case has a different acuity level, more lower-acuity cases and visits fueled capacity strain as hospitals worked to keep their few pediatric ICU beds available for higher-acuity cases.
Many hospitals have opted to shutter pediatric units to make room for more adult patients, who are usually more profitable — another factor contributing to capacity issues.
"Some of the smaller institutions have lost their ability to provide care for pediatric patients; [they] don't have the skill set for that. Unfortunately, unless there's more resources dedicated to pediatric care, I think we'll continue to struggle if we see surges like we [did this year]," Aaron Harthan, PharmD, pediatric critical care pharmacist at OSF Healthcare Children's Hospital of Illinois in Peoria, told Becker's.
Throughout the most recent RSV outbreak, children's hospitals routinely found themselves having to decline transfer requests from community hospitals as they struggled to keep beds open.
"We definitely have days during a typical respiratory season when we are at capacity or over capacity, but what we have never seen before was the numbers of requests for transfers of patients and the number of consecutive days where we were not just at capacity, but overflowing and having to turn away hundreds of transfer requests, which is the same [thing] all of the other children's hospitals were having to do," said Allison Bartlett, MD, pediatric infectious disease specialist at the University of Chicago Medicine Comer Children's Hospital.
To ease the strain respiratory virus season had on its emergency department, Comer Children's added an emergency room fast track in the clinic space to treat some of the lower-acuity patients who did not require emergency-level care. Such a strategy could be a challenge for hospitals to implement, however, given chronic healthcare labor shortages.
Drug supply challenges: 'We're just trying to survive'
The dramatic rise in pediatric cases did not just strain capacity. With more children getting sick, pain relievers tumbled into shortages. Shortages of Tamiflu generics, Tylenol, Motrin and ibuprofen generics, amoxicillin and local anesthetics persist.
"One of the concerns that I have in the future is, as we start to see an uptrend again like we saw, will places and facilities start to stockpile the few medications?" Dr. Harthan said. "Our retail pharmacy had trouble getting Tamiflu for a little bit there. That's another thing: Will the supply chain improve or be able to mitigate supply chain problems so that we can have adequate supplies and the medications we need for these patients?"
Most RSV cases are treated with supportive care because there are no vaccines or broad protection drugs approved. Dr. Harthan also said the limited number of treatments set off a "cascading effect" of pediatric drug shortages.
"I think the biggest challenge with RSV is that we don't have any great treatment options for the virus," Kruti Yagnik, DO, an infectious disease physician at Cleveland Clinic's Indian River Hospital in Gifford, Fla., said. "When you see a physician, you really feel helpless because you don't have a magic cure for RSV."
Multiple drugmakers recently submitted applications to the FDA to review RSV vaccine and drug candidates, but hospital workers said they are more concerned with the sick patients in front of them and a lack of beds than a potential new therapeutic. After a drug or vaccine is approved, the hospital pharmacy formulary process can take months to determine risks and benefits, and for hospitals and their systems to reach agreement and order supply, according to Dr. Harthan.
He said he has not seen the latest news on AstraZeneca and Sanofi's potential RSV drug.
"Right now, we're just trying to survive," Dr. Harthan said.