Oregon Health and Science University and Randall Children’s Hospital are taking emergency steps to admit more children to their pediatric intensive care units. That’s happening as a surge in RSV, a common childhood virus that can be dangerous for infants and older people, has hit Oregon.
The hospitals account for two of just three in the state that provide intensive care, including life support, to children. Representatives from OHSU said all of the state’s pediatric ICU beds are full and it is formally shifting to crisis standards of care.
“Every hospital will at times turn patients away,” said Dr. Carl Eriksson, a pediatric critical care expert at OHSU. “What we’re seeing now is the collective group of hospitals is at the point where we’re concerned about our ability to serve the next patient. And that’s why we’re taking this next step.”
The standards are also affecting available services for other children in need of hospital-level care, like teenagers in mental health crises.
OPB’s health reporter Amelia Templeton has been covering the crisis and she joined host Geoff Norcross to discuss the scarcity of pediatric beds in the state. A complete transcript of the conversation follows.
Editor’s note: At the time this interview was recorded, Randall Children’s Hospital had not yet declared crisis standards of care.
Geoff Norcross: So we started with the crisis at OHSU. But what are you hearing from other hospitals around the state about the RSV crisis?
Amelia Templeton: RSV is really impacting a part of the health system that fared well during the pandemic: pediatrics. RSV is particularly bad for very young kids. One pediatrician I spoke with said it’s the busiest her pediatric unit has been in about 10 years. She said colleagues have told her this is a lot like what they saw during the last big flu pandemic, H1N1 [in 2009].
I spoke with OHSU and two major hospitals outside the Portland metro area, Salem Hospital and PeaceHealth Riverbend in Eugene. I heard that about half the in-patient beds for kids right now are being used for patients with RSV. Most RSV patients do not need intensive care, but the sickest babies do - all the way up to things like ventilation. Right now, the state’s three pediatric ICUS are all at capacity.
Norcross: So with those ICUs at capacity, what are the rest of the hospitals in the state doing?
Templeton: I think there can be a real struggle to find an ICU bed right now for pediatric patients. I heard of one case, for example, of a hospital in Medford that had tried to get their patient transferred to OHSU for ICU level care and was not able to.
The hospitals I talked to in Salem and Eugene said they are doing a few things to manage this situation. They’re trying to stretch the level of care they can provide locally, to save space for the very sickest pediatric patients at the specialty ICUs at Doernbecher [the children’s section at OHSU] and Legacy [home to Randall Children’s Hospital]. The Portland hospitals, meanwhile, have been trying to put older kids in the adult ICUs and to move babies in the neonatal ICUs to create more capacity that way.
And in some cases, patients who need ICU level care are getting sent to Idaho. Washington and California hospitals are just as full as Oregon - in fact, some pediatric patients from those states are ending up here.
Norcross: What do the crisis standards of care allow OHSU to do?
Templeton: It allows them to assign more patients to each critical care nurse. Normally the absolute max for a pediatric ICU nurse would be two patients at a time. Now it could be, say, three. That will allow the hospital to immediately add more ICU beds in a nearby surgical recovery room.
Norcross: You’ve heard that another group of kids is struggling during this RSV crisis. Teenagers in mental health crisis. Can you explain that?
Well, they’re the other major pediatric population. And because Oregon has a dire shortage of specialized mental health beds for teens, they wind up often getting care in the emergency department or in generalized hospital pediatric units. Those are exactly the same places that are overwhelmed by tiny babies with breathing problems.
Just imagine you’re a teen in crisis showing up at the ER - you’re going to wait longer to be seen, maybe, and it might be harder to find a bed for you. Jill Pearson, the medical director of pediatrics at Salem Health, told me she is really concerned about those kids.
“Making sure those kids have access to health and mental health resources is really on my mind because we’re all drowning in the surge of congestion and RSV,” Pearson said. “But I want to make sure that that doesn’t limit the accessibility to those kids to really get in and be seen when they need to be seen.”
Norcross: So that’s how the system as a whole is faring. Can you explain, at the individual patient level, what is RSV like? Do kids recover? What can people do to help and what should people know about managing this virus in their own home?
Templeton: First, I really want to stress: Most cases of RSV can be managed at home.
Key, especially for babies, is nasal suctioning. Aggressive suctioning, said Dr. Pearson.
“Newborns are called ‘obligate nose breathers’ so they have to have an open nose to breathe and they won’t eat, they won’t breathe well, they’ll be breathing rapidly, they’ll be really struggling and once you suck their nose out they’re made like 100% better,” she said.
Keep them hydrated. You want your baby to be peeing three times a day at least.
Signs for when you bring them in [to the ER]: lf they are breathing fast or using accessory muscles to breathe. So if they’re tummy breathing or pulling in the muscles by their collarbone, it’s time to head to urgent care or the ED.