Corewell places visitor restrictions as pediatric RSV cases threaten Michigan hospitals
Respiratory syncytial virus (RSV) has not peaked in Michigan, doctors warned Friday, as the eastern division of the state’s largest health system said it would impose restrictions on visitors as other health officials noted a statewide shortage of pediatric beds.
Hospital pediatric intensive care units across Michigan were at 89% capacity Friday, according to the Michigan Health and Hospital Association and the Michigan Department of Health. A lack of beds and the highly contagious nature of respiratory illnesses make it difficult to care for the sickest pediatric patients, according to a group of state hospitals.
Detroit’s acute pediatric hospital capacity is “extremely limited,” Detroit Chief Public Health Officer Denise Fair Razo said in a news release Friday.
Across the entire Corewell Health East emergency center, there were 167 children hospitalized with RSV Wednesday, up from 128 the week before and 35 in early October. Corewell Health East, formerly known as Beaumont Health, is implementing new visiting restrictions at its eight hospitals starting Monday. Children under the age of five will not be allowed to visit patients unless there are extreme circumstances, Corewell Health officials said in a statement Friday.
“Everyone can do their part to stop or limit the spread of respiratory diseases in our community. Wash your hands regularly, and if you are sick, stay home. If you or a loved one experiences any life-threatening symptoms, such as trouble breathing, seek immediate medical attention,” said Dr. Nick Gilpin, Director of Infection Prevention for Corewell Health East.
Danielle Giacoletti, 33, didn’t expect to spend five days in the pediatric intensive care unit when she took her 2-month-old son, Camden, to the University of Michigan’s Mott Children’s Hospital on Oct. 22 with a case of RSV. His only symptoms were lack of appetite and fever.
After going to the emergency room and being admitted to the PICU, Camden “took a really bad turn” and needed a BiPAP, or type of ventilator, to breathe the next day, Giacoletti said.
“We had doctors, we had colleagues, we had residents, we had respiratory therapists. They were all around his bed,” Giacoletti said. “All you want to do is hold him and comfort him and you can’t. This little kid is surrounded by 10 people and they’re there to do what’s best for him, but there’s no way he’s going to understand that.”
A few days later, Camden recovered enough to breathe on his own, but Giacoletti said it was probably one of the worst experiences of her life.
“It can progress very quickly and turn around very quickly … As a parent, you have to be extremely diligent if your children are diagnosed with RSV,” Giacoletti said.
What others see
RSV and other winter viruses are spreading respiratory diseases and rapidly infecting more young patients than in previous years. Earlier this week, the Oakland County Health Department made the announcement a six-year-old Macomb boy died of RSVthe first child death in that state during the recent surge.
Helen DeVos Children’s Hospital in Grand Rapids, operated by Corewell Health West, is at full capacity but continues to serve children and their families, said Chief Pediatrician Dominic Sanfilippo. Sixty percent of children hospitalized with viral respiratory infections at DeVos Children’s Hospital have RSV as of Friday.
“Sometimes we stretch and admit more patients than our bed capacity is. And we’ve been able to do that because we as a children’s hospital … cannot deny care to a child who needs our help,” Sanfilippo said. “Most of the cases we’re seeing are children with RSV. This has hit us earlier and harder than in years past.”
By the end of October, University of Michigan Health CS Mott Children’s Hospital had 154 cases of RSV and bronchiolitis, a 66% increase from October 2021, spokeswoman Beata Mostafavi said. The five-hospital Henry Ford Health System, which does not have a children’s hospital, has had seven pediatric patients admitted with RSV since Friday.
RSV is a common respiratory infection that causes cold-like symptoms, according to the Centers for Disease Control and Prevention. Most children are infected with RSV by the time they are two, although 58,000-80,000 children under the age of five are hospitalized for RSV each year.
Symptoms of RSV usually resolve within a week or two in adults, but the virus can cause serious illness in infants and the elderly. RSV is the most common cause of pneumonia and bronchiolitis, an inflammation of the lungs, in children younger than one year, the CDC says.
“(RSV) causes the airways to swell and young children have smaller airways,” said Rebecca Schein, a pediatric infectious disease specialist at Michigan State University Health Care. “So when their airways swell, they wheeze and have trouble getting air, so they gasp for air more. They work harder to breathe and need more support.”
RSV can also make chronic health conditions like asthma worse. Premature babies and young children with conditions such as chronic lung disease, congenital heart disease, weakened immune systems, or neuromuscular disorders are especially at risk of serious complications.
The Michigan Hospital Association urged patients with mild cold-like symptoms to stay home. In some areas, emergency room capacity is stretched by patients with non-emergency medical conditions. People with moderate to severe symptoms, including shortness of breath, should seek hospital care, according to the association. Patients with worsening cold-like symptoms can seek care in an emergency room or their primary care physician, the MHA recommends.
“If someone doesn’t need to go to the emergency department … everyone should try to avoid it,” said Sanfilippo of DeVos Children’s Hospital. “There are many other viruses that cause children to be sick, to be in the emergency room, and to be hospitalized.”
Why is RSV spreading now?
RSV is not a new virus, but there are many more cases unusually early in the year compared to the past two years, said Jonathan Gold, a pediatrician at Michigan State University and chairman of the government affairs and advocacy committee of the Michigan chapter of the American Academy of Pediatrics.
“There was a significant reduction in RSV in the first year of the pandemic,” Gold said. “People wore masks a lot and isolated themselves and kept away from each other in all environments.”
When restrictions related to COVID-19 began to ease in the spring and summer of 2021, doctors started seeing cases again, which was unusual because RSV is typically a winter virus, Gold said.
Many doctors think the rise in RSV cases this fall is at least partly due to a lack of exposure to the virus during the start of the COVID-19 pandemic and to people becoming less concerned about hygiene and social distancing since the pandemic began.
“There were kids who just hadn’t been exposed to RSV before and didn’t have immunity. As they started coming together, they were more susceptible, and I think that’s probably a big part of what happened this year as well,” Gold said.
“People are getting more comfortable doing things and, frankly, they’re probably a little less strict about handwashing and wearing masks and keeping distance and staying home when they’re sick.”
The RSV season typically lasts two to four months, and it’s too early to know if the number of cases will exceed the bad years before the COVID-19 pandemic, Schein said.
“The typical RSV season … usually starts in late November, December and ends by April,” Schein said. “…We saw cases at the end of September, but the numbers got bad in October.”
Threat of ‘tridemic’
Hospitals across Michigan are concerned about coincident future waves of RSV, influenza and COVID-19. While flu levels are now low in Michigan, they are rising sharply in southern states. Doctors say it’s only a matter of time before the flu hits Michigan.
“It’s really about hospital beds,” Schein said. “Right now there are a lot of children with RSV who are having trouble breathing and need ventilatory support. And if you add those children with the flu, it’s only going to increase the shortage of hospital beds.”
Sanfilippo said the pediatrics department at DeVos Children’s Hospital will “deal with it” if all three viruses hit Michigan at once, but they are preparing.
“We are preparing to create more beds, working with the state. We are working to proactively have more staff to help care for those children,” he said.
The best way to prevent a wave of all three viruses is to get vaccinated, said Uzma Shah, chief of pediatrics at Henry Ford Health.
“There is no vaccine for RSV, but there is a vaccine for influenza and COVID,” Shah said. “If it can be controlled by vaccination, then we won’t have a triple threat.”
When to seek emergency help
Early symptoms of pediatric RSV include runny nose, loss of appetite, and cough, which may progress to wheezing or difficulty breathing. The virus sometimes just causes irritability in infants, but it can also trigger a decrease in appetite, activity and breathing with apnea, according to the CDC.
While all parents are concerned, especially when their children are young, some cases of RSV can be treated at home with good hydration and Tylenol, Shah said. If children develop a fever, parents can call their primary care physician to discuss treatment options, but should go to the emergency room if their child is having trouble breathing or staying hydrated, she said.
The most serious sign of respiratory distress is flooding, Sanfilippo said. Flared nostrils, gurgling, rapid breathing, pulling in between the ribs and wobbly breathing are also signs in babies, he said.
The precautions people took during the height of the COVID-19 pandemic will also work to stop the spread of RSV, Gold said.
“Wash your hands. For older children and adults, covering your cough with your elbow,” Gold said. “Wearing a mask can help if you’re sick… and just wiping surfaces.”
Detroit’s health department encouraged residents to stay home if they are sick and parents to consider having their children wear masks in public places, including school.