ER doctor says RSV surge in children is ‘1,000 times worse’ than you might imagine

ER doctor says RSV surge in children is ‘1,000 times worse’ than you might imagine

As respiratory viruses such as RSV (respiratory syncytial virus) are on the rise among young children across the United States, many children’s hospitals are overwhelmed by a flood of patients filling emergency rooms and hospital beds.

“There’s no room anywhere,” Dr. Sage Myers, a pediatric emergency medicine physician at the Children’s Hospital of Philadelphia, told TODAY.

The Children’s Hospital of Philadelphia (also known as CHOP) is the oldest children’s hospital in the country and one of the largest with 594 beds. The hospital has been at or above capacity for three weeks now, and the unprecedented volume of patients is causing wait times and capacity issues far beyond what staff could have imagined.

“I’ve been working in pediatric emergency medicine at CHOP for over 15 years and this is definitely the largest number of patients I’ve ever seen come to the emergency department and our hospitals were the most full ever,” Myers said.

Last week, Myers took to Twitter to share what she saw in a pediatric emergency room. Her comments went viral.

“We’re seeing a lot of respiratory viruses circulating right now that have appeared much earlier than we normally see,” Myers said, adding that RSV is more of a late fall or winter virus, but cases started to rise in the summer.

RSV cases have jumped in Philadelphia since September, according to data from the City of Philadelphia Department of Public Health. Nationally, weekly rates of RSV hospitalizations have reached levels typically seen in December, according to data from US Centers for Disease Control and Prevention.

The rise in RSV coincides with the early flu season, Myers said, and activity is already there attacking with full force in parts of the South. Last week, the US reported on the highest rate of hospitalizations due to influenza for this time of year in the decade, with young children among the hardest hit groups, TODAY previously reported.

Rhinovirus and enterovirus, common viruses that cause respiratory illness, are also circulating at higher levels than usual, Myers said, and COVID-19 hasn’t gone away either.

Children’s immunity to these viruses may have weakened over the past two years due to a lack of exposure during the pandemic, which may explain why these seasonal respiratory viruses are hitting harder and earlier than expected, TODAY previously reported.

Experts have warned against potential “triple epidemic” of RSV, influenza and COVID-19 this winter, which could strain health care systems and stretch medical resources.

Most children who get RSV will recover on their own, but Myers said she is seeing an increasing number of children who struggle to breathe and end up in the emergency room. Children hospitalized with RSV supportive care, such as fluids and oxygen, is usually needed, but some need prolonged care or being put on a ventilator. Some children may develop complications, such as pneumonia or bronchiolitis.

“Young children in general are more likely to have difficulty with respiratory illnesses, especially RSV, in part because we build immunity over time … so the older you are, the stronger your immunity is and the easier it is to fight it,” he said. Myers.

“There are simply no beds available.”

The sheer volume of sick children in the emergency room and hospitalized patients creates delays and bottlenecks in care, according to Myers. “We have waiting times for children in the emergency department that are much longer than we ever thought possible, despite doing everything we can to see children quickly.”

So many children come to CHOP’s emergency department at once that there is a wait to be seen and triaged when patients first come in, Myers said. The waiting time in the actual waiting room to see a doctor is also long, and even children who need to be hospitalized have to wait until a place becomes available.

“There’s just no beds available, and a lot of kids are sitting in the emergency department waiting … which reduces the space we have to see new kids,” Myers said. This includes children who come to the emergency room for RSV or any other reason. “Obviously we’re still seeing all the kids with appendicitis and broken arms and those things,” Myers said.

This isn’t just a problem in the Philadelphia area, Myers said, and CHOP has been inundated with requests to transfer patients from hospitals in other states as far away as Virginia. “It’s not typical at all … They’re reaching out as far as they can to try to find places to send their kids,” Myers added.

A growing problem for already overburdened hospitals

What’s happening at CHOP is just a snapshot of what’s going on in many children’s hospitals across the country. The crisis comes after the closure of pediatric wards at many US hospitals to make way for an influx of adult patients due to COVID-19.

“Very few children were getting sick … so some hospitals closed their pediatric floors completely … and there was less room in the community for children to be cared for,” Myers said.

Health worker shortages and burnout are exacerbating the problem. “We (at CHOP) are fortunate to still be able to use all of our bed capacity,” Myers said. “There are hospitals that may have an open bed, but they can’t use it because they don’t have enough staff to do it safely.”

A severe flu season could make matters worse, Myers warned, noting that “influenza is more likely to cause pediatric deaths than RSV.”

It’s not clear how the winter will play out, but Myers said she predicts “it’s just going to be a longer and longer wait for the kids … There’s literally nowhere else to send them.”

How parents can help protect children

“Children in general are incredibly resilient. … Most of the time he will recover,” Myers said. But it’s important for parents to learn how to distinguish between a mild case that can be treated at home and one that requires additional care or a visit to the emergency room.

“Pediatricians can be very helpful,” Myers said, adding that parents should not hesitate to reach out if their child is sick.

Signs of serious illness include, but are not limited to, difficulty breathing or wheezing, and discoloration of the skin or lips.

Parents can also protect their children by making sure they are up to date on their vaccines, Myers said. Every child 6 months and older should get their own seasonal flu vaccine and the primary series of vaccines against COVID-19, and children 5 years and older should receive a booster shot against COVID-19, experts told TODAY. Some children may need two flu shots.

“The more we can control the spread of the flu and the fewer children who get sick, the better,” Myers said.

Adults should also get vaccinated, Myers added, because they are less likely to become infected and pass the virus on to children. Immunization is “a good priority if you’re trying to avoid sitting in a waiting room for hours and hours,” Myers said.

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