Pitting society’s lack of concern over the crisis in pediatric infectious disease

Flashback fairly early days of Covid. There was fairly decent evidence that children were not very effective spreaders of Covid and zero solid evidence that closing schools was very effective at reducing its spread. But on the possibility that it might protect significantly above and beyond masking and other simple abatements, not the kids who were never at great risk of serious disease from Covid, but adults they might come into contact with, schools were shut down, with kids having very predictable negative consequences over these last years as a result. Fine. Done.

Now, three years later. Preschoolers and toddlers are en masse being exposed to their first RSV and flu infections with no small number getting sick enough to need oxygen and some needing ICU care. Okay. It has to happen sometime.

But. There has been a long term trend to fewer staffed pediatric hospital beds which then rapidly accelerated during Covid as so few kids needed care for respiratory infectious disease.

I am having many patients who have had to be transferred out of state to find a hospital or ICU bed already. As influenza cases continue to rise rapidly, especially after Thanksgiving, there is a reasonable chance that those kids will be parked in the ED with no beds to find anywhere. The kids potentially hypoxic in the waiting room, currently often waiting hours, will wait longer or just not get seen. There is no back up plan.

And how is this being reported on in the media. Most commonly not at all, sometimes in the last several days with reports of a “potential triple-demic” with an aside mentioning that many pediatric hospitals are at capacity but the thrust of the report on what this means for Covid and adults. The catastrophe that is in progress as the retaining wall is currently being breached by a storm surge that is rising rapidly is not being mentioned: it is Covid that sells the story. Screw Covid. Screw the reporting that doesn’t understand how serious of an issue this is. Kids are potentially going to have respiratory failure in waiting rooms, and not from goddamn Covid.

Screw our society that was willing keep kids socially isolated and harmed in the name of possible hypothetical impact on Covid spread but that won’t do a single damn thing to flatten the curve as staffed pediatric bed capacity gets swamped. Screw those not getting their flu shots by now. Screw those going to an extended family Thanksgiving tomorrow with sniffles and coughs that may be RSV or early influenza. Could they at least wear a mask when they are not actively eating? Sure they could. Will they? No. They’re over that by now.

Maybe RSV actually is peaking and will drop fast and influenza won’t continue to explode. I freakin’ hope so. But I am very scared of what is coming this next month, and very pissed that the rest of our society that cared so much about Covid, that demanded so much sacrifice from kids out of minimally overblown fears of kids as spreaders of it, is not willing to do any behaviors to reduce the risk of their spreading these diseases to relatively higher risk younger children all at once.

People are terrible at risk assessment.

We had a kid in the preschool where I worked with a “keep and epi-pen on had” allergy to wheat, who we had to watch out for all the time, because flour dust in the kitchen could set him off. We had to be so thorough in wiping down everything after snack, etc. It was crazy.

On the last day of school, his father told me that there was a daily medication he could be on that would pretty much eliminate the danger of incidental contact with wheat-- he wouldn’t be able to eat a sandwich on what bread, but he wouldn’t go into anaphylaxis from inhaling some flour in the air.

But his parents didn’t want to “put chemicals into his body.”

Fully vaccinated kid, mind you. Whose parents didn’t deny him antibiotics when he had a bacterial infection, nor did they seem wary of the epi-pen and Benadryl we had on hand.

This one sticks out in my mind because it was personally exasperating, but I could come up with examples all day of people making bad decisions like this.

I realize that your example seems especially callous, and very much like adults taking care of adults at children’s expense. It might just be low-quality thinking that people churn out so often, though.

My state health authority has been sounding the alarm for weeks, but at least on Facebook, they get laughing emojis and crazytalk comments.

I’m just holding my breath waiting for another measles outbreak, it feels like that kind of season and the antivaxxers have only been getting crazier.

Wait no more. Three measles cases in Phoenix area could signal potential outbreak

Our current governor signed a bill saying that schools cannot enforce masking or social distancing. Kids do NOT need to be vaccinated for anything at all if their parents claim religious exemptions.

There was a time when receiving cash benefits aka TANF aka welfare required the children the taxpayers were supporting to have all childhood vaccinations. That time is not now.

I can’t find a cite now, but I recently read about chicken pox somewhere is a really Red county of the state and polio in New York.

The polio outbreak in New York State was linked to an ultra-Orthodox Jewish community who are mostly unvaccinated, and children do need to be vaxed in order to get WIC benefits. Not so sure about TANF, because that may depend on the state.

When I was a graduate student working on a history project, I came across a journal from a British soldier who came down with scurvy while a prisoner of war in a German camp. He wrote that he always thought the effects of scurvy, the joint pain, bleeding gums, and constant fatigue were exaggerated by those in the past. When he experienced it firsthand he came to realize those descriptions were fairly accurate.

I feel as though we as a whole are in a similar position. I was born in 1976, my parents never really had to worry about me getting rubella, mumps, whooping cough, smallpox, or polio and I never really worried about that for my nieces and nephews. Because we haven’t suffered that much in a few generations, we’ve grown somewhat complacent. We haven’t experienced them firsthand, so we can fool ourselves into thinking they weren’t that bad, that hygiene is why we don’t have to worry anymore, or that it’s okay if my little Precious doesn’t get vaccinated because everyone else will.

It’s sad, but I think it’s likely we’ll remain in denial until something comes along that leaves a lot of dead kids in its wake.

Pfttt, they aren’t zygotes, embryos, or fetuses.

There are a lot of selfish adults out there is my thought.

We actually saw some of that during covid - wealthy and/or powerful people who could afford to provide protection for their family, or take an extended “vacation” somewhere there just didn’t happen to be a lot of people, who openly declared that the economy was more important than human life.

Well, I think there are a lot of adults who think kids getting sick and landing in the hospital isn’t important because it doesn’t affect them directly. Those kids don’t vote, they don’t work in “essential” jobs or make money for the selfish adults.

Sorry, feeling cynical this morning.

I was pissed that we felt, as a society, that it’s just too hard to mask, but we could shut down schools. There were states where the bars were open, but the schools were closed. WTF? Which of those institutions spreads covid more effectively?

But I’m not sure what we can do right now to flatten the RSV curve. And the pediatric beds were shut down because they lost money, and had been losing money for years. Because our healthcare system is broken.

There is a major pediatric hospital that is severely limiting its PICU beds due to a dramatic shortage of nursing staff. The result of this is unprecedented and dangerous back-ups of kids in ED, some of whom need very close monitoring by skilled staff.

The facility is in crisis mode, offering increasingly outrageous amounts of money (north of $250/hour in some cases) to any RN with a pulse to come and help out. Needless to say, most of these nurses are not ED-trained and are not qualified to take care of your critically ill toddler.

This is happening now, and it’s not even the busy RSV season yet.

This is the problem. The anti-vaxxers and anti-maskers have become entrenched, and will never concede, and everyone else has gotten sick of the arguments. Heckler’s Veto has won.

And it’s not just the US. We’re having the same problems with our kid’s hospitals here in Canada, and a local school board meeting about possibly re-instating a mask mandate in schools last week was inundated with anti-maskers, who disrupted the meeting so much it had to be shut down early, with no decisions made.

This is just our reality now.

Something to be said for Zoom is that you can hold a meeting where participants are safe and anyone disrupting or not following protocol can be muted or removed.

That being said, i have several friends who are teachers, and i supported closing schools, especially middle and high school, where the kids spread covid as well as adults, until vaccines were available.

And I’m quite serious in my question, what can we do now to flatten the RSV curve? Do you think we should have a widespread mask mandate to protect our children? Something else?

I do a covid test before I go to medical appointments - and this past Tuesday popped positive, so I called my oncologist and arranged for a telemed visit, I had done the bloodwork the week previous. I was happy to change to a video conference, I am in the maintenance part of treatment so a monthly visit isn’t needed [he trusts me to do my own BP and blood ox, and mrAru checked my chest out because I was a bit wheezy when I took the test, no pneumonia, just my normal stress wheeze. Heart doing good, which makes me happy.]

I actually don’t know what the current evidence points to but evidence during the early days did not clearly point to that conclusion

Anecdotally, most of the parents i know caught covid from their kids. But of course, current variants behave differently than the original strain.

And i certainly know some parents who DIDN’T catch it when they’re kids had it. (And some couples who didn’t catch it from each other )

Thanks for this post DSeid. I’ve been relatively casual about covid since I caught it myself in the big wave a year ago; I’ve kept an eye on numbers in my area but not religiously. I decided that when people were saying “The flu kills so many people and we don’t take that seriously” that I would start taking the flu more seriously (I always get my shot but I’ve never altered my behavior or masked or anything). Replace flu with rsv and I’m going to change my behavior because of this thread. Thank you.

I seem to recall reading, not long ago, that some hospitals were scaling back or even closing down their pediatric units because they were being threatened by wackos.

Is that actually happening in any significant numbers? Enough to be a factor in what the OP is discussing?

RSV and the rapidly ascending Influenza curve, both of which hospitalize the under two crowd disproportionately.

Masks work.

Wide spread mask use, especially in schools, would substantially slow the spread of both. There is zero chance of mask mandates coming back in any district and virtually no chance that any public figure of authority will strongly suggest or even strongly encourage returning to widespread use. It’s not only the anti-maskers; it includes those who were diligent during Covid peaks and just recently have started going back out. Again people are just over that. So much was done “out of an abundance of caution” that most are going to stick their fingers in their ears and repeat lalala to any warning of impending disaster.

I’m not sure though that the long term trend of staffed pediatric hospital beds is a result of a broken healthcare system. Honestly it occurred more as a result of successes by healthcare. Before the rotavirus vaccine came out hospitals had a regular … stream … of admissions of little ones needing IV fluids for dehydration association with that infection. Other admissions for pneumonia and meningitis had already decreased with other immunizations. Better asthma protocols cut down asthma admissions (as did better access to primary care that could provide it, and better usage of these protocols by primary care providers). It is hard to justify staff and beds dedicated to pediatrics when the typical census most of the year is zero to three (with a few days of infectious storm surge each year during RSV and flu). Then came three years of no storm surge, with the beds and staff desperately needed for sick adults … the beds that were in desperate short supply ped side over these last years have been for psychiatric admissions that spiked during Covid and its aftermath, but pediatric respiratory therapists and nurses moved on in large numbers.

Building up capacity to handle this post Covid spike was not a realistic ask. It simply couldn’t happen. The staff is not there to hire anymore.

Normal seasonality is not existent right now and likely won’t be for a few years. RSV has been in major circulation since late Spring with a major spike as soon as school started back up. Influenza is spiking up much earlier than normal seasonality would have it. Usually RSV and influenza do not “share the stage”, one exits stage left as the other enters stage right, but not this year. These are different times.

My own micro view: what to do in our currently understaffed (not for lack of trying to hire) general pediatrics office? Our office nurses and are burning out dealing with a constantly overbooked schedule, phone calls, and MyChart messages. We worry that some might quit and other staff is calling in sick last minute with what we are pretty sure are mental health days. Large numbers of calls for sick visits are being turned away by them and redirected to overcrowded Immediate Care Centers (ICC). We’ve just decided to implement pushing off any new appointments for well care over two years old (with rare exceptions at the office managers judgement) and closing to new patients for now, to be revisited end of December. Nurses used to have capacity to do flu shots for parents and sibs along with the child scheduled for a well visit. That’s out the window. This is not a sustainable fix and the impact of this on the macro problem is only preventing our adding more overflow into the ICCs which often now have hours of waits and are with some regularity having kids coming in who must be transferred by ambulance to the ED, where they had gone to first but gave up. That’s a pretty marginal help.

This is bad.

@DeadTreasSecretaries - I engaged in those debates ad nauseum back at the time (and yes that was before variants). Feel free to search for the threads but from my POV it is past history. I’ll leave it with what is clear and infuriating from the article: the position that the default was to close schools and to keep them closed not based on any evidence that having schools open presented a risk, despite the fact that other countries kept schools open safely, but because they were not convinced that the evidence on schools being open was not any risk (a claim no one was making) was “conclusive” enough for their liking, no fucks given to the vast harms imposed by that choice: “no one disputes that attending school in-person is critical for childhood development” - but tough shit for them.

@Llama_Llogophile not that I know of.