There is a confluence of factors and frankly I am very scared.
Lockdown and masks worked very well at preventing children of all ages from getting RSV and influenza for the last three years.
Therefore older children and adults have not been exposed to it and more of them are susceptible to infections. Their infections are still generally mild, sometimes even asymptomatic, they’ve still seen the bug before and have fairly big “small airways”, but they spread it (oh it can trigger asthma episodes and severe illness in a few older children and adults but fairly few).
Children up to three years old though … most have never lived through RSV exposure. They are almost all susceptible, all having their very first infection with it, and all with fairly small small airways. They are relatively high risk for severe disease from RSV, with certain sub populations of that group more so (babies, former premiers, etc.). And they are all being exposed because of all those older sibs and parents bringing it in, with mild symptoms themselves. Volume volume volume! Most of them still have relatively mild disease. Some significant number will wheeze, have modest difficulty breathing, poor feeding, but able to managed fine with attentive parenting, recovering within the week. Some fairly small fraction get hypoxic, can’t breathe well enough to get enough fluids in, and need to be hospitalized, and a very small fraction of infections are fatal. Have many times as many infections occurring in this relatively high risk group and no surprise to have many times more of those serious cases.
Now overlay on that a long term trend that was made much more dramatic during COVID: decreasing pediatric hospital capacity. Over the years the vast majority of community hospitals have dropped have pediatric capacity. Our local one did and I couldn’t blame them. The unit usually had a census of zero to four except during specific infectious disease season spikes. (Various vaccinations, inclusive of for rotavirus diarrhea, and better asthma prevention care made huge impacts in reducing numbers.) And those few small spikes went to zero during COVID, so many more closed up. The pediatric staff moved on, transitioning to adult respiratory care or out of the business entirely. Not possible to re-open those beds quickly even if the corporate hacks gave a green light.
RSV has been steady since Spring and is only increasing with onset of school. And now influenza is in a rapid ascent.
Even before influenza started to rise waits in EDs were often 6 to 8 hours and it has been common to have to transfer kids needing inpatient care out of state to find a bed.
Next week, at this rate, with influenza rising (children under two have a relatively high risk of needing hospitalization with influenza, especially the unvaccinated)? It is reasonably expected that there will not be beds to use anywhere. The child needing admission will stay in the ED on oxygen maybe for days, but the child sitting in the waiting room hypoxic won’t be seen … and there is no back up plan.
When there was a chance that COVID would exceed inpatient capacity the world responded, sometimes in rational ways, sometimes not, separate debate that I gave up on in the time … but pediatric hospital capacity being swamped, the imminent likely preventable deaths of kids due to lack of a bed to get oxygen at? Does not seem to rank.
Schools should go back to masking to flatten the curve … not of COVID which was always a relatively low risk of serious disease for kids, and remains such … but of influenza and RSV. And the chance of that happening is not a rounding error of zero; it is zero.
Do I sound tired and cranky? Well yes I am.