Oregon Health and Science University and Randall Children’s Hospital are taking emergency measures to admit more children to their pediatric intensive care units. That’s happening as a wave of RSV, a common childhood virus that can be dangerous to babies and the elderly, has hit Oregon.
The hospitals account for two of only three in the state that provide intensive care, including life support, to children. OHSU representatives said all of the state’s pediatric ICU beds are full and it is formally shifting to crisis care standards.
“Every hospital will reject patients at some point,” says Dr. Carl Eriksson, a pediatric critical care expert at OHSU. “What we are seeing now is that the collective group of hospitals is at the point where we are concerned about our ability to serve the next patient. And that is why we are taking this next step.”
The standards also affect the services available to other children who need hospital-level care, such as teens in mental health crises.
OPB’s health reporter Amelia Templeton has covered the crisis, and she joined host Geoff Norcross to discuss the state’s scarcity of children’s beds. A full transcript of the conversation follows.
Editor’s Note: At the time of recording this interview, Randall Children’s Hospital had not yet issued crisis standards of care.
Jeff Norcross: So we started the crisis at OHSU. But what are you hearing from other hospitals in the state about the RSV crisis?
Amelia Templeton: RSV is really impacting a part of the health system that did well during the pandemic: pediatrics. RSV is especially bad for very young children. A pediatrician I spoke to said it’s the busiest pediatric ward for about 10 years. She said colleagues have told her this is very similar to what they saw during the last major 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’ve heard that about half of children’s hospital beds are currently used for patients with RSV. Most RSV patients don’t need intensive care, but the sickest babies do – all the way down to things like ventilator support. At this time, the state’s three pediatric ICUs are all full.
Norcross: So what are the rest of the hospitals in the state doing with those ICUs at capacity?
Templeton: I think right now it can be very difficult to find an ICU bed for pediatric patients. For example, I heard of a case of a hospital in Medford that had tried to transfer their patient to OHSU for ICU level care and was unsuccessful.
The hospitals I spoke to in Salem and Eugene said they are doing a few things to manage this situation. They are trying to expand the level of care they can provide locally, to save space for the very sickest pediatric patients in the specialized ICUs in Doernbecher [the children’s section at OHSU] and legacy [home to Randall Children’s Hospital]. Portland hospitals, meanwhile, have been trying to move older children into adult ICUs and move babies into neonatal ICUs to create more capacity.
And in some cases, patients who need ICU-level care are sent to Idaho. The hospitals in Washington and California are just as full as in Oregon – some pediatric patients from those states even end up here.
Norcross: What does OHSU allow under the crisis standards for care?
Temple barrel: This allows them to allocate more patients to each critical care nurse. Normally, the absolute maximum for a pediatric ICU nurse is two patients at a time. Now it can be three. This enables the hospital to immediately add more IC beds in a nearby recovery room.
Norcross: You’ve heard that another group of kids is struggling during this RSV crisis. Teenagers in a 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 often receive care in the emergency department or pediatric wards of general hospitals. Those are the very same places that are overrun by little babies with breathing problems.
Imagine being a teenager in crisis and showing up to the emergency room – you might wait longer to be seen, and it might be harder to find you a bed. Jill Pearson, medical director of pediatrics at Salem Health, told me she’s really worried about those kids.
“I’m really thinking about making sure those kids have access to health and mental health resources because we’re all drowning in the wave of congestion and RSV,” Pearson said. “But I want to make sure that doesn’t limit accessibility for those kids to really come in and be seen when they need to be seen.”
Norcross: So that’s how it goes with the system as a whole. Can you explain on an individual patient level what RSV is like? Do children recover? What can people do to help and what should people know about dealing with this virus in their own homes?
Temple barrel: First, I really want to emphasize, most cases of RSV can be managed at home.
The key, especially for babies, is nose sucking. Sucking aggressively, Dr. Pearson said.
“Newborns are called ‘obligatory nasal breathers,’ so they have to have an open nose to breathe and they won’t eat, they won’t breathe properly, they’ll breathe fast, they’ll have a really hard time and once you suck their nose out , they are made 100% better,” she said.
Keep them hydrated. You want your baby to pee at least three times a day.
Signs for when you bring them in [to the ER]: If they breathe quickly or use auxiliary muscles to breathe. So if they have abdominal breathing or the muscles at their collarbone are pulling, it’s time to go to the urgent care or emergency room.