RSV cases fill Michigan children's hospitals. At U-M's Mott: 'We're 100% full'

Capacity at pediatric hospitals across Michigan is strained as a record number of severely ill children with respiratory syncytial virus, or RSV, flood emergency rooms and fill hospital beds.

"There is not a hospital in Michigan that takes care of pediatric patients that has not told us that they are feeling stress right now, immense stress," Dr. Natasha Bagdasarian, Michigan's chief medical executive, told the Free Press Thursday.

At the University of Michigan Health's C.S Mott Children’s Hospital in Ann Arbor, the wait in the emergency department is hourslong and some elective procedures have been postponed to help manage the crush of patients.

“We have never seen a surge in pediatric respiratory viruses like this before," said Luanne Thomas Ewald, chief operating officer at Mott and Von Voigtlander Women's Hospital, in a statement. "Our hospital is 100% full."

'Unless your child is the sickest,' you'll have to wait

Across the state at Corewell Health Helen DeVos Children's Hospital in Grand Rapids, some children are being treated in chairs because no rooms or even hallway beds are available. Many private rooms throughout the hospital have been converted to double rooms.

"We usually see on average around 145 kids a day in the emergency department, and we're currently averaging over 225 kids a day," said Dr. Erica Michiels, a pediatric emergency room physician at Helen DeVos Children's Hospital. "That means that you're very likely going to have a wait unless your child is the sickest of children who was brought in.

"You may receive your care in the hallway in a bed or in a chair. And the whole department is just going to feel very busy. But I want to reassure everyone it feels busy, but it's very controlled. The emergency department staff is accustomed to dealing with surges and we will take care of all of you. It just might take a little longer than it has in the past."

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'We don't know where the peak is for this RSV season'

About 86% of Michigan's pediatric ICU beds — used to treat the sickest kids — were full as of Thursday, said John Karasinski, a spokesperson for the Michigan Health and Hospital Association.

"In addition to the high rates of RSV, the state is averaging over 30 COVID pediatric patients in Michigan hospitals over the past month while experiencing higher rates of flu compared to the past several years," Karasinski said. "Capacity is also strained by critical staffing shortages."

Some hospitals have activated their incident command systems, he said, to address the crisis and manage resources.

"Hospitals are also working in coordination statewide to transfer young patients to appropriate acuity settings to open up ICU space for the most severely ill children," he said. 

At the DeVos pediatric intensive care unit, which generally cares for about 24 children, 42 kids were admitted Wednesday, Michiels said.

"When viruses hit communities, they tend to do it in a surge-like fashion," she said. "We don't know where the peak is for this RSV season, but we have been on almost a vertical uprise for the last several weeks.

"Our entire system is working to make space for as many kids as we can. We are on daily calls with leaders from all over the state to talk about bed space that's available.

"This is not business as usual, and we need to collaborate all across the state with all of the children's hospitals and really try to make some creative solutions so that we can act immediately — not dissimilar to what we did with adults during COVID."

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Tackling staff shortages

Bagdasarian told the Free Press that Michigan's health leaders are doing all they can to support hospitals caring for this swell of severely ill children and are "investigating all possibilities" when it comes to assistance.

"When we talk about bed issues, I think the public perceives this ... as we don't have enough rooms ... enough beds," she said, when actually, it's about having the staffing — the nurses, doctors, respiratory therapists and other medical personnel — to care for the sick children lying in the beds.

"We recognize that is the limitation here, and we are working on a number of fronts to see what we can do to help support pediatric staffing across the state."

The Michigan Department of Health and Human Services is shoring up its volunteer registries and making sure hospitals that are hardest hit have access to those registries, she said.

"We're working on a number of fronts and you can probably expect some more information about this next week," she said.

The leaders of the state's children's hospitals plan to meet Friday to discuss creating a data-sharing system that will allow them to see capacity at each hospital to help manage Michigan's patient load, Thomas Ewald said.

"We're going to share data when we have PICU (pediatric intensive care unit) beds available and where they are at any given time, trying to create a dashboard for the state," she said.

Dawn O'Connell, assistant secretary for the U.S. Administration for Strategic Preparedness and Response, said during a Friday news briefing that the federal government is working with state and local health care providers to assess hospital capacity problems tied to the RSV surge.

The federal agency can deploy to struggling hospitals supplies from the Strategic National Stockpile, including masks, surgical gloves, gowns and ventilators, O’Connell said. National Disaster Medical System teams also could be deployed to hard-hit areas.

A spokesperson for the strategic response administration told the Free Press that the agency had not yet received any requests for federal relief from Michigan as of Thursday afternoon.

Mott is managing the heavy volume of RSV patients

At Mott in Ann Arbor, Thomas Ewald said efforts are underway to add 30 to 50 more beds to the current 300-bed pediatric capacity.

"It's easy for us to double up since we have all private rooms," she said. "Our concern, obviously, is staffing. We have the room to really increase our bed count by about 30 to 50, but we're just extremely concerned about getting staffing to support those 30 to 50 beds.

"We have requests out for travel nurses. We are seeing how quickly we can bring additional physicians onboard. So the easy part is really doubling up rooms. The hard part is stretching the current staff and trying to bring in new staff."

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So far this season, Mott has treated 259 children with RSV — a 46% increase over 2021 — and hospital leaders said the situation is likely to get worse with the upcoming flu season and the possibility of another spike in COVID-19 cases.

“This is incredibly concerning because we haven’t even seen the full impact of flu season yet,” Thomas Ewald said.

At this stage, however, she said leaders at Mott haven't asked for federal assistance to manage the RSV surge.

"We're staying in close contact to sort of see what we can do at a state level," she said. "We have not asked for that to be triggered yet."

Mott is leaning on its partners at Trinity Health Oakland and Trinity Health Ann Arbor as well as at Spectrum Health to treat some of the pediatric patients it doesn't have the capacity to care for right now.

"Every day, we are taking some transfers and we are declining other transfers," Thomas Ewald said. "They do have some available pediatric beds. So if we have to decline a lower-level transfer, we can have the family go there, and then if the child needs a consult with one of the specialists at C.S. Mott, we can do a phone consult and really help ... the pediatricians in the community hospitals help us manage that patient at that location."

Corewell Health East sees 1,579% rise in RSV cases

Since mid-September, Corewell Health East, the new name for Beaumont Health, has seen a 1,579% spike in children it has treated for RSV at its emergency centers and eight hospitals.

The health system treated 34 kids with RSV in the week of Sept. 19-25, but in the week of Oct. 31-Nov. 6, 571 kids got care for the virus, the health system told the Free Press.

That means families often face long wait times in emergency rooms, and at times, children may be treated in chairs rather than hospital beds if there aren't enough for all the patients who need them, said Dr. Matthew Denenberg, system chief of pediatrics for Corewell Health East.

To expand capacity so it can care for more children, the health system is converting observation units, adult ICU and surgical beds to pediatric beds, he said. It also began enforcing new visitor restrictions this week to limit the spread of RSV, flu and COVID-19 at its hospitals.

What is RSV and how serious is it?

While RSV is a common viral illness that typically causes mild, cold-like symptoms in healthy adults and adolescents, it can make infants, young children, older people and those with compromised immune systems severely ill. Sometimes, it can be fatal.

About 5 out of every 1,000 infants and toddlers younger than age 2 are hospitalized with RSV infections, according to a five-year prospective study based on surveillance of hospitalized children published in Pediatrics, the official medical journal of the American Academy of Pediatrics.

"This is a higher rate than for flu or COVID-19," Katelyn Jetelina, an epidemiologist and an assistant professor at the University of Texas Health Science Center, said in her substack, Your Local Epidemiologist. "The younger the child, the more likely hospitalization is. This is because their airways are just so tiny and can’t let airflow through when inflamed."

The average hospital stay for children is about five days, she said, and roughly 7% will need admission to an ICU for RSV.

"Among those hospitalized, most children were previously healthy," Jetelina said.

Before the coronavirus pandemic, RSV killed 100 to 500 U.S. children under age 5 each year, she said.

So far this year, the virus has killed at least one Michigan child. A 6-year-old boy from Macomb County died Nov. 2 of RSV at an Oakland County hospital.

Among older adults, between 60,000 to 120,000 in the U.S. are hospitalized each year, Jetelina said, and 6,000 to 10,000 of them die due to RSV infection.

"Just like COVID-19, RSV is rough on older adults because their immune systems are weaker and they are more likely to have underlying health conditions, like heart or lung disease," she said.

Doctors: Seek the right level of health care

As the RSV surge intensifies, health leaders urge parents of children with respiratory illnesses to call their primary care physician before bringing them to the hospital to be sure they need emergency care.

“The vast majority of children with RSV experience cold symptoms and can rest and recover at home,” said Dr. Kimberly Monroe, interim chief clinical officer and pediatric hospitalist at Mott. “However, if they’re showing any signs of severe illness, such as trouble breathing, they may need immediate care and should be brought to the emergency department. We’re particularly concerned about children under the age of 2.”

In most cases, symptoms like cough, runny nose, sore throat, earaches, vomiting, diarrhea, eye drainage and fussiness can be treated by a pediatrician or family physician.

An urgent care center might be the best place to go for treatment of minor illnesses or injuries that don't appear serious but cannot wait until the next day, such as a bone injury that isn't causing severe pain and doesn't appear to be crooked; sprains or minor pains; minor burns; minor asthma flares, and small cuts.

What are the signs that my child might need to go to the emergency room with RSV?

Most children will recover from RSV at home, doctors have told the Free Press. But caretakers should watch for the following symptoms as signs that infants and children might need immediate care at a hospital:

• Rapid breathing
• Wheezing or grunting noise
• Nostrils flaring and/or muscles in the neck, chest or abdomen are strained when trying to breathe
• Not eating well
• Excessive fussiness or excessive lethargy
• Bluish coloration of the skin
• Dehydration, which shows up in infants as fewer wet diapers
• Apnea episodes

Why is the Michigan RSV surge so severe now?

There is no evidence that RSV has shifted or changed in a way that causes more severe disease, Bagdasarian said.

Rather, she said the prevailing theory is that the COVID-19 pandemic has had a ripple effect on other common respiratory viruses. As people stayed home, avoided crowded places and wore masks for more than two years, it slowed the spread of coronavirus along with their exposure to other viruses, including RSV.

Because of that, there are now more young children who've never been exposed to RSV and whose bodies have no immunity to it.

"Every viral respiratory season, we see kids under the age of 1 who have never experienced RSV before who are seeing it for the first time," she said. "This year, it's not only kids who are under the age of 1, but it's also kids who were under the age of 2 and under the age of 3 because of all of the fantastic efforts we had at mitigating viral transmission over the COVID pandemic.

"So some of it is that and some of it, I think, is ... fatigue about those mitigation strategies as people have wanted to forget about COVID and forget about cold and flu season. I think that we need to really remind folks that the common-sense techniques that we've been using for decades still work.

"It still works to wash your hands really well before you eat or after use the restroom or after you've been touching doorknobs and after you've been in public spaces.

"It still works to cover your coughs and sneezes. And ... if you're unwell if you have a runny nose, the best thing you can do is either completely avoid going out in public or at the very least put a mask on so that you are not transmitting your germs to other people."

Contact Kristen Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.