• The Children's Hospital Association and the American Academy of Pediatrics told the Biden administration that "unprecedented levels" of RSV combined with increasing flu circulation are pushing some hospitals to the breaking point.
• They asked the federal government to declare an emergency to provide hospitals with added flexibility to meet the surge.
• Infants 6 months and younger are getting hospitalized with RSV at seven times the rate observed before the Covid-19 pandemic in 2018, according to CDC data.

Doctors are calling on the Biden administration to declare an emergency in response to an "alarming surge" of children hospitalized with respiratory syncytial virus and flu this season.

The Children's Hospital Association and the American Academy of Pediatrics warned President Joe Biden and Health Secretary Xavier Becerra in a letter this week that "unprecedented levels" of RSV combined with increasing flu circulation are pushing some hospitals to the breaking point.

Infants 6 months and younger are getting hospitalized with RSV at more than seven times the rate observed before the Covid-19 pandemic in 2018, according to data from the Centers for Disease Control and Prevention. Flu hospitalizations are also at a decade high with children and the elderly most at risk, according to the CDC.

As respiratory viruses surge, more than three-fourths of pediatric hospital beds are occupied across the U.S., according to data from the Health and Human Services Department. Seventeen states are reporting that more than 80% of beds are full, according to the data. Children's hospitals in Arizona, the District of Columbia, Maine, Minnesota, Rhode Island, Kentucky and Utah are almost completely at capacity.

An emergency declaration would provide hospitals with the flexibility needed to free up bed capacity and staffing to make sure children get the care they need, Children's Hospital Association CEO Mark Wietecha and AAP CEO Mark Del Monte told Biden and Becerra in the letter this week.

The president should declare an emergency under the Stafford Act or the National Emergencies Act, and the health secretary should declare a public health emergency, Wietecha and Del Monte wrote.

"We need emergency funding support and flexibilities along the same lines of what was provided to respond to COVID surges," they wrote.

State emergencies

The surge in kids falling ill with respiratory viruses comes amid staffing shortages as many health care workers have switched careers or retired due to pandemic-era burnout. There also are large numbers of children being hospitalized for mental issues which is also straining capacity.

The American College of Emergency Physicians, in a letter to Biden earlier this month, warned that emergency departments are at a "breaking point" as patient volume exceeds staffed beds. Hospitals are often forced to hold patients in emergency departments because there are no inpatient beds available, which can result in long waits, diminished care and bad results for patients. ACEP described the situation as a public health emergency.

Oregon this week became the first state to declare on emergency in response to the RSV surge. Gov. Kate Brown said the declaration will support the state's two pediatric hospitals through the deployment of emergency volunteer medical teams. Oregon's pediatric hospitalization rate has more than tripled since late October, according to the governor's office.

A spokesperson for the Health and Human Services Department said the federal government is offering communities support on a case-by-case basis. A national public health emergency would be determined based on countrywide data, science trends and the insight of public health experts, the spokesperson said.

Senior U.S. health officials, in a call with reporters earlier this month, said the federal government is working with state and local partners to ease capacity issues at hospitals as respiratory illnesses surge. Dawn O'Connell, the assistant secretary for preparedness and response, said federal health teams and medical supplies in the national stockpile are available for states when needed. So far, no state has requested this level of support, O'Connell said.

Newborn hospitalization rates double

Public health officials in the U.S have repeatedly called on all eligible people to receive their Covid booster and flu shot to help ease the burden of respiratory disease this winter. There is no vaccine for RSV.

About 171 out of every 100,000 infants younger than 6 months were hospitalized with RSV for the week ending Nov. 12, according to the CDC's surveillance system that tracks 12 states. That is more than double the RSV hospitalization rate for newborns last year and more than seven times the rate in 2018, the last complete season before the Covid-19 pandemic.

The flu is hospitalizing about 10 out every 100,000 kids younger than age 5, according to CDC data. The hospitalization rate for these kids is at a decade high and about double the overall current national rate. Five kids have died of the flu so far this season, according to CDC.

RSV and flu are surging in part because people have largely abandoned the public health measures implemented during the height of the Covid pandemic, such as masking and social distancing, which suppressed circulation of these viruses, according Dr. Jose Romero, director of the CDC's National Center for Immunization and Respiratory Diseases.

Romero, during a call with reporters earlier this month, said many children did not get infected with RSV over the past two years due to the Covid health precautions. As a consequence, many kids did not develop any immunity and are catching the virus for the first time. The first infection tends to be more severe.

RSV is a common respiratory virus that almost all children catch by age 2. It normally causes mild symptoms similar to a cold, but the virus can be dangerous for infants 6 months and younger as well as school-aged kids who have weak immune systems. It is the leading cause of hospitalization for infants in the U.S., according to the CDC.

No underlying conditions

RSV causes inflammation and congestion in the lower airways, called bronchiolitis. Infants often need oxygen support because their airways are smaller and the inflammation makes it difficult for them to breathe. They also often need IV fluids for several days because they are dehydrated or not feeding well.

About 2% of all infants are hospitalized with RSV and 79% of those hospitalized younger than age 2 have no underlying medical conditions. Up to 300 children under age 5 die annually from RSV, according to the CDC.

Children's Hospital Colorado is "bursting at the seams" primarily due to a surge of RSV cases, said Dr. Sean O'Leary, a pediatrician and infectious disease expert. Inpatient beds and the intensive care unit are both full, O'Leary said.

The hospital's emergency department has set up a tent outside to see patients. Staff that typically don't work in the emergency room are taking hours there to help out, and the primary clinic is also adding hours to help ease the pressure, he said.

"We are breaking census records for the history of the hospital every day. It's unprecedented," said O'Leary, who is also vice chair of the AAP's infectious disease committee.

Comer Children's Hospital in Chicago has been at capacity for two months, said Dr. Allison Bartlett, a pediatrician and infectious disease expert. RSV arrived earlier and in greater force this year than in the past, Bartlett said. Many of the hospitalized kids have tended to be older this year, age 2 and above, likely because they did not get infected during the pandemic, she said.

UPMC Children's Hospital in Pittsburgh has faced a huge surge in respiratory illnesses since September, said Dr. Raymond Pitetti, director of the hospital's emergency department. The surge began with RSV but now influenza cases are skyrocketing, Pitetti said. About 20% of children who are brought to the hospital with respiratory illness are admitted and about five kids end up in the intensive care unit daily, he said.

Full hospital beds

Some days the hospital is full and children have to be held in the emergency room until an inpatient bed opens up, Pitetti said, but UPMC has been able to create new beds every day to move kids out of the ER.

More than 80% of the beds at Children's Healthcare Atlanta have been full for the past several months, said Dr. Andi Shane, head of epidemiology at the hospital. RSV began circulating during the summer months and then surged in early September, Shane said. Then more children started falling with the flu in early October as RSV cases started to decline, she said.

"We had Covid, then we have RSV, then we have influenza," Shane said. "So basically four months with no break and many, many children needing emergency room care, needing urgent care, needing hospitalizations. It's been very challenging just to keep up with all those children."

Flu activity is highest in Alabama, Georgia, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and Washington, D.C., according to CDC data. Arkansas, Louisiana, Maryland, New Mexico, New Jersey, New York City and Texas are seeing high levels of flu-like illness.

In the Southeast, the influenza A H3N2 strain appears to be the most common right now, the CDC's Romero told reporters earlier this month. This strain is associated with more severe illness in the elderly and young children, he said.

Unvaccinated

Almost all children hospitalized with the flu at Children's Healthcare Atlanta have not received their annual vaccination, Shane said. Part of the problem is the virus came early this year so people didn't have time, she said.

"We usually say get your flu vaccine by Halloween. Well by Halloween, we were having lots and lots and lots of flu here in Georgia," Shane said.

In addition to vaccination, public health officials are encouraging people to stay home when sick, avoid close contact with those who are ill, cover coughs and sneezes and wash their hands frequently. Those who want to take extra precautions can also wear a mask in public.

Romero said parents should seek immediate medical attention for their children if they show any of the following warning signs: trouble breathing, blueish lips or face, chest or muscle pain, dehydration (dry mouth, crying without tears, or not urinating for hours), or not being alert or interactive when awake.

Update: This story was updated to include the latest RSV data for the week ending Nov. 12, and pediatric bed occupancy data.