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Summary and Posture
Summary: National pediatric bed capacity is the scarcest it has been in two years, with 71 percent of US pediatric hospital beds reported as filled. Since October 21, hospitals in the following states and localities have seen rising pediatric surge: Rhode Island, Washington, Colorado, Texas, Ohio, Louisiana, New Jersey, Massachusetts, Connecticut, Maryland, Virginia, and Washington, DC. The increase in pediatric hospital admissions is largely due to a rise in respiratory-related illnesses, such as respiratory syncytial virus (RSV), enterovirus, and rhinovirus (RSV being the most critical illness for which children are currently being admitted to the hospital). Officials from the US Centers for Disease Control and Prevention are advising hospital systems to increase communication and resource/stock-sharing to address the present surge, but there is currently no known coordinated response to this event.
Posture: Healthcare Ready is on alert, monitoring potential concerns for supply chain disruptions and potential impacts to healthcare services as a result of this event.
Since 2020, RSV has been on a different seasonal cycle than in prior years, making RSV cases more difficult to predict by public health. Usually, RSV season onset is in September with a peak in December through February and an offset by May. This year RSV season onset, peak, and offset is lining up more closely with that of influenza as these cycles converge. Adding to the challenge: The condition can also be difficult for clinicians to diagnose, as symptoms are like other conditions, such as COVID-19 and the common cold. Infants younger than six months, especially those who are premature, are at and especially high risk for contracting RSV and are affected by typical symptoms of this illness. Excessive medical surge caused by RSV and other respiratory diseases may threaten the health outcomes of children, especially infants if the medical surge situation worsens and crisis standards of care are implemented.
Treatments for Respiratory Syncytial Virus (RSV)
Prevention and preparedness will be essential to avoid worsening surge conditions for infants, children, and adolescents. Children and young adults – who are eligible – are encouraged to get flu shots prior to flu season, especially because there is no vaccine for RSV, yet. This will help prevent seasonal cases of the flu and lessen the risk of increased hospitalizations due to other respiratory illnesses. Fewer flu-related hospitalizations will ensure greater bed capacity in pediatric hospitals for the treatment of other illnesses.
A monoclonal antibody therapy called palivizumab is available to prevent severe RSV illness in certain infants and children who are at high risk for severe disease. It cannot cure or treat children who are already suffering from serious cases of RSV; it is a preventative treatment. Monoclonal antibody therapy is not ideal in this situation because it is invasive and costly. However, results seen in delivery monoclonal antibodies to pediatric cases were effective in mitigating symptoms. Infants who are born prematurely or with congenital heart or lung disease may benefited the most by this treatment.
The American Academy of Pediatrics published guidance for use of palivizumab prophylaxis to prevent hospitalizations for severe RSV during the 2022-2023 RSV Season in August 2022.
Supply chain information: Palivizumab is sold under the brand name Synagis and is marketed by Sobi in the United States. Sobi purchased US rights to Synagis from AstraZeneca in 2018. We are working to determine considerations for availability of this treatment in future assessments.
There are several challenges unique to managing pediatric medical surge, particularly for the healthcare workforce and supply chain. Pediatric hospitals require more intensive nursing resources to treat and monitor patients – especially patients in intensive care and neonatal intensive care. Pediatric supply chains can also be more vulnerable to supply chain disruptions, as some critical products have only one supplier or manufacturer capable of producing the necessary pediatric-specific equipment and supplies.
Products of concern for this event include supplies and equipment that are commonly used to treat respiratory illnesses, and that may have limited numbers of manufacturers. Products that should be tracked for disruptions due to increased demand, include:
Treatments like palivizumab
Pediatric intubation supplies
Desitin and diapers
Pediatric personal protective equipment (PPE), including N95s
As flu season approaches, it is essential that the healthcare workforce remain healthy and capable of responding to rising medical surge. During a time where workforce shortages are rampant across all sectors within the US from the past two and a half years, pediatric hospitals must prepare a strong workforce to combat surges of hospitalizations from respiratory illnesses. Nurses, doctors, and hospital staff are critical for care and are also facing shortages in hospitals. This may pose a threat to establishing predictable quality of care for patients. Because pediatrics is a specialty practice, there may be additional strain on workforce with pediatrics experience.
Preparedness Considerations for Healthcare Facilities
There are several steps that can be taken to enhance regional preparedness. Healthcare facilities and pediatric hospitals can prepare communication and resource sharing networks to be poised for response by:
Refreshing and reviewing transfer agreements with other children’s’ hospitals or adult hospitals with pediatric bed capacity;
Refreshing contacts with distributors and vendors to alert them of potential needs;
Confirming contacts with county or city public health departments in case assistance needs to be requested;
As the US healthcare system prepares for flu season this fall and winter, it will be essential that pediatric hospitals have beds available and access to the necessary medical supplies. Regional facilities should be poised to activate existing partnerships to ensure pediatric hospitals are armed with needed supplies (including via state caches, regional supplies via local healthcare coalitions, or other strategies in place to support surge or alternatives to existing supply sources). State and local public health departments may disperse information on the safety and efficacy of flu vaccines to aid in communication needs around this event, along with providing additional guidance to support clinical diagnosis or helping parents and caretakers to understand when to seek medical attention.
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