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Children’s hospitals are under strain in the United States as they care for unusually high numbers of kids infected with RSV and other respiratory viruses.

It’s the latest example of how the pandemic has upended the usual seasonal patterns of respiratory illnesses, denying a respite for health-care professionals ahead of a potential hectic winter as the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a>, influenza and other viruses collide.

Respiratory syncytial virus, a common cause of cold-like illness in young children known as RSV, started surging in late summer, months before its typical season from November to early spring. This month, the United States has been recording about 5,000 cases per week, according to <a href="https://www.cdc.gov/surveillance/nrevss/images/trend_images/RSV14Num_Nat.htm" target=_blank>federal data</a>, which is on par with last year but far higher than October 2020, when more coronavirus restrictions were in effect and very few people were getting RSV.

Hospitals are worried about child RSV this year. Here’s what to know.

“It’s very hard to find a bed in a children’s hospital — specifically an intensive care unit bed for a kid with bad pneumonia or bad RSV because they are so full,” said Jesse Hackell, a doctor who chairs the committee on practice and ambulatory medicine for the American Academy of Pediatrics.

Nearly three-quarters of pediatric hospital beds are occupied, according to<a href="https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh"> federal health data</a>. Rhode Island, the District of Columbia and Delaware report more than 94 percent of pediatric beds occupied. Maine, Arizona, Texas, Kentucky, Oklahoma and Missouri reported between 85 and 90 percent of beds occupied. The data is limited to facilities that report the information.

Several children’s hospitals in the D.C. area <a href="https://www.washingtonpost.com/dc-md-va/2022/10/20/pediatrics-hospital-capacity-dc-children/" target=_blank>have been at capacity </a>for weeks; 18 children were waiting for a room in the ICU on Tuesday at Children’s National in the District.

D.C. Realtor Kate Foster-Bankey was more attuned to RSV after she started hearing from clients whose children were afflicted with the virus in recent weeks, including one whose child was admitted to Children’s National.

Kate Foster-Bankey

Then her 3-year-old daughter Isabelle fell ill, becoming lethargic, complaining of a fast heartbeat and not eating. They waited two hours in the packed waiting room of a pediatric urgent-care center where Foster-Bankey, a mother of four, was used to seeing only a handful of patients.

During a follow-up visit Tuesday, Isabelle was transported by ambulance to the emergency room of a children’s hospital, where she tested positive for RSV and had to wait until the following morning for a bed.

“It sounds like in covid, we gutted our pediatric care,” said Foster-Bankey, 41. “Kids shouldn’t have to wait in a waiting room with a bunch of other sick kids for hours.”

At Connecticut Children’s Hospital, the emergency room is so full that patients are being triaged in hallways. Teens with bone fractures and appendicitis are being diverted or transferred to adult-care centers to create additional space for respiratory patients. Hospital officials are considering the possibility of enlisting the National Guard to set up tents and care for the influx of patients.

Over the past nine days, 110 children with RSV have come in to the emergency room, and at times as many as 25 children with RSV were waiting for an inpatient bed, said Juan Salazar, physician in chief at Connecticut Children’s. He said that for the first time in his career he has had to mandate doctors in other specialties such as endocrinology and rheumatology work with RSV patients — a situation reminiscent of the “all hands on deck” approach many adult hospitals took in March 2020, when the coronavirus began to sweep through the United States.

“During my tenure here I haven’t seen anything like this,” said Salazar, who has worked in infectious diseases for 30 years.

For decades, fear and failure in the hunt for an RSV vaccine. Now, success.

Salazar and other doctors said one possible reason for the rise in RSV cases is that “pandemic babies” born in the past three years had been protected from respiratory pathogens due to social distancing and masking.

Salazar said another theory suggests children exposed to covid-19 have weakened immune systems, even if they had asymptomatic or mild cases. Even if babies had asymptomatic or mild cases, he said it’s possible that the percentage of infection-fighting B-cells might have dropped, creating “a certain level of immunosuppression” just as they are getting hit with a viral infection.

“So the virus has found a very susceptible population and spread very quickly,” Salazar said.

Texas Children’s Hospital in Houston, the nation’s largest pediatric medical center, had more than 40 RSV inpatients as of Friday, with several children in intensive care.

James Versalovic, pathologist in chief at Texas Children’s, said the surge of RSV outside of the typical season could be attributed to how different respiratory viruses interact with each other and how the pandemic changed children born in recent years.

“Their immune systems and immunity may have been altered in ways that we’re just beginning to appreciate,” he said, adding that the pandemic has changed humankind’s “pattern of susceptibility to respiratory viruses.”

Covid is making flu and other viruses act in unfamiliar ways

Hackell, of the American Academy of Pediatrics, said masking during the pandemic simply delayed the normal infection pattern for respiratory pathogens. “We are seeing a lot more cases at one time where they used to be spread out,” he said.

RSV, which mostly infected infants and toddlers before the pandemic, has now been seen in children older than 3, said Andrew Pavia, an infectious-disease expert at the University of Utah Health and Intermountain Primary Children’s Hospital.

Most RSV and other respiratory illness cases will not require hospitalizations. But when so many children are getting sick at once, even a small percentage requiring hospital care can exhaust beds.

Elizabeth Murray, a pediatric emergency medicine physician at the University of Rochester-Golisano Children’s Hospital, said her hospital is seeing between 20 and 30 more patients a day because of the crush of respiratory illnesses. About a fifth of patients have RSV. Some are staying in the emergency department or post-surgical areas instead of getting a traditional room because the hospital is getting full.

“We have to use spaces a little more creatively,” Murray said.

Marc Lashley, a pediatrician at New York’s Allied Physicians Group, one of the largest pediatric organizations in the country, said his pediatric practice is experiencing a busier fall because of rising RSV cases.

“It is pretty labor intensive to keep them out of the hospital,” Lashley said, recommending parents keep sick children at home to reduce the spread of illness and the strain on the health-care system. “We don’t want children to live in a bubble, but we do want parents to be prudent if a child has cold symptoms, which is how RSV can start.”

Few Americans get updated covid shots ahead of expected winter surge

Experts also have been concerned about stubbornly<a href="https://www.washingtonpost.com/health/2022/09/18/kids-coronavirus-vaccine/" target=_blank> low coronavirus vaccination and booster rates</a> in children, as authorities prepare for a winter influx fueled by variants adept at infecting people despite previous shots and infections.

While children tend to have milder cases of covid-19, hospitals can still be overwhelmed by pediatric cases during waves of mass infection when the small percentage of children who do fall severely ill amounts to thousands.

The staff at Intermountain Primary Children’s Hospital, which was at 92 percent capacity as of Friday, is bracing for a confluence of RSV, flu and covid-19 surges.

“The ingredients are in place for all three waves overlapping,” Pavia said.

When coronavirus receded last year, other viruses roared back

It’s why medical experts are amplifying their pleas for people to get vaccinated for influenza and coronavirus — and to beware of multiple viruses hitting at once.

“If you are not immunized and you get infected, you are going to have much more severe infection,” said Angela Myers, division director for infectious diseases at Children’s Mercy Kansas City, which is also experiencing an uptick in RSV cases.

For Foster-Bankey the virus proved unpredictable.

Doctors had prepared to discharge Isabelle on Thursday, but her oxygen levels dipped dramatically and she nearly passed out. She was put on overnight oxygen support and started to rebound Friday, cheering up after playing with an Elsa doll.

After three nights in the hospital, Isabelle was able to return home in time for dinner Friday. Her older sisters welcomed her back with a new pumpkin headband.

Jenna Portnoy contributed to this report.

Northwestern University, BS in journalism and political science. 

American University, MSJ in journalism. 

Fenit Nirappil is a reporter for the Health & Science team who covers public health, infectious diseases and LGBTQ issues. He previously covered local politics. 

Fenit Nirappil

Columbia University

Ariana Eunjung Cha is a national reporter. She has previously served as The Post's bureau chief in Shanghai and San Francisco, and as a correspondent in Baghdad.