Texas Children’s and Children’s Hospitals are surrounded by two viruses: RSV and COVID-19

Estefani López’s 11-month-old baby had difficulty breathing. The girl, Ava Rivera, became infected with COVID-19 and began to have seizures. Then her pulse weakened. Her mom couldn’t feel her breathing anymore.

Lopez rushed her to the emergency room, where staff began initial treatment, dropping a tube into her throat and oxygenating her lungs. However, the baby’s condition required care in a children’s hospital and no one in the Houston area could accept her. They were all full.

Instead, Lopez needed to monitor hospital staff on a helicopter, airlifting the baby to a temple 150 miles away, and providing emergency medical care at the nearest children’s hospital with space. Lopez drove to the hospital for the next three hours hoping that the baby would survive.

“I felt like my heart had fallen from my chest. I didn’t know what was going on for three hours,” Lopez said. “I felt like it was three days.”

More children are being treated for COVID-19 in Texas hospitals than ever before. However, there is a second factor that drives the way to overwhelm children’s hospitals. It is an out-of-season outbreak of respiratory syncytial virus (RSV), a highly contagious virus that may require hospitalization, primarily in children under the age of five, especially in infants.

Last year, RSV was mostly dormant, but experts attribute it to people’s masks during the pandemic. Now, in the last few weeks, thousands of Texas children have been tested positive for the virus.

In addition, the COVID-19 delta mutant appears to affect more unvaccinated children than previous mutants. It is unknown whether children are also more ill than other variants of COVID-19. And as the regular flu season approaches, medical professionals are concerned about how hospital capacity will be affected.

From the start of the pandemic to August 9, more than 5,800 children in Texas were hospitalized with COVID-19, according to the Centers for Disease Control and Prevention. According to the American Academy of Pediatrics and the Association of Children’s Hospitals, 783 children were admitted to a Texas hospital with COVID-19 between July 1st and August 9th.

Lopez’s daughter is okay now. The doctor replaced the intubation with a nasal tube, her fever broke, and she was able to go home the next day. However, the situation in children’s hospitals continues to deteriorate. In Texas, these hospitals are becoming increasingly difficult to meet the needs of beds for children with COVID-19 and RSV, as well as other conditions and injuries. And doctors are afraid of what will happen with the reopening of school, with far fewer children masked and far more children in direct attendance than last year.

“The number of children hospitalized in COVID-19 has increased significantly. Dr. Seth D. Kaplan, President of the Texas Pediatric Society, said: More than that, some people need ICU care. “This is a more aggressive variant. It makes more children sick and requires more hospitalization. Therefore, in addition to RSV. And that’s why it’s actually causing capacity issues. “

“It’s spreading like a wildfire,” said Dr. Jim Versalovich, director of pathology and interim pediatrician at the Texas Children’s Hospital in Houston. “For the past few weeks, Texas Children’s has escalated its strategy in terms of dealing with this double surge.”

The hospital has extended the emergency treatment time. Doctors are postponing elective surgery that requires a postoperative bed. Staff are opening new units in the hospital and working overtime to meet demand. Within Texas Children, more than 45 children were hospitalized with COVID-19 on Wednesday, and hospital staff diagnosed more than 1,600 cases of RSV. Approximately 90% of hospital COVID-19-positive patients (all children and adolescents) were infected with the delta type.

About half of Texas Children’s RSV and COVID-19 patients are babies.

The influx of RSV cases during the summer was surprising to doctors who usually see it spread later in the year. According to Versalovich, RSV surges have been seen in southern states, and children’s hospitals in other regions have responded to increased hospitalizations due to COVID-19.

To make matters worse, Versalovic said his hospital identified 25 children with both RSV and COVID-19. He is convinced that his hospital system can effectively treat these cases, but it is a new phenomenon and doctors do not know what to expect. More than half of people diagnosed with both viruses are hospitalized, and hospitalization rates are much higher than with either virus alone.

“We’re certainly worried about it … We’ve never seen it before,” Versalovic said. “We are concerned about that [the double-diagnosis cases] It may be more severe. “

Meanwhile, adult hospitals are facing their own crisis as the number of COVID-19 patients filling intensive care units throughout the state is increasing. Staff shortages exacerbate the problem as more adults (the majority of them are unvaccinated) are hospitalized with delta variants. According to the latest federal numbers reported last week, 53 hospitals in Texas have completely exhausted beds in the intensive care unit. The situation may have deteriorated since then.

Last summer, a children’s hospital helped take some of the non-COVID adult patients flooded from a nearby hospital during the worst stages of the pandemic. But now that children’s hospitals are also facing a crisis, it will no longer be an option.

“We are preparing for a very difficult time in the coming weeks and we need to predict more childhood and adolescent COVID cases at the beginning of the school year,” Versalovic said. “We cannot plan to take an adult patient and drop off a nearby hospital because we need to reserve those beds for the children and family we serve.”

The delta mutant is believed to be at least twice as infectious as the previous mutant of COVID-19 and preyed primarily on the unvaccinated population. The majority of unvaccinated children are children under the age of 12 who are not yet eligible for vaccination. Less than 27% are fully vaccinated, even between the ages of 12 and 15 in Texas, who are old enough to get a shot.

Versalovich estimates that even if the vaccine is approved for children under the age of 12, it could be in late September or early October, but it can take weeks to slow the surge. He said it would take several months.

Pediatrics chairman Kaplan said parents need to focus on masking their children and getting vaccinated if they qualify. Vaccines are still the most effective defense against the virus. Even the rare breakthrough infections in which vaccinated people are infected with COVID-19, they are still largely protected from hospitalization.

“We know that COVID-19 can be transmitted through a population of children. I know that many of them are not vaccinated and many are not even eligible for vaccination. We know, “said Kaplan. “People who are not fully vaccinated should wear a mask when they are in a public place indoors and at a social distance.”

Dr. Marys Zanne Whitworth, Head of Pediatric Infectious Diseases at Cook Children’s Urgent Hospital in Fort Worth, said her facility also had a sharp rise in RSV and COVID-19. Cook saw about 200 RSVs each week last month.

“I think everyone in the country was really surprised at how much RSV happened this summer. It’s the first time this has happened,” she said.

In the early days of the pandemic, some thought that children were less likely to be infected with COVID-19, but Whitworth said parents should pay attention to the emergence of the delta type. On Tuesday, there were 20 children hospitalized with COVID-19 at Cook Children, according to data from the hospital.

“Children are at risk of serious illness,” she said. “In general, kids do pretty well with COVID, but there are a lot of kids who don’t, and I never know who will.”

Estefani Lopez said people want to hear from her and her daughter and take action to protect their children and the children of others. She is afraid of other parents now that the children’s hospital is very crowded.

“My daughter is very small. She may have died,” she said. “I hope people take this seriously.”

Correction, August 12, 2021: Earlier versions of this story exaggerated the number of children recently admitted to COVID-19 in Texas. According to the Centers for Disease Control and Prevention, more than 5,800 children were hospitalized during the seven days of August. That number correctly referred to children hospitalized with COVID-19 since the beginning of the pandemic. In fact, between July 1st and August 9th this year, 783 children were admitted to a Texas hospital with COVID-19.

The Texas Tribune provided this story.