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Pressure finally easing on overwhelmed children's hospitals

Screenshot 2023-01-17 at 09-08-10 (WEBP Image 1760 × 1174 pixels) — Scaled (84%).png
Lester Graham
Michigan Radio
A staff member at Helen DeVos Children's Hospital cares for nine-month-old Santiago Botello Rodriguez on December 7. Santiago was transferred to the hospital the night before. DeVos Children's is receiving so many transfer requests, they can't take every one. "I have had many calls come in where they said 'We've called 15 other places and they've all said no,'" says Dr. Andrea Hadley.

Only a month ago, Michigan’s children’s hospitals were facing impossible choices: turn desperately sick kids away? Or stretch staff dangerously thin?

The recent unprecedented surge of RSV and influenza cases quickly overwhelmed hospitals in November and December. In a state with only 10 pediatric ICUs, some hospitals were forced to double up rooms, request emergency beds, or keep families waiting in the emergency room for hours.

Now, with cases of RSV down dramatically and flu appearing to drop as well, doctors like Kimberly Monroe at C.S. Mott Children’s Hospital in Ann Arbor say they’re no longer at max capacity.

“Right now we're past the RSV peak, we're past the flu peak,” Monroe said Monday. “We are still operating at a pretty high capacity. … You will see at times there is still some boarding happening in the emergency room, which is just patients waiting for a bed upstairs. But this is at a much smaller degree than it was during …November and December.”

That surge in pediatric hospitalizations also came at a time when the state has lost 1,700 staffed beds since 2020, according to the Michigan Health and Hospital Association. At Children’s Hospital of Michigan in suburban Detroit, that meant 40% of their beds were closed during “one of the worst respiratory illness surges I can remember as a physician,” Dr. Rudolph Valentini, chief medical officer at Children’s Hospital of Michigan in suburban Detroit, said in December. "The biggest challenge to our ability to care for more children was our lack of available staff,” Valentini said in a statement at the time.

“Fortunately, I think we've weathered the storm, if you will, because what we saw were unprecedented numbers of RSV and flu cases,” Valentini said Monday. “At the same time, they got to the point of overwhelming our staffing challenge. So now our staffing challenge, which has been coming under better control, is certainly able to cope with the existing volume. So I think we're in pretty good shape now.”

Pediatricians are still keeping an eye on whether Michigan will see an increase in bacterial infections like Invasive Group Strep A, which the CDC recently issued a warning about after states like Colorado reported an increase. In rare cases, it can cause serious illness in kids.

While Michigan saw a monthly increase in cases of Invasive Group Strep A in December, it’s not unusual compared to previous years, according to the Michigan Department of Health and Human Services. “While we continue to monitor this increase in cases we are not currently aware of any unusual clusters of illness and have not heard of any active cluster investigations from any of Michigan’s 45 local health departments,” an health department spokesperson said via email earlier this month.

Dr. Monroe at C.S. Mott said the balance for parents between emergency care and primary care can be tricky, and she cautioned parents not to be too frightened by every new-sounding disease.

“I'll always say for parents, ‘If your gut feeling is your kid needs to be seen immediately, then bring them to a local emergency room,’” Monroe said. “But instead of having parents really worry about every new possible disease out there … I also want parents to know that you already have a game plan. You have a primary care doctor … and if you don't have one for your child, please get one. That is your teammate. Call them when you have questions.

"If you know that a fever might be concerning, that not eating might be a concern, not urinating might be concerning,” then let your doctor know, Monroe said. Otherwise, parents have already been through enough.

“But highly activating parents’ autonomic nervous system every few months with a new disease, I just don't know how helpful that is overall. It certainly isn't helpful for people's mental health,” she said.

It’s also unclear whether the surge of respiratory illnesses in late 2022 were just a post-peak pandemic aberration, or something that could be a recurring phenomenon. Valentini is hopeful next year will be better.

“I honestly don't think we'll see something like we just did anytime soon,” he said. “That's a real optimistic statement. But I think it's because, we think that the reason it was so uncharacteristic this fall was because it was a consequence of the pandemic. So that shouldn't happen every year. I think this was the year where we let everybody mingle. And the 2-year-olds were vulnerable, the 1-year-olds were vulnerable, and the babies were vulnerable. They had never seen RSV. And so now next year … we should probably just deal with a traditional RSV volume.”

Dr. Monroe is less confident.

“No one knows for sure,” she said. “We can all make guesses. But one of the things that I really want to do, and what we're working on, is preparing for it happening again. Because I don't know if it's not going to happen again. Certainly it seems as though every child under five got RSV this year."

"My hope is that it won't be as high of a peak, but I don't know for sure. However, I like to plan for it being high. … There's always been a high capacity playbook, but this year really tilted it in a different direction," said Monroe.

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