The rapidly spreading viral infection has driven hospital admissions and daily emergency room visits to record levels in Orange County, prompting officials to declare a health emergency.

The county, like the rest of California, is facing a viral triple whammy: the continuing spread of the coronavirus, a seasonal spike in influenza, and the spread of respiratory syncytial virus, or RSV, a respiratory illness that can be dangerous to young children.

Children’s hospitals can get stressed quickly when viruses break out because there are relatively few beds to begin with. Orange County, for example, has only two hospitals dedicated to childcare, both of which are “operating in their childcare capacity. [patients] Provincial health officer Dr. Regina Chensu-kwong said Tuesday.

She said the issuance of the emergency declaration – which Chenseo-kwong did late Monday – provides the government with the ability to require hospitals that do not normally treat children “to take care of them if and when we need it”. This flexibility may come in handy in the coming months, when many officials expect both the coronavirus and influenza to become more active.

“I’m interested in what the future holds,” said Chinsyo Kwong. If cases of influenza and respiratory cellular virus rise simultaneously, “We’re in trouble. These two viruses usually affect our young children. There are so many beds that Children’s Hospital has to take care of the very sick.”

Children’s Health of Orange County, which operates a primary hospital in Orange and a smaller facility in Mission Viejo, is seeing “unprecedented volumes,” in both inpatient units and the emergency room, for all reasons, according to Melanie Patterson, vice president of patient care services and chief nursing officer.

At CHOC Hospital in Orange, more than 400 pediatric patients are seen each day in the emergency room. About 15% of children seen are admitted to the emergency room.

On Tuesday, 285 patients were admitted to the 334-bed CHOC In Orange a year ago, there were 188.

“This is a huge leap for us,” Patterson said.

At the 54-bed Mission Viejo hospital, 43 patients were admitted on Tuesday, compared to 28 on the same day a year ago.

Other hospitals in California also reported worsening influx of respiratory syncytial virus early in the season. Daisy Dodd, a pediatric infectious disease specialist for Kaiser Permanente in Orange County, said the “flow has been big, it’s been much faster” than usual, although the health care system is still able to meet demand.

So far, Los Angeles County public health officials have said they haven’t seen any significant increases in hospital bed occupancy.

However, individual hospitals report that they are very busy. Dr. James Stein, chief medical officer of Children’s Hospital Los Angeles, said in a statement that the facility is able to accept children from its emergency room. But the emergency room is so busy, and its available capacity so stretched, that CHLA cannot always accept referrals from other hospitals.

Children’s testing for RSV is increasing at the Los Angeles hospital, with a positive rate of 38%, up from 31% in the previous week. Both numbers exceed the peak over the entire past winter, which was 24%, according to Marissa Glucoft, the hospital’s executive director of quality and safety.

Many hospitals do not have large numbers of cribs, which means even small increases can have a big impact, said Dr. Christina Galli, director of the Los Angeles County Department of Health Services.

For example, if a hospital has 12 pediatric ICU beds and six are already occupied, she said, “You can really quickly get up to 100% by just accepting six patients. And then, based on their turnover and how long they stay in the hospital, You can see how fast you run into a difficult situation.”

“Fortunately, we don’t have a serious problem now, but we understand how quickly it can change,” she told the county board of supervisors on Tuesday.

Respiratory syncytial virus is highly transmissible, but to generally healthy adults and older children, it is more of a nuisance than a serious threat. However, children are especially at risk because the virus attacks the very small airways that lead to their lungs, causing them to become inflamed.

Excessive mucus production can block the airways. While adults and older children can simply cough, children may need extra help with breathing. Those most at risk are newborns and infants in their first year of life, especially those under 6 months of age.

Premature babies, babies with underlying heart disease or chronic lung problems, and babies with weakened immune systems are at greater risk, as are the elderly.

Specific warning signs that a child needs urgent medical attention include:

  • They are breathing faster than usual, with their chest pulled in and their nose open
  • Dehydration, including to the point of crying without shedding tears
  • Not producing wet diapers within seven or eight hours
  • refusal to feed
  • Turning blue around the mouth due to lack of oxygen

For children ages 3 or 4, warning signs can include wheezing and rapid breathing. Critically ill children may need oxygen or other support in the hospital to help them breathe, including being put on a ventilator.

“Not just young children. We have kids between the ages of 5 and 6 in the hospital right now,” Dodd said.

Annually, an estimated 58,000 children under the age of five are hospitalized with RSV nationwide, resulting in 100 to 500 deaths. Of those 65 or older, an estimated 177,000 are hospitalized annually, with 14,000 deaths.

“Our best efforts to protect ourselves and our children from respiratory illnesses are the same things we have practiced throughout the pandemic, including using masks when you are indoors around others and staying home when you are sick,” said Chinseo-kwong.

Respiratory syncytial virus affects many parts of the country particularly well, probably because transmission has been relatively latent for the past two years and there are many young children who have little immunity to the virus. Dr. Ashish Jha, the White House COVID-19 response coordinator, estimated last week that about 90% of children end up contracting RSV at least once when they are two years old. But “because of this pandemic, some standard types of patterns have been disrupted, so we see a lot of RSV at once,” he said.

The percentage of respiratory samples that tested positive for RSV in LA County is also at its highest level over the past five years. About 12% of samples tested positive for RSV, up from about 6% to 7% last October and less than 1% during the previous three October.

Among children younger than 5 years old, 7% of emergency department visits are associated with RSV or acute bronchiolitis, a swelling of the airways usually caused by RSV. This is higher than at any time in the past three years.

“As with influenza, we cannot predict whether this is an early peak or the start of a severe season. But we do know that RSV activity is unusually high at this time of year and calls for caution,” Ferrer said.

“The triple whammy of all three viruses circulating at the same time could strain an already overburdened medical system,” San Diego County health officials wrote in a statement late last week.

“Since we are seeing a sharp increase in influenza and RSV cases, I urge San Diegan to do their part to prevent the spread of disease,” said Dr. Wilma Wootten, the county public health officer. Although there is no vaccine for RSV, there are ample vaccines available against influenza and COVID-19.

Either way, Wooten noted, vaccines “take two weeks to become fully effective, so people should get both injections as soon as possible.”

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