Kids with respiratory viruses are filling hospitals
Flu-like illnesses surge in Charlotte, flooding ERs and pediatric units
The following article appeared in the Oct. 19, 2022, edition of The Charlotte Ledger, an e-newsletter with original business and general news for Charlotte. Sign up for free:
After Covid safeguards, immune systems are grappling with more common viruses
Sully Sweeney, aged 7 weeks, went to a busy emergency room earlier this month with a cough and fever — part of a surge of patients in Charlotte and around North Carolina with non-Covid, flu-like symptoms. (Photo courtesy of Jamie Sweeney.)
by Michelle Crouch
Co-published with North Carolina Health News
Jamie Sweeney of Charlotte, a former pediatric nurse, didn’t worry too much when her 7-week-old baby, Sully, first developed a cough. But over the next few days, Sully’s coughing worsened, each episode rattling his tiny body.
When Sully stopped eating and started acting lethargic on Oct. 10, Sweeney knew her son needed medical attention.
By the time they got to Atrium Health Levine Children’s Hospital, Sully had spiked a fever. Sweeney tried not to panic.
The emergency room was “absolutely packed,” she said. “It was a madhouse.”
An hour and a half later, Sweeney was still sitting in an overflow waiting room, and no one had looked at her son.
“I felt completely helpless,” Sweeney said. “It was a nightmare.”
Two and a half years after Covid first arrived, doctors across the state are now sounding the alarm about surges in other types of respiratory illnesses, especially among children. The percentage of emergency room visits from people with influenza-like illnesses is double what is typical for this time of year, according to state data.
The spike in illness has doctors scrambling to find pediatric hospital beds, as high numbers of sick children land in hospitals. Several health systems across the state, including Atrium and Cone Health in Greensboro, have had to divert kids to other medical centers recently because their beds have filled.
“All of us have been struggling with capacity,” said Sameer Kamath, a pediatric critical care medicine specialist at Duke University Health System, referring to the limited number of hospitals statewide that have pediatric beds.
“Every time I think we’ve hit the peak, it keeps rising,” Kamath added. “It’s unrelenting. When you’re in the throes of bed management, it seems like every day is a peak.”
Mike Cinoman, medical director of the pediatric intensive care unit at Cone Health, described his ICU this way: “We are drowning in children with respiratory illnesses. This has been an onslaught, much earlier than we usually see it.”
Linked to the Covid pandemic
Precautions such as social distancing and wearing masks during the pandemic didn’t just slow the spread of Covid; they also prevented the spread of other respiratory illnesses. The 2020 flu season was mostly a non-event, for instance.
Now that most of those measures have been dropped, those illnesses are back.
Young children are particularly susceptible because some of them haven’t had any exposure to viruses at all, said David Weber, a professor of medicine, pediatrics and epidemiology at UNC Chapel Hill.
In a typical, non-pandemic year, the average child picks up eight infections, most of them respiratory, Weber said. Those infections “don’t give you long-lasting immunity, but you do get some immunity that helps protect you,” he said.
A ‘mixed bag’ of viruses
The surge in illness in North Carolina is being caused by several different viruses, including rhinoviruses (responsible for most cold-like illnesses), enteroviruses, respiratory syncytial virus (RSV) and influenza, said State Epidemiologist Zack Moore.
“A couple of months ago, if someone had a cold, I’d tell them, ‘That’s Covid,’” Moore said. “That’s not the case anymore. It’s much more of a mixed bag.”
State and national data reveal that flu activity has been rising for the past few weeks — possibly portending an early flu season that may peak in late 2022 instead of in the early new year, when it usually tops out. (Australia’s flu season peaked two months early, and what happens there often — but not always — predicts the flu season here.)
StarMed, which has urgent care clinics in Charlotte, Asheville and Jacksonville, has seen a recent spike in patients testing positive for influenza, said Chief Medical Officer Arin Piramzadian. “We always pick up some flu cases in October, but we’re seeing more than normal,” he said.
RSV and why it’s dangerous
Although the rise in flu cases is a concern, the respiratory illness landing the most kids in the hospital right now by far is RSV, doctors said. RSV cases statewide are already at peak levels typically seen in colder winter months, Moore said, and the trend shows no signs of slowing down.
Cases of RSV (in blue) are surging in North Carolina, while cases of the flu (green) are increasing earlier in the season than in previous years, according to state data. (Source: N.C. Department of Health and Human Services)
Atrium Health said Levine Children’s Hospital has averaged five to 10 cases of RSV each week since mid-August, but cases have tripled within the past week, with 31 patients admitted.
In most adults and older kids, RSV causes typical cold symptoms such as coughing, congestion, a runny nose and a fever.
However, RSV can be dangerous for infants, the elderly and anyone with a breathing or cardiac ailment because it can inflame the small airways in the lungs, creating a condition called bronchiolitis, said David Priest, senior vice president and chief of safety, quality and epidemiology at Novant Health.
“When your airways are small and you get infected by RSV, that inflammation can have a dramatic impact on your ability to breathe,” Priest said. “We have a number of children in the hospital right now with bronchiolitis and RSV infection.”
Doctors this year have also been seeing more toddlers with severe RSV, said Rhonda Patt, medical director of Atrium Health Levine Children’s Charlotte Pediatrics. That’s probably because they were infants during the pandemic, so they didn’t get a chance to develop any natural immunity to RSV because they were exposed to fewer other children in daycares and school settings, she said.
Most kids who are hospitalized with RSV are treated with intravenous fluids and oxygen support, Kamath said. There is also an antiviral treatment that is reserved for those who are immunocompromised. “Thankfully, most (children) shake it off in 24 to 48 hours and are able to go home looking like they used to,” he said.
What parents should know
If your child is 3 months old or younger, the American Academy of Pediatrics says it’s important to call your pediatrician at the first sign of illness. “With young babies, it may be hard to tell when they are very sick,” the academy says. “Colds can quickly become dangerous problems.”
In older children, the academy says you should call a doctor if you notice:
Any signs of breathing trouble, including blue lips or nails, nostrils that get larger with each breath or if the skin above or below their ribs sucks in with each breath
Nasal mucus that lasts longer than 10 days
A cough that lasts more than a week
Ear pain
A temperature over 102 degrees Fahrenheit
Excessive sleepiness or irritability
To protect your family from RSV and other respiratory illnesses, experts stressed the same precautions we all learned during the pandemic: keep your distance from others, wash your hands regularly (RSV in particular lives on surfaces, Priest said), and consider wearing a mask, especially if you are in a crowded indoor location.
Also, make sure your kids get their flu shots and Covid boosters, doctors said, because both influenza and Covid cases are expected to rise as the weather cools.
“Unfortunately, I think these are the good times right now,” Moore said. “I think we are going to start seeing both more Covid and flu in upcoming weeks.”
A six-hour wait
As for Sully, he tested positive for two different respiratory viruses, RSV and rhinovirus. It took six hours for him to be called in the ER, his mom said, even though the nurses who triaged him said he was a top priority because of his age.
Sully was ultimately admitted to the hospital and spent five days there. He received oxygen support to help with his breathing, and he also had a feeding tube and an IV for fluids.
“I’ve never cried so much in all my life,” Sweeney said.
Sully finally came home last Sunday, and despite a little cough, Sweeney said he is acting like himself again.
“For sure, those were the worst few days of my life, but I am so grateful he is OK,” Sweeney said. “Now, I’m worried about reinfection and what the rest of the season is going to bring.”
Michelle Crouch covers health care. If you have tips or ideas for her, please shoot her an email at mcrouch@northcarolinahealthnews.org.
This article is part of a partnership between The Ledger and North Carolina Health News to produce original health care reporting focused on the Charlotte area. For more information, or to support this effort with a tax-free gift, click here.
The full edition of the Oct. 19, 2022, Charlotte Ledger for paying members included the following articles:
An exclusive update on a parent’s lawsuit against Charlotte Latin School — a story that, for some reason, only The Ledger has been covering. Find out what the judge ruled, what both sides said and what happens next.
A list of notable Charlotte business figures who have donated to Ted Budd or Cheri Beasley in the big U.S. Senate race.
A check-in in with fireworks merchants in South Carolina — who are stocking up and hiring workers because of Diwali, the Indian festival of lights.
Ledger members also received a touching story on Tuesday in our Ways of Life obituaries newsletter, about a Charlotte couple — Larry and Sue Breckenridge — who were married for 56 years … and died three days apart. “He made it very clear. He couldn’t conceive of life without her,” their son told us.
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Executive editor: Tony Mecia; Managing editor: Cristina Bolling; Staff writer: Lindsey Banks; Contributing editor: Tim Whitmire, CXN Advisory; Contributing photographer/videographer: Kevin Young, The 5 and 2 Project