Two common respiratory viruses continue to keep Houston pediatric hospitals unusually busy this time of year, with both the flu and RSV seeing a second surge following a rise in cases over the spring and summer, respectively.
Before the COVID-19 pandemic, children sickened with either illness flocked to hospitals later in the winter months, from November to January. But intense isolation, social distancing and masking appears to have changed when those viruses spread, experts say, with a swath of young children being exposed for the first time.
It’s also unusual to see both viruses surging twice in the same year, puzzling top pediatric doctors in Houston.
“I was not necessarily expecting a surge right now,” said Dr. Michael Chang, a pediatric infectious disease specialist at UTHealth and Children’s Memorial Hermann Hospital. “Having had a summer (RSV) surge, I was expecting that was it. It’s very unusual to have two surges in a single season. It happens, rarely, but it’s very uncommon.”
Both RSV, or respiratory syncytial virus, and the flu have similar symptoms with slight differences. Both illnesses produce cold-like symptoms. The flu is more associated with a higher fever, while a key indicator of RSV is wheezing, according to the Cleveland Clinic. Nearly all children catch RSV before age 2. Both illnesses often do not require hospitalization, but young infants and older adults with compromised immune systems are at higher risk of severe illness from RSV.
RSV saw a massive spike last summer, and Chang and other pediatric doctors had warned of another summer surge this year. But when cases initially started to rise in June, the numbers never dropped back to baseline levels. The statewide positivity rate for antigen tests hovered around 10 percent until September and early October, when the positivity rate jumped again to more than 25 percent, according to the Texas Department of State Health Services. Last summer, the statewide positivity rate for antigen tests surpassed 30 percent.
Influenza A, one strain of the flu, also is on the rise after an increase in March and April. Houston Methodist’s respiratory pathogen data shows the hospital system is seeing year-long high in weekly cases with 656.
Despite the unusual pattern, parents of young children in the Houston area should not panic, doctors say. While national reports indicate record high patient volumes in some parts of the country, Houston is better equipped than other large cities to handle the surge, with two large pediatric hospitals in Texas Children’s and Children’s Memorial Hermann. The dual virus threat also is nothing new for pediatricians, as the flu and RSV season often overlapped before the pandemic.
“This is how every December and January used to be in children’s hospitals across the country,” Chang said.
COVID cases remain low in the Houston area. While some hospitals may hit capacity on busier days, and patients may encounter long wait times, the small percentage of RSV and flu patients who need hospitalization should be able to find beds, doctors say. Dr. James Versalovic, chief pathologist at Texas Children’s Hospital, said parents should consult with pediatricians if their children have persistent symptoms, including coughing, fever, poor feeding or rapid breathing. Virtual appointments are also available if area hospitals are strained.
With respiratory illnesses spreading among children more widely and earlier than in previous years, hospital leaders and medical experts say pediatric hospital beds across the state are in short supply.
After two years of mild flu seasons — a result of mitigation strategies to limit the spread of COVID-19 — medical experts say the number of children developing respiratory illnesses is already much higher this year, leading to more visits to health care centers and increasingly strained resources to treat those children.
Experts say the strain stems from overburdened hospital systems still reeling from the impact of the COVID-19 pandemic and a shortage of medical providers.
Dr. Gerald Stagg, a pediatrician working in Mount Pleasant, said cases of respiratory syncytial virus, known as RSV, and an earlier flu season have added pressure to hospital systems on top of other respiratory illnesses caused by COVID-19 and other viruses.
“I’ve been doing this for 42 years and I’ve never seen anything quite like it,” Stagg said of the number of children needing treatment for respiratory illnesses this year.
With the higher rates of respiratory illnesses, Stagg said not only are hospitals filling up, but clinics like his are having trouble keeping up with the huge uptick in visits from children with the flu.
Stagg said it’s become more difficult over the last two months to find beds in larger medical systems for sick children who require higher levels of care than what rural hospitals are able to provide.
“We’ve had to even send kids to Arkansas or Louisiana from our Texas facility because we couldn’t find a bed,” Stagg said.
He added that the shortage of hospital beds is a risk to children with serious illnesses that are not respiratory because there isn’t sufficient space in intensive care units for them.
Carrie Kroll, the vice president of advocacy, public policy and political strategy at the Texas Hospital Association, said the shortage of pediatric beds is a workforce issue. Hospital systems are still dealing with staffing shortages after droves of nurses and other hospital workers, suffering from pandemic-related burnout, retired or left the field.
“A bed is a bed. If it doesn’t have anyone to staff it, you can’t put a kid in it,” Kroll said.
Dr. Iván Meléndez, the Hidalgo County health authority, said his region has enough beds and resources to meet the needs of the community at the moment.
Meléndez did warn that this year could have significantly more cases of the flu than previous ones. Federal health data released Friday reported 880,000 cases of influenza and 360 flu-related deaths nationally. The last time the country saw similar rates of the flu was in 2009. And flu season has just started; it generally spans from October to May.
Earlier this month, Hidalgo County reported one of the first deaths of a child due to the flu this season.
“We’re thinking this may be the third since the turn of the century of being a ‘high-flu’ year,” Meléndez said.
He said the prevalence of the flu this year is an unintended consequence of masking and isolating during the COVID-19 pandemic.
“As a community, worldwide, we didn’t develop those antibodies that are usually present in the community at some level to protect people,” he said.
To address the surge of respiratory illnesses, Meléndez and other medical experts strongly recommended vaccinations against the flu and COVID-19.
Sure would be nice if we had a governor that was capable of delivering that message. There’s no vaccine for RSV, but the flu shot and the bivalent booster are easily available, so do what you can to protect yourself. Your Local Epidemiologist has more.