Children’s hospitals scrambling to find room for very sick patients

Surge of respiratory viruses severely stresses pediatric facilities

A massive wave of respiratory viral infections — especially influenza — continues to hit kids hard and overwhelm pediatric hospitals in Georgia.

The surge is so serious that the Georgia Department of Public Health is urging adult hospitals — themselves jammed with patients — to admit some older children who are at least 16 to help alleviate the crush of young patients piling into the pediatric hospitals. Emergency room waits as long as eight hours are not uncommon and pediatric hospital systems are having to shift staffing and resources to try and meet the demand.

The unusually early spike of respiratory infections is not only swamping pediatric units in Georgia but hospitals across the country. The crush is reminiscent of the surge of patients overwhelming adult hospitals in the early days and recurring waves of the COVID-19 pandemic.

Views of  Children’s Healthcare of Atlanta as seen on Thursday, October 13,  (Natrice Miller/

Credit: Natrice Miller /

icon to expand image

Credit: Natrice Miller /

In Georgia, 84% of pediatric ICU beds are occupied, according to the most recent federal data. That’s up from last week’s 83% and a staggering increase from April, when it was just under 60%.

“They are having our March 2020,” said Dr. Doug Olson, medical director of the emergency department at Northside Hospital Forsyth about pediatric units being slammed. “This is very serious. This is a very big deal.”

While a recent rise in childhood RSV infections has shown signs of slowing down in Georgia, cases of influenza have picked up steam. Last month, Children’s Healthcare of Atlanta said they were seeing an “unprecedented” number of sick children, prompting them to expand their emergency room with a tent erected in a parking lot.

On Friday, the Georgia Department of Public Health reported another sharp increase in the number of patient visits to doctors for flu or flu-like illness during the week ending Nov. 5 to an estimated 9.2%, up from 8.5% from the previous week. There were 203 people in metro Atlanta hospitalized with influenza during the same week and so far this season two adults have died as a result of the flu in Georgia, according to DPH.

In the Southeast, the dominant flu strain is a particularly nasty strain that is often associated with severe illness and hospitalization, according to the CDC. It’s a subtype of the influenza A virus — known by the scientific name of H3N2 — which can be especially hard on children and older adults.

Olson is seeing that up close. The number of adults and children falling ill — and seriously ill — is much greater than usual.

“And we’re actually expecting to worsen,” said Olson. “I mean, I think we are just getting started with the flu. Children’s has been full and they can only take what they can take.”

Olson said they recently had a young child being seen in the emergency department who needed intensive care. The closest hospital with a bed available was in Macon.

The request from DPH recommends emergency medical services transport patients who are at least 16 to the closest appropriate adult facility. Olson said he was anticipating that DPH would ask adult hospitals to admit older teens. He said the Northside Hospital system had already been admitting some older teenagers sick with the flu and other illnesses.

Children are often treated in emergency rooms at adult hospitals. Olson said about 10% of the patients at Northside Hospital Forsyth are children and most can be treated at the emergency room and go home. Even before this request, adult hospitals admitted and treated older children in emergency situations but some older teens, including older children with complex, chronic medical conditions, must still need treatment at a pediatric center.

The DPH’s surge plan comes at a time when adult hospitals are already crowded with sick patients, even if not quite at the crisis levels early in the COVID pandemic. About 84% of adult ICU beds are also full.

The vast majority of intensive care unit hospitalizations at Children’s Healthcare of Atlanta are for respiratory viruses, according to a spokesperson, with flu-related hospitalizations accounting for most of the current surge. RSV, which had surged in infants and young children in August, September, and October, has been slowing down in recent weeks. The number of children hospitalized for COVID-19 at Children’s is a distant third.

Provided by Children's Healthcare of Atlanta

Credit: custom

icon to expand image

Credit: custom

Pete Quinones, president and CEO of the MetroAtlanta Ambulance Service, which operates a fleet of over 100 vehicles across the Atlanta region said the healthcare systems his company works with have been able so far to handle rising caseloads. He said the ambulances are fully stocked with needed supplies and equipment to treat and transport neonatal and pediatric patients.

Quinones did say some staff members have had to request time off to stay home with their own sick children.

Dr. Valera Hudson, the chair of the Medical College of Georgia Department of Pediatrics and pediatrician-in-chief for the Children’s Hospital of Georgia, said the hospital system is being stressed by the rising number of children needing to be admitted, including intensive care admissions.

“Part of what’s unusual is the timing for us. So, this is much earlier [than normal]. The typical patterns of respiratory viruses have been completely disrupted by the years of the pandemic,” she said. “So, we’re really in new territory with regard to even understanding what the pattern of respiratory illnesses is going to be on this side of the pandemic.”

In dealing with this surge, Hudson said her hospital and “all the other children’s hospitals that I’m in communication with, everyone has experienced intermittent periods of having to go on diversion either for regular admissions or ICU admissions. It’s very fluid and flexible.”

Diversion is generally the hospital’s status of not being able to accept any additional patients.

Whether to go on diversion or not is an “hour-by-hour, shift-by-shift assessment.”

She said doctors and nurses have to triage because the “most distressed and sickest patients need to be seen first.”

“And sometimes it’s very distressing to parents because your own child is the sickest child that you’re aware of, as opposed to understanding the severity of illness for the other children who are presenting to the ED.”

She urged people to get vaccinated against flu, which she said is the key to helping bring down the current wave. Public health officials say anyone six months old and older can get the vaccine. Everyone living in a home with an infant younger than six months should be vaccinated not only to protect themselves, but the infant as well.

A flu vaccine can prevent infection, and among those who still become sick with flu, vaccination can reduce the severity of the illness.

AJC data journalist Stephanie Lamm contributed to this article.