Surge of viruses, accidents fills pediatric ICU beds in Georgia

Despite a reported drop in new cases of the flu and other respiratory viruses, children’s hospital beds are still at full capacity,

Just three weeks after Thanksgiving, respiratory illness in Georgia continues to rage, especially among children. Hospitals that were already strained are now at the brink, with 99% of pediatric intensive care beds in the state filled, according to federal data.

Of the 375 pediatric ICU beds in Georgia, data on Monday showed only two were not filled.

A spokesperson for Children’s Healthcare of Atlanta confirmed they are seeing high numbers of young patients, but noted the number of beds available in the children’s ICU can fluctuate by the hour.

The onslaught of patients has been driven by children who are extremely sick from viral infections, combined with an uptick in traumatic injuries to children — which may include broken bones or auto accidents. Physicians say these two causes have combined to fill children’s beds around the state.

On Wednesday, emergency room wait times were reported on the Children’s Healthcare of Atlanta system’s website at more than three hours at all Children’s hospitals. The ICU’s are so busy, as soon as a child is discharged, the space is cleaned and prepared for another child waiting to be admitted.

Children’s Healthcare reports seeing cases of the seasonal flu, rhinovirus, enterovirus, and respiratory syncytial virus, or RSV. Some arrive in the emergency room breathing rapidly, using their stomachs to suck in air, a sign of respiratory distress. Some are lethargic, showing signs of dehydration.

But doctors say the typical winter surge in respiratory illness doesn’t fully explain why pediatric beds are so full now. For reasons that are less clear, children with other illnesses and injuries are also finding themselves in the hospital.

In normal times, ICUs for adults and children typically run at roughly 70% to 80% of their capacity, which allows hospitals to operate efficiently and still allows wiggle room for additional patients. Hospitals can increase their ICU beds to cope with surges, but the biggest challenge is often staffing.

Overall hospital capacity also plays a role in whether a full ICU is problematic. Anna Adams, executive vice president of external affairs for the Georgia Hospital Association, said if overall inpatient numbers are much lower than a hospital’s ICU capacity, it’s easier to adjust staffing and other resources.

But overall, 86% of all hospital beds are full in Georgia, which is also unusually high, according to federal data.

“The lack of (pediatric) ICU beds in the state is concerning and a little scary,” said Dr. Hugo Scornik, a local pediatrician and former president of the Georgia chapter of the American Academy of Pediatrics. He said his pediatric clinic in Conyers remains busy. He’s seen a slight dip in flu cases, but a slight uptick in COVID-19 cases. He’s also seeing a rise in strep cases, and “lots of fevers, colds and coughs due to other viruses.”

For healthy adults, rhinovirus and enteroviruses are among the causes of the common cold but for children, they can be severe. Symptoms of RSV often look like a common cold, but in some cases, RSV can turn dangerous, especially among infants and older adults, leading to breathing difficulty and complications such as pneumonia.

Credit: custom

Credit: custom

On the Georgia coast, the ICU is also full, and doctors there also noted more at work than just viruses. Dr. Mike Bossak, director of hospital medicine at the Willett Children’s Hospital of Savannah, part of Savannah’s Memorial Health hospital safety net, said multiple virus surges appear to be on the decline.

“RSV numbers look good; the flu numbers have all sort of peaked and are coming downward,” Bossak said. “But I think in a general sense, everybody is feeling the crunch of just a lot sicker patients.”

Besides respiratory illnesses, kids have become more active this fall and so some emergency visits are associated with injuries, he said. “I think it’s just kids getting out and being out more than they were,” he said. “I think, even during a pandemic ... everyone was kind of indoors. Now we’re just seeing all these kids who are falling off of things and jumping off of things and running and doing.” Bossak said.

“It’s an alarm we have been ringing for several weeks now,” said Dr. Felipe Lobelo, an epidemiologist at Kaiser Permanente of Georgia. “It’s sort of like with a tsunami, you get wave after wave. Waves of infections are driven by different viruses. And there’s a lag between the time children get infected and when they get sick and when they end up in the hospital and the ICU.”

The Centers for Disease Control and Prevention said the Southeast is being hit this year by a particularly nasty seasonal flu strain that is often associated with severe illness and hospitalization.

“Some people don’t realize that the flu can be a very serious illness,” said Scornik. “Yes, most people will have fever and body aches and recover in a few days. But there are severe complications that are possible with the flu. The flu can cause something called encephalitis.... The most common complication is pneumonia.”

In Georgia, only about 20% of people who are age-eligible for flu vaccine have been immunized so far this season, according to data from earlier this month from the state Department of Public Health obtained by The Atlanta Journal-Constitution. And only 8.1% of people in Georgia who are age-eligible for an updated bivalent COVID booster have received one, according to the latest CDC data Wednesday.

A flu vaccine can prevent infection, and among those who still become sick with flu, vaccination can reduce the severity of the illness. The same is true for COVID vaccines and boosters which can help protect against severe outcomes like hospitalization and death.

COVID cases in Georgia have been steadily rising with the 7-day average of new confirmed cases increasing to 1,079 as of Wednesday, up from 423 a month earlier, which is a 155% increase, according to DPH data. Now that at-home COVID-19 tests have become commonplace, actual case numbers in Georgia and all of the U.S. are far higher than what’s being reported to health agencies.

Lobelo, father to two young children including a newborn, said the current elevated levels of viruses has caused his family to take more precautions, and think carefully about when to go to an urgent care center or emergency room.

“We’ve had what was probably a regular cold in our household and luckily our baby has not been sick,” Lobelo said. “In another situation, we may have been more inclined for an 8-year-old with a cough to see the doctor. But it makes you wonder if you should go to the emergency room or urgent care for pediatrics when everyone there is sick.”

Lobelo said he had ditched the mask in many settings for much of the year, but recently started wearing one again in crowds.

“As much as people don’t want to hear it, every family situation is going to be different,” said Lobelo. “You want to put yourself where you are diminishing the risk but understanding you will never get to zero.”

“I would recommend people err on the side of caution right now,” he said.

Data journalist Stephanie Lamm contributed to this report.

This article has been updated to include the title of Dr. Mike Bossak, who is director of hospital medicine.