Dr. Mike Bossak is director of pediatric hospitalist medicine at Memorial Health Dwaine & Cynthia Willett Children’s Hospital of Savannah. In a pair of recent interviews with staff writer Tamar Hallerman, he explained how the 50-bed facility, part of the city’s largest hospital, handled twin surges of COVID-19 and an unseasonable bout of respiratory syncytial virus, or RSV, this summer.
In Georgia, confirmed COVID-19 infections among children under 18 peaked on Aug. 28. Earlier this week, the rolling average had decreased by 62% from that high watermark, according to data from the state Department of Public Health. But even as new case rates and hospitalizations have significantly decreased in recent weeks, Georgia ranked third nationally, behind only Texas and Florida, for pediatric COVID-19 hospital admissions on Thursday.
These interviews have been combined and edited for length and clarity.
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“A lot of what medicine is based on is experience: we saw this, we know what diseases look like, we know what our census looks like throughout the year. But COVID seems to be this unknown, this factor that comes in and basically says ‘we’re rewriting what’s going on here. You have no idea when we’re coming.’
In children’s hospitals there’s typically an ebb and flow of patients that everybody understands and plans for.
We’re usually busy from September through about March. With kids going back to school, we start to get a lot of allergies, asthma issues and upper respiratory infections. Then through the winter we see lots of flu and RSV. Things slow down a bit through the spring and summer.
I don’t think anybody was really prepared for the surge that we just got, because it was not a time that we were expecting. Everybody expected this variant to act like the last variant.
In that first surge that we had last year, there was a very low positivity rate amongst kids under 18, and even lower in the younger groups. We saw very little of any respiratory disease, so a lot of what our first-year residents would have learned in the winter with RSV, they missed. When RSV kicked up in such a ferocious way in May, June, July, everybody was sort of not expecting that and it was a little bit difficult.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
With delta, we’d have two to eight COVID patients on the wards at a time, which would have been unheard of before. Thankfully our ER numbers have decreased a little bit over the last few weeks. That being said, the acuity and severity of the disease is still very high, so we’re seeing less cases but the kids are still very sick.
RSV has been a little bit on the decline as well. It’s definitely not this huge surge that we saw in July, but we’re still seeing four or five kids a week with RSV that are coming through.
I’m sort of saying with a very hopeful attitude that we are coming out the back end of delta. But the bigger concern here is that we’re going to continue to have COVID cases through the fall and then we’re going to start to pick back up on our RSV cases in October and November and add to that a flu population that is very variable year to year.
I think we’re all just kind of holding our breath to see how we do. It’s one of those things where we look at the numbers and think that we have enough resources and staff to take care of everybody, but we’ll never know until we get there.
Anytime we start to tax the resources of the hospital, we put an emotional toll on the staff. A problem with RSV, COVID and the flu is that kids can become very sick very quickly, and so you don’t always have the ability to see what’s coming down the pike. So when we have a lot of sick kids like this, we are going to have to staff up and increase the amount of doctors in the hospital at a time, especially on weekends when our staff is already a little thin. That means more work for everybody and less time away from the hospital, which is not the best for your mental health.
For me, the hardest COVID-19 cases are the babies. Not from a perspective of their illness, because babies are resilient, but because there’s nothing they can do. This was not something that they could have staved off by getting a vaccine or putting on a mask.
The other cases that we’re unfortunately seeing a lot of are kids with out-of-control diabetes and COVID symptoms. These are patients we know. We diagnosed them originally, we’ve seen them from time to time, and so to see them sick like this and back in the hospital is difficult. Especially for the kids who are taking care of themselves, who are taking their insulin and still getting COVID, you feel bad for those kids.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
That said, the thing that I am preparing for now is not COVID. It’s the possibility of MIS-C (multisystem inflammatory syndrome in children, a rare ailment that’s dogged some kids who had COVID-19), because that is where I see the possibility of a burden really hitting the hospital. We have no idea if the patients that we’re seeing now with COVID will come back with MIS-C in six to eight weeks, how many of them we’ll see and how sick they’re going to be. Are we going to have the medicine in-house to take care of it? There are very specific pharmaceuticals to take care of this and we’ve had shortages of these medicines previously.
I think the best thing that’s come out of this is that people are really coming to see that the vaccines are worthwhile and the only way we’re going to end this is for more people to get vaccinated. Every time I go downstairs on a vaccine clinic day it makes me smile when I see that the lobby is full. There’s been some back-and-forth and some discussions, but it makes me hopeful that a lot of these patients are getting vaccinated, and that maybe in the nearish future we will be able to vaccinate even younger children.
In general, I would hope that the adolescents that we see doing well and not having issues or being admitted to the hospital will encourage those who are hesitant to get their children aged 5 to 11 vaccinated when it becomes approved. I think if we can get that group vaccinated, you protect a much larger proportion of patients that way. Really it’s the 5 or 6-year-old who goes to school, is asymptomatic and brings COVID back to the house to get the 2-week-old sick, that’s the biggest target for this vaccine. I think that’s going to be a huge boon to us as far as protecting everyone.”
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