Corewell sets visitor restrictions as pediatric RSV cases threaten to overwhelm Michigan hospitals

The respiratory syncytial virus (RSV) has not peaked in Michigan, physicians warned Friday, the eastern division of the state's largest health system said it would impose visitor restrictions as other health officials noted a pediatric bed shortage is emerging across the state.

Hospital pediatric intensive care units across Michigan are at 89% of their capacity as of Friday, according to data from the Michigan Health and Hospital Association and Michigan Department of Health. Bed shortages and the highly contagious nature of respiratory illnesses make it difficult to care for the sickest pediatric patients, according to the state hospital group.

Acute pediatric hospital capacity in Detroit is "extremely limited," Detroit Chief Public Health officer Denise Fair Razo said in a Friday news release.

Across all Corewell Health East emergency center, there were 167 children hospitalized with RSV as of Wednesday, up from 128 a week before and 35 at the beginning of October. Corewell Health East, formerly known as Beaumont Health, is imposing new visitation restrictions starting Monday across its eight hospitals. Children under the age of five will not be allowed to visit patients unless there are extreme circumstances, Corewell Health officials said in a Friday release.

“Everyone can do their part to help stop or limit the spread of respiratory illnesses in our community. Please wash your hands regularly and, if you’re feeling sick, stay home. If you or a loved one experiences any life-threatening symptoms, such as trouble breathing, please seek medical attention immediately,” said Dr. Nick Gilpin, director of infection prevention for Corewell Health East.

Danielle Giacoletti, 33, wasn’t expecting to spend five days in the pediatric intensive care unit when she took her two-month-old son Camden to the University of Michigan Mott Children’s Hospital on Oct. 22 with a case of RSV. His only symptoms were a lack of appetite and fever.

After going to the emergency room and getting admitted to the PICU, Camden "made a really bad turn" and needed a BiPAP, or a type of ventilator, to breathe the next day, Giacoletti said.

"We had the attending physicians, we had the fellows, we have the residents, we had respiratory therapists. They were all surrounding his bed," Giacoletti said. "All you want to do is hold him and comfort him and you can't. This little baby is surrounded by 10 people and they're there to do what's best for him, but there's no way for him to comprehend that."

A few days later, Camden had recovered enough to breathe on his own, but Giacoletti said it was probably one of the worst experiences of her life.

"It can progress really fast and turn very quickly. ... As a parent, you have to be super diligent if your kids are diagnosed with RSV," Giacoletti said.

What others are seeing

RSV and other winter viruses are spreading respiratory illnesses and rapidly infecting more young patients compared with previous years. Earlier this week the Oakland County Health Department announced that a six-year-old boy from Macomb died from RSV, the state's first pediatric death during the recent surge.

The Helen DeVos Children's Hospital in Grand Rapids, operated by Corewell Health West, is at capacity but continues to serve children and their families, Pediatrician-in-Chief Dominic Sanfilippo said. Sixty percent of children hospitalized with viral respiratory infections at the DeVos Children's Hospital have RSV as of Friday.

"There are times that we stretch and accommodate more patients than our bed capacity. And we've been able to do that because we as a children's hospital ... cannot deny a child care that needs our help," Sanfilippo said. "The majority of cases we're seeing are children with RSV. This has hit us earlier and more heavy than in years past."

By the end of October, the University of Michigan Health C.S. Mott Children’s Hospital had 154 RSV and Bronchiolitis cases, a 66% increase from October 2021, spokeswoman Beata Mostafavi said. The five hospital Henry Ford Health System, which does not have a children's hospital, has seven pediatric patients admitted with RSV as of Friday.

RSV is a common respiratory infection that causes cold-like symptoms, according to the Centers for Disease Control and Prevention. Most children have been infected with RSV by the time they are two years old, although 58,000-80,000 kids under the age of five are hospitalized as a result of RSV every year.

RSV symptoms are typically resolved in one or two weeks for adults, but the virus can cause serious illness in infants and older adults. RSV is the most common cause of pneumonia and bronchiolitis, an inflammation of the lung, in children under the age of one, the CDC says.

"(RSV) causes the airways to swell and young children have smaller airways," said Rebecca Schein, a pediatric infectious disease specialist with Michigan State University Health Care. "So when their airways swell, they wheeze and they have trouble getting air, and so they gasp more for air. They work harder to breathe and they need more support."

RSV can also worsen chronic health conditions such as asthma. Premature babies and young children with conditions such as chronic lung disease, congenital heart disease, weakened immune systems or neuromuscular disorders are particularly at risk for severe complications.

The Michigan hospital association urged patients with mild cold-like symptoms to stay home. Emergency room capacity is being depleted by patients with non-emergency medical conditions in some areas. People with moderate to severe symptoms, including shortness of breath, should seek hospital care, according to the association. Patients with worsening cold-like symptoms can seek care at an urgent care facility or with their primary physician, MHA recommends.

"If someone doesn't need to come to an emergency department... everyone should try to avoid that," Sanfilippo of DeVos Children's Hospital said. "There are a lot of other viruses going around as well that are resulting in kids being ill, being in the emergency department as well as being hospitalized."

Why is RSV spreading now?

RSV is not a new virus but there are a lot more cases unseasonably early in the year compared with the last two years, said Jonathan Gold, a pediatrician at Michigan State University and chair of the government affairs and advocacy committee of the Michigan chapter of the American Academy of Pediatrics.

"There was a marked decrease in RSV the first year or so of the pandemic," Gold said. "People were very much wearing masks and isolating and keeping away from each other in all settings."

When COVID-19 restrictions started to ease in the spring and summer of 2021, doctors began seeing cases again, which was unusual since RSV is typically a winter virus, Gold said.

Many physicians think the surge in RSV cases this fall is at least partially due to a lack of exposure to the virus during the beginning of the COVID-19 pandemic and people becoming less concerned about hygiene and social distancing since the pandemic began.

"There were kids who were just not exposed RSV before and had no immunity. And so as they started to come together, they were more susceptible, and I think that's probably a big part of what was happening this year as well," Gold said.

"People are getting more comfortable with doing things and quite honestly, they're probably being a little bit less stringent about washing hands and wearing masks and staying distanced and staying home when they're sick."

RSV season typically lasts two to four months, and it is too early to know whether the number of cases will exceed bad years before the COVID-19 pandemic, Schein said.

"The typical RSV season ... usually starts end of November, December and is over by April," Schein said. "...We were seeing in cases at the end of September, but the numbers got bad in October."

'Tridemic' threat

Hospitals across Michigan are concerned about coinciding future surges of RSV, influenza and COVID-19. While influenza levels are low in Michigan now, they are spiking in Southern states. Physicians say it is only a matter of time before the flu comes to Michigan.

"It's just really about hospital bed spaces," Schein said. "There's a lot of children with RSV right now who are having trouble breathing and needing respiratory support. And then if you add on to that children with influenza, it's just going to compound the shortage of hospital beds."

Sanfilippo said the pediatric department at DeVos Children's Hospital would "cope with it" if all three viruses hit Michigan at once but they are preparing.

"We're preparing to create more beds, working with the state. We're working on proactively having more personnel to help take care of those kids," he said.

The best way to prevent a surge of all three viruses is to get vaccinated, said Uzma Shah, chair of pediatrics at Henry Ford Health.

"There's no vaccine for RSV, but there's a vaccine for flu and COVID," Shah said. "If one can control that by being vaccinated, then we won't have a triple threat."

When to seek emergency care

Early symptoms of pediatric RSV include a runny nose, loss of appetite and coughing, which can progress to wheezing or difficulty breathing. The virus sometimes only causes irritability in infants but can also trigger decreases in appetite, activity and apneic breathing, according to the CDC.

While all parents worry, especially when their children are young, some RSV cases can be treated at home with good hydration and Tylenol, Shah said. If children develop a fever, parents can call their primary care provider to discuss treatment options, but should go to the emergency room if their child is having difficulty breathing or hydrating, she said.

The most severe sign of respiratory distress is turning blue, Sanfilippo said. Flared nostrils, grunting respirations, increased respiratory rate, tugging in between the ribs and seesaw respirations are also tell-tale signs in babies, he said.

Precautions that people took during the height of the COVID-19 pandemic will work to stop the spread of RSV too, Gold said.

"Washing your hands. For the older kids and adults, covering your cough with your elbow," Gold said. "Wearing a mask can help if you're sick ... and just kind of wiping down surfaces."

The Detroit Health Department encouraged residents to stay home if sick and parents to consider having their children wear masks in public places, including school.

hmackay@detroitnews.com

@hmackayDN