Hospitals in Los Angeles County are experiencing rising cases of respiratory syncytial virus, commonly called RSV, while still dealing with strains on staffing that have continued to linger since the start of the Covid-19 pandemic.
According to Dr. James Stein, chief medical officer at Children’s Hospital Los Angeles, the facility is seeing a surge of RSV cases unseasonably earlier than normal.
“This increase in RSV and other respiratory illnesses have stretched our capacity in the emergency department, but we are still able to accommodate inpatient RSV admissions from our emergency department at this time,” Stein wrote in an email. “We continue to do our best to accept respiratory transfers from other emergency departments in the community during this surge, but we are not always able to accommodate them due to our emergency capacity constraints.”
As of the end of last year, Children’s Hospital Los Angeles had 286 pediatric beds and 74 intensive care beds, according to financial and utilization reports.
According to the Centers for Disease Control and Prevention, respiratory syncytial virus is a common respiratory ailment that typically causes mild, cold-like symptoms. Most people recover in one to two weeks, but as recent surges throughout the country have shown, the virus can be serious for infants and older adults.
The pediatrics unit at Providence Cedars-Sinai Tarzana has also identified unseasonal cases of RSV, according to a hospital spokesperson, who wrote that the unit’s bed space is not being overwhelmed. However, the unit, which had 18 beds as of the end of last year, is dealing with strains to staffing.
“They always are reasonably prepared, as they are one of a handful of hospitals with pediatrics, including a pediatrics ICU and neonatal ICU serving a large swath of northern L.A. County,” the spokesperson added. “I say ‘reasonably’ because you can’t be prepared for the unknown, as we learned in early 2020.”
More flu
In the South Bay, Providence Little Company of Mary Medical Center -Torrance told the Business Journal that it is seeing moderate amounts of RSV, but not enough to consider it a surge. Scott Ciesielski, chief nursing officer at the medical center, wrote that the facility is seeing more cases of the flu than anything else, but has not been impacted on the inpatient side of things with flu or Covid-19 yet.
According to the National Respiratory and Enteric Virus Surveillance System, California’s five-week average of RSV cases in early November was the highest in more than two years.
What has some health care leaders such as Adam Blackstone concerned is the potential for rising RSV cases to combine with a surge in flu and Covid cases as the holidays bring larger groups of people inside for gatherings. Blackstone is the senior vice president of communications and event management at the Hospital Association of Southern California.
“With the circulation of multiple respiratory illnesses such as RSV, influenza and Covid-19, there is significant concern that a so-called tripledemic could drastically reduce capacities.” Blackstone wrote. “In the last two-plus years, hospitals had a concentrated focus on treating waves of Covid-19 patients. Now, the additional concern of two other potent respiratory viruses could further compound stress on the health care system.”
Flu transmission has been virtually nonexistent in the past two years, according to Blackstone, who added that such a factor, in addition to Covid-19 and RSV, means that uncertainties remain in terms of how severe case rates may become during the holidays.
“Our health care system has faced an onslaught of varied challenges, with staffing issues remaining at the forefront of those concerns,” Blackstone wrote. “With historic staffing shortages and uncertainty about what this winter holds, our hospitals could face continued hardship following nearly three years of little reprieve.”
Preparation
However, one factor that hospitals have in their favor this winter is preparation.
“We’ve been battle hardened by the worst respiratory pandemic in a hundred years, so we don’t scare as easily as we did once upon a time,” said Dr. Mark Dumais, the chief medical officer of Northridge Hospital Medical Center. “I think we feel really good about where we are because we’ve learned so much from having gone through the pandemic so far to date.”
Northridge Hospital, as a part of the Dignity Health network, has access to a national and regional network of supplies, Dumais explained, which came in handy during the earlier stages of the Covid pandemic. Hospitals are also likely still well versed in pivoting internal policies, such as flexing any elective surgeries and modifying patient triage, when necessary.
Medical centers are also better at testing than before and have improved access to therapeutic medicine to fight Covid symptoms. Larger hospitals like Northridge also have the necessary space to isolate specific wings to accommodate a disease wave.
Dr. Neha Nanda, the interim chief of infectious disease for Keck Medicine of USC, said that the primary challenge she anticipates with providing care this winter is that health care workers — who are obviously exposed to illness as part of their jobs — will have to take leave after getting sick themselves.
“We anticipate that the impact that’s going to occur on our operations over the next three months is going to be driven more by sick calls from employees and health care workers than it is by patient volume when we talk about Covid,” she said.
Nanda said she would expect to see a slight uptick this year in hospitalizations for the flu and RSV, but the level of immunity for Covid throughout Los Angeles County makes her more optimistic when compared to prior surges.
She noted that most of Keck Medicine’s operations do not include significant pediatric care, so its experience with RSV would be limited.
What helps in medical settings, Nanda said, is universal masking throughout facilities, the continued use of PPE, and reopening operations with a special emphasis on improving ventilation.
“A lot of our protocols, they have still stood the test of time,” she said. “What we’ve let go is we don’t have things like dedicated floors or wings like we previously did when Covid started. We’ve departed with that, because we’ve kind of reached a place where we have to live in a hybrid world. ”
Staff Reporter Howard Fine contributed to this article.
