Dr. Lara Jirmanus asked the mom on the video visit last week to bring the computer closer to the baby’s chest. The 2-week-old’s breathing was noisy and concerning, but Jirmanus couldn’t tell from the video if the sounds were from the baby’s nose or from her lungs.
It was too late in the afternoon to get the baby an appointment at the primary care clinic and, wanting to be cautious, Jirmanus recommended the baby go to the emergency room. But which one? She called a nearby community hospital, but staff there suggested she send the baby to another nearby hospital. The community hospital wouldn’t be able to admit the baby if her illness was serious, as it didn’t have inpatient pediatric beds, and it was having trouble sending children who did need hospitalization elsewhere.
“The doctor told me, ‘Probably we could manage it, but if she does need to be hospitalized, we’re having trouble transferring,’” recounted Jirmanus, a primary care physician practicing in Revere.
She sent the baby to Mass. General Hospital instead.
Pediatric hospitalizations have been on the rise, due to an early seasonal surge of respiratory diseases such as respiratory syncytial virus, enterovirus, and rhinovirus.
Boston MedFlight, a nonprofit critical care medical transportation company, said it has seen a 60 percent increase in pediatric transfers so far in October compared to the same period a year ago. Over the first 19 days this month, five of the 73 pediatric transfers have been to hospitals out of state.
Growing caseloads have combined with a staffing shortage affecting nearly every part of the health care complex, making it harder to add beds.
As a result, local doctors are scrambling to find space for patients, and hospitals are having increasing difficulty finding beds for very sick pediatric patients. Sometimes, the closest beds available are in other states.
“The community hospitals will need to transport a patient to a higher level of care, and there just isn’t the capacity to take care of these patients,” said Maura Hughes, CEO of Boston MedFlight.
Some doctors speculate that the early rise in respiratory illnesses may be due to the elimination of COVID-19 mitigation strategies. Masking and remote learning may have saved lives, but they also prevented children from developing immunity to infections.
While COVID numbers are trending up in children statewide, that is not contributing significantly to a rise in pediatric hospitalizations.
Lawrence General Hospital this week has had to send one patient to Albany, N.Y., and another to Portland, Maine, because there were no available pediatric intensive care unit beds in Massachusetts. Last week, they transferred patients to Baystate Medical Center, which is about two hours away.
“These are acutely ill pediatric patients,” said Deborah Wilson, CEO of Lawrence General Hospital. “My staff call everywhere, and keep calling.”
While Lawrence General doesn’t have pediatric intensive care unit beds, the hospital has been able to accept patients from Central Massachusetts who need lower intensity care. Normally the hospital takes care of two or three pediatric inpatients at any given time. Lately, that has risen to six to eight.
Though the hospital has a 15-bed pediatric inpatient unit, it cannot operate all the beds due to staffing challenges.
Justin Precourt, chief nursing officer for UMass Memorial Medical Center, said the hospital is also seeing out-of-state transfer requests, including from Vermont, Southern New Hampshire, Rhode Island, and Connecticut.
The hospital is currently using 80 to 95 percent of its 40 inpatient pediatric beds. The hospital has struggled to use more of its capacity, as two-thirds of its beds are in shared rooms, which cannot accommodate multiple children with infectious diseases or behavioral problems.
The Department of Public Health has begun weekly calls with hospitals that have pediatric inpatient beds to better coordinate transfers between hospitals and share information on which facilities have space.
Other states have had to take more drastic measures, with Connecticut Children’s Medical Center in Hartford telling ABC News that it was in talks with the National Guard and Federal Emergency Management Agency to set up a tent on the hospital’s lawn to deal with a potential influx of cases.
While circumstances haven’t escalated that far in Massachusetts, local physicians are worried about what might come this winter with cases already this high.
“This has shifted by a couple of months in terms of the timing of when we are seeing this kind of a surge in pediatric hospitalizations for respiratory viruses,” said Dr. Kristin Moffitt, an infectious diseases physician at Boston Children’s Hospital. “One concern would be if we’re already hitting these high numbers, will it sustain for the winter, or is this an early peak?”
Flu season and a potential COVID surge this winter could converge to further worsen pediatric bed availability.
“Not to be pessimistic, but we haven’t seen the full brunt of influenza, we haven’t seen the full brunt of COVID [this season],” said Dr. Paul Biddinger, chief preparedness and continuity officer for Mass General Brigham. “Even if it doesn’t lead to a drastic increase in hospitalizations, it plays a role in staffing shortages and can be a challenge for us.” MGH, he said, was seeing the highest numbers of children hospitalized with respiratory infections since the start of the pandemic.
Rising demand and staffing shortages come on top of incremental closures of pediatric inpatient units at community hospitals over the last decade.
More recently, Shriners Hospital for Children has eliminated pediatric beds in Boston, and announced plans to close inpatient pediatric beds in Springfield. And Tufts Children’s Hospital closed its 41 operational inpatient beds in July; that closure, however, coincided with the opening of several new beds at Boston Children’s, which has opened 33 of a planned 50 additional beds.
Exacerbating the capacity crunch has been the ongoing behavioral health crisis. In August, before school restarted, UMass Memorial Medical Center had five or six pediatric psychiatric patients. Since the school year began, that has increased to 15 to 20. There has also been a rise in pediatric traumas, such as from sports injuries, and falls on a bikes.
To accommodate the patients, the hospital is using some adult emergency department beds for pediatric patients, and looking at opportunities to open more pediatric beds in other adult areas as well as the neonatal intensive care unit and nursery.
As surprising as the early rise in infections and hospitalizations may seem, Jirmanus said that without masking in schools, increased infections among children — of COVID and other illnesses — were bound to occur.
“You don’t need a public health degree or to be an MD to imagine that this would be the case,” Jirmanus said. “You get a bunch of people, and put them together in often poorly ventilated spaces all day. And small children are not the most hygienic people in the world. Of course they will get each other sick. When people are like, ‘Why is this happening?,’ this is happening because we planned for it to happen.”
Kay Lazar of the Globe staff contributed to this report.
Jessica Bartlett can be reached at firstname.lastname@example.org. Follow her on Twitter @ByJessBartlett.