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‘We’re in uncharted territory’: Doctors warn of spike in children hospitalized with RSV

Dr. Paul Biddinger, far right, attending emergency medical doctor at Massachusetts General Hospital waiting to address news media Thursday.Erin Clark/Globe Staff

Executives from Mass General Brigham said Thursday they were seeing an “unprecedented” spike in children hospitalized with respiratory syncytial virus, a common illness that typically circulates later in the season and poses the greatest risk to infants, young children and the elderly.

Pediatric intensive care unit beds at Massachusetts General for Children were operating at 150% capacity on Thursday, as cases of RSV continued to overwhelm regional hospitals.

“All of [the state’s pediatric hospitals] are full every single day,” said Dr. Brian Cummings, medical director in the Department of Pediatrics at Mass General for Children, speaking at a news briefing. “At any given time point, when you look in the morning, there are no available pediatric ICU beds. There are no available pediatric general care beds. Almost all of us are operating over capacity.”


To address the crisis, the health system and the hospital have activated incident management teams and are meeting daily to discuss capacity and resources, some of which are in short supply, such as nebulized albuterol, a treatment that opens the airways to help patients breathe.

Like many of its peers, the health system has postponed scheduled surgeries. Additionally, clinicians are educating community hospitals and emergency rooms on how to deliver oxygen support, normally administered on a hospital floor once patients are admitted. Some children who need ICU-level care are also being treated in regular hospital settings, because of a lack of beds. On Thursday alone, the hospital was providing care to seven more patients than it could accommodate in its pediatric intensive care unit.

The U.S. Department of Health and Human Services is also providing training and resources to hospitals. .

For now, RSV cases are continuing to climb at Mass General Brigham. In October, the system saw 2,000 cases of the virus. It has seen another 1,000 cases in just the first week of November. Of those, 250 have required some level of hospitalization, and 10 to 20% have required intensive care unit beds.


That has quickly overwhelmed the 14 pediatric intensive care unit beds at Massachusetts General for Children, forcing some patients over the age of 15 to be cared for in adult beds, and requiring that the system open neonatal intensive care unit beds for children slightly older than the age group NICUs typically care for.

Clinicians said that masking would decrease transmission, but didn’t go so far as to suggest that children resume wearing masks in schools and daycares. Clinicians also emphasized the need for good hygiene: hand washing, cleaning common surfaces, and avoiding socializing with those who are ill.

It was unclear if cases of RSV were nearing their peak, though the clinicians said they expect cases would level off in the coming weeks or months.

“I think we’re in uncharted territory,” said Dr. Paul Biddinger, chief preparedness and continuity officer for Mass General Brigham.

Clinicians noted that the vast majority of children infected with RSV would recover. Parents should call their pediatrician if their children seem unusually tired, if they are working harder than normal to breathe or not drinking fluids. Children at highest risk of hospitalization are typically younger or have chronic conditions such as heart disease.

“Usually those hospitalizations are brief, but it can be very severe,” said Cummings. “And so some patients may need breathing support in the pediatric intensive care unit.”


The physicians also recommended that parents avail themselves and their children of vaccines for flu, COVID, and other transmissible diseases.

Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her on Twitter @ByJessBartlett.