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Hospitals prepare for winter as state sees earlier-than-normal surge in RSV infections

A sick child receives medication by inhalation mask to cure Respiratory Syncytial Virus. Photo by

In late September, Maryland emergency rooms began seeing a surge in children — many of them very young — struggling to breathe because of Respiratory Syncytial Virus, known as RSV. According to a Maryland Department of Health dashboard that tracks the virus, the number of hospitalizations leapt from 33 in the last week of September to 257 in the final week of October.

Because Maryland typically sees its RSV numbers spike in late November and December, this year’s surge sent emergency departments, urgent care centers and pediatricians scrambling. Thankfully, the state’s RSV case rate plateaued quickly. By the end of November, hospitalizations had been cut by two-thirds, to 88.

“Right now, we’re seeing a slight reprieve from what we’ve seen in the last few months,” said Dr. Lauren McGovern, a pediatric hospitalist at TidalHealth.

Respiratory viruses spread easily in day care settings, schools and other places where children interact with one another. In an interview, Dr. Jason Custer, medical director of the Pediatric Intensive Care Unit at the University of Maryland Children’s Hospital recommended that parents get all vaccines that their children are eligible for and focus on hand-washing and other healthy behaviors.

Custer said there are “four or five” respiratory viruses that are circulating throughout Maryland now. In addition to RSV and the seasonal flu, “there’s a virus called parainfluenza, which often can cause croup, and we have a virus called rhino enterovirus, which is a rhinovirus enterovirus,” he said. “We’re still seeing all of those.”

COVID-19 also remains a factor when it comes to the availability of hospital beds across Maryland.

When it comes to the remainder of the flu season, McGovern said it is difficult to predict what will happen, but she said systems are positioning themselves to be ready to care for their patients. She advises parents to seek care for their children if dehydration is associated with their symptom or if they struggle to breathe.

RSV “can be particularly severe in newborns and younger patients,” Custer said, requiring hospitalization, high-flow oxygen support and in some cases mechanical ventilation. “It certainly can affect patients who have underlying health conditions more severely, so patients with underlying chronic lung issues or heart issues often we’ll get hospitalized with these viruses,” he added.

There is no RSV vaccine, though one is in development, Custer said. The drug palivizumab is available to patients who meet narrow criteria.

Custer advised families to keep in close contact with their pediatricians to help determine when a child needs treatment.

“We don’t want people coming into the emergency department unless they have to, of course. The waits are long and we want patients in there that need the emergency care,” he said. “But certainly if your child is breathing hard and fast, if they’re not eating well, if they’re not waking up, or they’re more lethargic, that’s the type of thing you want to go get health care quickly.”

The national nursing shortage is hitting all hospitals hard. Many have more beds than they can fill do to staffing issues. Like facilities everywhere, Maryland hospitals have been relying on “traveling” nurses to fill the gaps.

Custer, who is helping spearhead the UMMS response to the spike in pediatric respiratory illnesses, said the system has been coordinating with Johns Hopkins Medicine and the Maryland Hospital Association throughout the surge.