News Track: Iowa respiratory illnesses in children decline after December peak

Background

CEDAR RAPIDS — After largely avoiding annual spikes in respiratory illnesses like respiratory syncytial virus (RSV) among children during the first two years of COVID-19 pandemic precautions, the virus started to spike across the state and nation last fall, overwhelming the pediatric departments of many hospitals.

In November, numbers from Iowa’s Respiratory Virus Surveillance Report showed 938 cases of RSV — a sharp increase from 155 cases in the first week of October.

In Cedar Rapids alone, the uptick in positivity rates and children’s hospitalizations gave doctors serious concerns about a virus that had spiked over winters for decades.

“We’ve had very high numbers, as have pretty much all pediatric units in the state,” said Dr. William Ching, pediatric hospitalist at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids, in November. “We’re seeing higher severity, particularly among toddlers. I think it’s going to be a long season.”

In addition to an earlier spike than usual, doctors were admitting older children with more severe cases than usual.

What has happened since

“The good news is, at least at our hospital, the horrors of the tripledemic did not seem to materialize,” Ching said this month. “We still had lots of kids getting sick with RSV, flu and other viruses, particularly enterovirus.”

After peaking with positivity rates of 45 percent for RSV in November, positivity rates started to steadily decline. By early December, when hospitalizations at St. Luke’s peaked, positivity rates hovered around 30 percent. By early January, the positivity rate dropped to 6 percent, and by February it declined to about 5 percent.

For both Mercy Medical Center in Cedar Rapids and UnityPoint Health-St. Luke’s Hospital, hospitalization for children from respiratory illnesses like RSV peaked in early December, filling pediatric floors before quickly declining in the weeks leading up to Christmas.

With transfer requests for ill children from hospitals as far as Chicago, the reverberation of RSV was felt even at hospitals in large metropolitan areas. At St. Luke’s, a full pediatric floor meant the hospital was unable to accept transfers many times.

“We had been running to the brim,” Ching said. “The curve shifted earlier (than usual.)”

He’s thankful that the curve in Cedar Rapids did not live up to his predictions.

In early December, hospitals across the state were briefly near capacity for critical care beds for children who needed ventilation. But anticipations of post-holiday spikes late into December and January didn’t happen, leaving some hospitalists to scratch their heads.

“I think we got lucky. It could’ve been worse,” said Dr. Tony Myers, chief medical officer of Mercy Medical Center in Cedar Rapids. “It’s very easy to worry about pediatrics because our capacity to take sick kids is limited.”

Now at Mercy, even admissions for influenza, which tend to peak in February, are lower than usual.

As cases for RSV, influenza and other respiratory viruses continue on a downward trend, Myers and Ching said they’re not quite yet out of the woods, but they can see a light at the end of the tunnel. A small surge came in after January’s return to school, and some of the cases requiring hospitalization in older children have been more severe, with some requiring non-invasive ventilation.

“This time of year, surges aren’t usually as bad as the initial peak,” Myers said. “I would be extraordinarily surprised if we had a peak of RSV this winter as bad as it was in December. You just don’t ever see that.”

Ching will continue to keep a close eye on capacity with staff who are weary after three relentless years of pandemic care and viral surges.

“Staffing impacts are still bad right now,” he said. “Our staff are fried.”

Both encourage parents to take the same precautions they have been up to now — keeping children away from people who may be sick, washing hands vigilantly and keeping kids home when they are ill.

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