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Tag: intensive-care units

  • The Big COVID Question for Hospitals This Fall

    The Big COVID Question for Hospitals This Fall

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    Back in the spring, around the end of the COVID-19 public-health emergency, hospitals around the country underwent a change in dress code. The masks that staff had been wearing at work for more than three years vanished, in some places overnight. At UChicago Medicine, where masking policies softened at the end of May, Emily Landon, the executive medical director of infection prevention and control, fielded hate mail from colleagues, some chiding her for waiting too long to lift the requirement, others accusing her of imperiling the immunocompromised. At Vanderbilt University Medical Center, which did away with masking in April, ahead of many institutions, Tom Talbot, the chief hospital epidemiologist, was inundated with thank-yous. “People were ready; they were tired,” he told me. “They’d been asking for several months before that, ‘Can we not stop?’”

    But across hospitals and policies, infection-prevention experts shared one sentiment: They felt almost certain that the masks would need to return, likely by the end of the calendar year. The big question was exactly when.

    For some hospitals, the answer is now. In recent weeks, as COVID-19 hospitalizations have been rising nationwide, stricter masking requirements have returned to a smattering of hospitals in Massachusetts, California, and New York. But what’s happening around the country is hardly uniform. The coming respiratory-virus season will be the country’s first after the end of the public-health emergency—its first, since the arrival of COVID, without crisis-caliber funding set aside, routine tracking of community spread, and health-care precautions already in place. After years of fighting COVID in concert, hospitals are back to going it alone.

    A return to masking has a clear logic in hospitals. Sick patients come into close contact; medical procedures produce aerosols. “It’s a perfect storm for potential transmission of microbes,” Costi David Sifri, the director of hospital epidemiology at UVA Health, told me. Hospitals are on the front lines of disease response: They, more than nearly any other place, must prioritize protecting society’s vulnerable. And with one more deadly respiratory virus now in winter’s repertoire, precautions should logically increase in lockstep. But “there is no clear answer on how to do this right,” says Cameron Wolfe, an infectious-disease physician at Duke. Americans have already staked out their stances on masks, and now hospitals have to operate within those confines.

    When hospitals moved away from masking this spring, they each did so at their own pace—and settled on very different baselines. Like many other hospitals in Massachusetts, Brigham and Women’s Hospital dropped its mask mandate on May 12, the day the public-health emergency expired; “it was a noticeable difference, just walking around the hospital” that day, Meghan Baker, a hospital epidemiologist for both Brigham and Women’s Hospital and Dana-Farber Cancer Institute, told me. UVA Health, meanwhile, weaned staff off of universal masking over the course of about 10 weeks.

    Most masks at the Brigham are now donned on only a case-by-case basis: when a patient has active respiratory symptoms, say, or when a health-care worker has been recently sick or exposed to the coronavirus. Staff also still mask around the same subset of vulnerable patients that received extra protection before the pandemic, including bone-marrow-transplant patients and others who are highly immunocompromised, says Chanu Rhee, an associate hospital epidemiologist at Brigham and Women’s Hospital. UVA Health, meanwhile, is requiring masks for everyone in the hospital’s highest-risk areas—among them, certain intensive-care units, as well as cancer, transplant, and infusion wards. And although Brigham patients can always request that their providers mask, at UVA, all patients are asked upon admission whether they’d like hospital staff to mask.

    Nearly every expert I spoke with told me they expected that masks would at some point come back. But unlike the early days of the pandemic, “there is basically no guidance from the top now,” Saskia Popescu, an epidemiologist and infection-prevention expert at the University of Maryland School of Medicine, said. The CDC still has a webpage with advice on when to mask. Those recommendations are tailored to the general public, though—and don’t advise covering up until COVID hospital admissions go “way high, when the horse has well and truly left the barn,” Landon, at UChicago, told me. “In health care, we need to do something before that”—tamping down transmission prior to wards filling up.

    More specific advice could still emerge from the CDC, or individual state health departments. But going forward, the assumption is that “each hospital is supposed to have its own general plan,” Rhee told me. (I reached out to the CDC repeatedly about whether it might update its infection-prevention-guidance webpage for COVID—last retooled in May—but didn’t receive a response.)

    Which leaves hospitals with one of two possible paths. They could schedule a start to masking season, based on when they estimate cases might rise—or they could react to data as they come in, tying masking policies to transmission bumps. With SARS-CoV-2 still so unpredictable, many hospitals are opting for the latter. That also means defining a true case rise—“what I think everybody is struggling with right now,” Rhee said. There is no universal definition, still, for what constitutes a surge. And with more immunity layered over the population, fewer infections are resulting in severe disease and death—even, to a limited extent, long COVID—making numbers that might have triggered mitigations just a year or two ago now less urgent catalysts.

    Read: The future of long COVID

    Further clouding the forecast is the fact that much of the data that experts once relied on to monitor COVID in the community have faded away. In most parts of the country, COVID cases are no longer regularly tallied; people are either not testing, or testing only at home. Wastewater surveillance and systems that track all influenza-like illnesses could provide some support. But that’s not a whole lot to go on, especially in parts of the country such as Tennessee, where sewage isn’t as closely tracked, Tom Talbot, of Vanderbilt, told me.

    Some hospitals have turned instead to in-house stats. At Duke—which has adopted a mitigation policy that’s very similar to UVA’s—Wolfe has mulled pulling the more-masking lever when respiratory viruses account for 2 to 4 percent of emergency and urgent-care visits; at UVA, Sifri has considered taking action once 1 or 2 percent of employees call out sick, with the aim of staunching sickness and preserving staff. “It really doesn’t take much to have an impact on our ability to maintain operations,” Sifri told me. But “I don’t know if those are the right numbers.” Plus, internal metrics are now tricky for the same reasons they’ve gotten shaky elsewhere, says Xiaoyan Song, the chief infection-control officer at Children’s National Hospital, in Washington, D.C. Screening is no longer routine for patients, skewing positivity stats; even sniffly health-care workers, several experts told me, are now less eager to test and report.

    Read: What COVID hospitalization numbers are missing

    For hospitals that have maintained a more masky baseline, scenarios in which universal masking returns are a little easier to envision and enact. At UChicago Medicine, Landon and her colleagues have developed a color-coded system that begins at teal—masking for high-risk patients, patients who request masked care, and anyone with symptoms, plus masking in high-risk areas—and goes through everyone-mask-up-everywhere red; their team plans to meet weekly to assess the situation, based on a variety of community and internal metrics, and march their masking up or down. Wolfe, of Duke, told me that his hospital “wanted to reserve a little bit of extra masking quite intentionally,” so that any shift back toward stricter standards would feel like less of a shock: Habits are hard to break and then reform.

    Other hospitals that have been living mostly maskless for months, though, have a longer road back to universal masking, and staff members who might not be game for the trek. Should masks need to return at the Brigham or Dana-Farber, for instance, “I suspect the reaction will be mixed,” Baker told me. “So we really are trying to be judicious.” The hospital might try to preserve some maskless zones in offices and waiting rooms, for instance, or lower-risk rooms. And at Children’s National, which has also largely done away with masks, Song plans to follow the local health department’s lead. “Once D.C. Health requires hospitals to reimplement the universal-masking policy,” she told me, “we will be implementing it too.”

    Other mitigations are on the table. Several hospital epidemiologists told me they expected to reimplement some degree of asymptomatic screening for various viruses around the same time they reinstate masks. But measures such as visiting restrictions are a tougher call. Wolfe is reluctant to pull that lever before he absolutely has to: Going through a hospital stay alone is one of the “harder things for patients to endure.”

    A bespoke approach to hospital masking isn’t impractical. COVID waves won’t happen synchronously across communities, and so perhaps neither should policies. But hospitals that lack the resources to keep tabs on viral spread will likely be at a disadvantage, and Popescu told me she worries that “we’re going to see significant transmission” in the very institutions least equipped to handle such influx. Even the best-resourced places may hit stumbling blocks: Many are still reeling from three-plus years of crisis and are dealing with nursing shortages and worker burnout.

    Coordination hasn’t entirely gone away. In North Carolina, Duke is working with the University of North Carolina at Chapel Hill and North Carolina State University to shift policies in tandem; in Washington State, several regional health-care organizations have pledged to align their masking policies. And the Veterans Health Administration—where masking remains required in high-risk units—has developed a playbook for augmenting mitigations across its many facilities, which together make up the country’s largest integrated health-care system, says Shereef Elnahal, the undersecretary of Veterans Affairs for health. Still, institutions can struggle to move in sync: Attitudes on masking aren’t exactly universal across health-care providers, even within a hospital.

    The country’s experience with COVID has made hospitals that much more attuned to the impacts of infectious disease. Before the pandemic began, Talbot said, masking was a rarity in his hospital, even around high-risk patients; many employees would go on shifts sick. “We were pretty complacent about influenza,” he told me. “People could come to work and spread it.” Now hospital workers hold themselves to a stricter standard. At the same time, they have become intimately attuned to the drawbacks of constant masking: Some have complained that masks interfere with communication, especially for patients who are young or hard of hearing, or who have a language barrier. “I do think you lose a little bit of that personal bonding,” Talbot said. And prior to the lifting of universal masking at Vanderbilt, he said, some staff were telling him that one out of 10 times they’d ask a patient or family to mask, the exchange would “get antagonistic.”

    Read: The pandemic’s legacy is already clear

    When lifting mandates, many of the hospital epidemiologists I spoke with were careful to message to colleagues that the situation was fluid: “We’re suspending universal masking temporarily,” as Landon put it to her colleagues. Still, she admits that she felt uncomfortable returning to a low-mask norm at all. (When she informally polled nearly two dozen other hospital epidemiologists around the country in the spring, most of them told her that they felt the same.) Health-care settings aren’t meant to look like the rest of the world; they are places where precautions are expected to go above and beyond. COVID’s arrival had cemented masks’ ability to stop respiratory spread in close quarters; removing them felt to Landon like pushing those data aside, and putting the onus on patients—particularly those already less likely to advocate for themselves—to account for their own protection.

    She can still imagine a United States in which a pandemic-era response solidified, as it has in several other countries, into a peacetime norm: where wearing masks would have remained as routine as donning gloves while drawing blood, a tangible symbol of pandemic lessons learned. Instead, many American hospitals will be entering their fourth COVID winter looking a lot like they did in early 2020—when the virus surprised us, when our defenses were down.

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    Katherine J. Wu

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  • Fall’s Vaccine Routine Didn’t Have to Be This Hard

    Fall’s Vaccine Routine Didn’t Have to Be This Hard

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    In an ideal version of this coming winter, the United States would fully revamp its approach to respiratory disease. Pre-pandemic, fall was just a time for flu shots, if that. Now, hundreds of millions of Americans have at their fingertips vaccines that can combat three cold-weather threats at once: flu, COVID, and, for a subset of us, respiratory syncytial virus. If everyone signed up to get the shots they qualified for, “it would be huge,” says Ofer Levy, the director of the Precision Vaccines Program at Boston Children’s Hospital. Hospital emergency rooms and intensive-care units wouldn’t fill; most cases of airway illness would truly, actually feel like “just” a common cold. “We would save tens of thousands of lives in the United States alone,” Levy told me.

    The logic of the plan is simple: Few public-health priorities are more pressing than getting three lifesaving vaccines to those who need them most, ahead of winter’s viral spikes. The logistics, however, are not as clear-cut. The best way to get vaccines into as many people as possible is to make getting shots “very, very easy,” says Chelsea Shover, an epidemiologist at UCLA. But that’s just not what we’ve set up this fall lineup of shots to do.

    Read: The flu-ification of COVID policy is almost complete

    Convenience isn’t the only issue keeping shots out of arms. But move past fear, distrust, or misinformation, solve for barriers such as insurance coverage, and getting a vaccine in the United States still means figuring out when shots are available and which you qualify for, finding and booking appointments, carving out the time to go. For adults, especially, who don’t routinely visit their doctor for wellness checkups, and whose workplaces don’t require vaccines to the extent that schools do, vaccination has become an onerous exercise in opt-ins.

    Bundling this year’s flu, COVID, and RSV vaccines into a single visit could, in theory, help ease the way to becoming a double or triple shotter. “Any time we can cut down on the number of visits for a patient to take care of them, we know that’s a big boost,” says Tochi Iroku-Malize, the president of the American Academy of Family Physicians. But the easiest iteration of that strategy, a three-in-one shot, similar to the MMR and DTaP vaccines of childhood, doesn’t yet exist (though some are in trials). Even the shorter-term solution—giving up to three injections at once—is hitting stumbling blocks. Pharmacies started receiving flu vaccines earlier this summer and are already giving them out to anyone over the age of six months. RSV vaccines, too, have hit shelves, and have been approved for people over the age of 60 and those 32 to 36 weeks pregnant; so far, however, they are being offered only to the first group. And although nearly all Americans are expected to be eligible for autumn’s updated COVID vaccines, those shots aren’t slated to make an appearance until mid-September or so, according to Kevin Griffis, a CDC spokesperson.

    Timing two or three shots together isn’t a perfect plan. Get them all too early, and some people’s protections against infection might fade before the season gets into full swing; get all of them too late, and a virus might beat the vaccine to the punch. Respiratory viruses don’t coordinate their seasons: Right now, for instance, COVID cases are on a sharp rise, but flu and RSV ones are not. Some data on the new RSV vaccines also suggests that co-administering them with other shots might trigger slightly worse side effects, or mildly curb the number of antibodies that the injections raise. Still, Levy argues that those theoretical downsides are outweighed by known benefits. “If someone is at clinic in the fall, they should get all the vaccines they’re eligible for,” he told me. Getting a slightly less effective, slightly more ornery shot a few months early is better than never getting a shot at all.

    All of that supposes that people understand that they are eligible for these shots. But already, family-medicine physicians such as Iroku-Malize, who practices in Long Island, have been fielding queries about the RSV vaccines from confused patients. Some new parents, for instance, have gotten the impression that the RSV vaccines are designed to be administered to infants, which isn’t quite right: Babies are the target of protection for the shots for pregnant people, but only because they temporarily inherit antibodies—not because they can get the injections themselves. Regulators also haven’t yet nailed down how often older adults might need the shot, though the current thinking is that the vaccine’s protection will last at least a couple of years. “It’s very hard to tell people, ‘I don’t know,’” says Jacinda Abdul-Mutakabbir, an infectious-disease pharmacist at UC San Diego.

    Other parts of the RSV-shot messaging are peppered with even more unknowns. The CDC has yet to release its final recommendation for pregnant people; for people over 60, the agency’s language has been “noncommittal,” says Rupali Limaye, a behavioral scientist at Johns Hopkins University. Unlike past guidelines that have straightforwardly recommended flu shots or most doses of the COVID-19 vaccine, RSV guidance says that eligible people may protect themselves against the virus—and are urged to first consult a health-care provider, which not all people have. The wishy-washiness is partly about safety: A few rare but serious medical events cropped up during the RSV vaccines’ clinical trials, including abnormal heartbeats and neurological complications. None of the experts I spoke with had qualms about recommending the shots anyway. Even so, some private health-insurance companies have seized on the CDC’s watered-down recommendation—and the fact that the agency hasn’t yet included RSV in its annual vaccine schedule for adults—as an excuse to not cover the shot, leaving some patients paying $300-plus out of pocket.

    For any of these shots, viral reputation matters too. Despite hospitalizing tens of thousands of Americans each year, especially at age extremes—numbers that, in some years, nearly rival those linked to flu—RSV is a lesser-known winter disease. People tend to take it less seriously, if it’s on their radar at all, Abdul-Mutakabbir told me. Which bodes poorly for future RSV-shot uptake. Annual flu shots have been recommended for 13 years for every American over the age of six months for 13 years. And still, just half the eligible population gets them in any given year. People tend to dismiss shots as subpar interventions against a disease that they don’t much fear, Limaye told me. With COVID, too, “people think it’s gotten mild,” she said. Only 28 percent of American adults are currently up to date on their COVID vaccine. And although older people have historically been more vigilant about nabbing shots, even vaccines against shingles—a notoriously painful disease—have reached just over a third of people who are 60-plus.

    Read: America’s flu-shot problem is also its COVID-shot problem

    To establish fall as an immunity-seeking season, shots would need to become an annual habit, ideally one easy to form. Mandates and financial incentives do prod people toward vaccines, but smaller nudges can persuade people to take initiative on their own. Some strategies may be as simple as semantic tweaks. Studies on HPV and flu vaccines suggest that telling patients they are “due” for a shot is better than offering it as an optional choice, says Gretchen Chapman, a behavioral scientist at Carnegie Mellon University. Other research suggests that carefully worded text-message reminders can evoke ownership—noting that a shot is “waiting for you,” or that the time has come to “claim your dose.” Noel Brewer, a behavioral scientist at the University of North Carolina at Chapel Hill, also thinks that vaccine deliverers could take inspiration from dentists who gently dog their patients with phone calls and postcards.

    Other interventions could be aimed at streamlining delivery. Government funding could make shots more available in rural regions, ensure access for those who lack insurance, and help local health departments offer shots in churches and hair salons, or even bring them door to door. More schools and workplaces, too, might try boosting uptake among students and employees. And although most shots are already given within the health-care system, there’s sludge to clear from that pipeline too. Better universal recordkeeping could help track people’s vaccination status through their lifetime. Kimberly Martin, a behavioral scientist at Yale, is researching ways to revamp medical training to help health-care providers earn their patients’ trust—especially among populations that remain marginalized by systemic racism. “The single biggest impact on vaccine uptake,” Brewer told me, “is a health-care provider recommendation.”

    An ideal vision of a fall in the future, then, would be turning vaccines into a default form of prevention—a more typical part of this country’s wellness workflow, says Saad Omer, the dean of the Peter O’Donnell Jr. School of Public Health, at UT Southwestern. After getting their vital signs checked, patients could have their vaccination status reviewed. “And then, if they’re eligible, you vaccinate them,” Omer told me. It’s a routine that pediatricians already have down pat. If adult health care follows suit, regular immunization is a habit we may never have to outgrow.

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    Katherine J. Wu

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  • Florida GOP congressman discharged from hospital after accident: ‘Grateful to be home’ | CNN Politics

    Florida GOP congressman discharged from hospital after accident: ‘Grateful to be home’ | CNN Politics

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    CNN
     — 

    Rep. Greg Steube was discharged from the hospital Saturday after being injured in an accident on his property in Sarasota, Florida, according to a tweet from the Republican congressman.

    “I’m grateful to be home and recovering after being discharged from the hospital today,” Steube said from his official Twitter account. “All praise and glory goes to God! Jen and I remain endlessly blessed by the prayers and support from our friends, family, and community.”

    On Wednesday, Steube “was knocked approximately 25 feet down off a ladder while cutting tree limbs,” and spent Wednesday evening in the intensive care unit, CNN previously reported.

    He was then moved out of the intensive care unit on Thursday, his office said in a statement.

    The Florida Republican on Saturday also thanked health care staff at Sarasota Memorial Hospital in a subsequent tweet, and said his office will provide updates next week on his recovery and his return to Washington, DC.

    Steube was first elected to the US House of Representatives in 2018. He comfortably won a third term in November representing Florida’s safely Republican 17th Congressional District.

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  • NICU mom stays by her son’s side after his nurses leave to strike | CNN Business

    NICU mom stays by her son’s side after his nurses leave to strike | CNN Business

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    New York
    CNN
     — 

    Lora Ribas hasn’t left her son’s bedside in four days.

    Her one-year-old baby, Logan, has been in the neonatal intensive care unit (NICU) since he was born. For the past three and a half months, he’s been under the care of Mount Sinai Hospital where thousands of nurses are currently striking.

    Logan was born prematurely at 27 weeks and is on a ventilator because his lungs were underdeveloped.

    Mount Sinai’s NICU has been consistently understaffed even before the strike, Ribas said. But since Mount Sinai’s nurses began picketing Monday, new travel nurses have replaced Logan’s primary care nurses – nurses who don’t fully understand her son’s needs, she said.

    Ribas said she’s too scared to leave her son alone under the care of the new travel nurses. She took a leave from work to stay by his side.

    “It’s scary to think that I can’t even go to the bathroom without me being concerned,” Ribas told CNN.

    Although the travel nurses are trying to compensate, they “don’t really know my son” and are still learning where supplies are around the unit, Ribas said.

    They aren’t able to give him one-on-one care because of the staffing shortages, according to the mom, and she said the staffing levels are even lower at night.

    Two nurses currently working inside Mount Sinai Hospital told CNN Monday that additional traveling nurses have not shown up as expected on their floors to replace nurses that are striking, causing stress for patients and staff.

    Mount Sinai Health System did not immediately respond to CNN’s request for comment.

    In preparation for the strike, Mount Sinai announced Friday it would transport newborns in its intensive care unit to other area hospitals. But the most critical babies – like Logan – have stayed in the hospital’s NICU unit. One NICU nurse at Mount Sinai who spoke to CNN on condition of anonymity, said moving a NICU baby to another hospital can be a risky move.

    “It’s a big journey for a baby who’s never been outside the hospital,” she told CNN. “It’s not anything that we want to happen. We want our babies to stay.”

    The more critical the baby’s condition is, the more complicated a transfer to another hospital becomes, the nurse explained.

    “You would need at least a doctor or nurse practitioner, a respiratory therapist if the patient is on respiratory support and a transport nurse to work the pumps and administer medicine if needed,” she said.

    Ribas said her son’s primary nurses who are striking right now are heartbroken they had to leave him and have been calling her to check on his status.

    “He has really wonderful primary nurses,” she said. “They were in tears having to leave him because my baby suffered cardiac arrest two days before the strike happened, and so now I’m dealing with that plus the shortage of staff. Which is very scary.”

    The nurses strike at two private New York City hospitals – Montefiore and Mount Sinai – involving over 7,000 nurses entered its second day Tuesday. Montefiore said it was holding bargaining sessions Tuesday. Mount Sinai has no plans to do so, according to the nurses’ union.

    The sticking point continues to be enforcing safe staffing levels, New York State Nurses Association (NYSNA) union officials said.

    A pediatric oncology nurse at Mount Sinai who administers chemotherapy to children with cancer said it’s hard to leave her patients to strike, but she knows it’s in the best interest of their care.

    “We love these patients more than anything,” Melissa Perleoni said, “and it breaks our heart – at least it breaks my heart – to be out here but I have to do this for the future of their care.”

    Ribas said she hopes hospital management reaches a contract with the nurses soon.

    “The nurses are the heart of the NICU, and they do need to figure it out before it becomes a different situation – because every single minute, every hour, the babies are running a very, very high risk of even dying in here.”

    “There’s nothing that could bring your kid back. Nothing,” she said.

    – CNN’s Tami Luhby, Vanessa Yurkevich and Mark Morales contributed to this report

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  • Nurses at Mount Sinai Morningside and West reach tentative agreement as more than 7,000 nurses still due to strike | CNN Business

    Nurses at Mount Sinai Morningside and West reach tentative agreement as more than 7,000 nurses still due to strike | CNN Business

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    New York
    CNN
     — 

    Mount Sinai Morningside and West hospital reached a tentative agreement with the state nursing union on a new contract Sunday, avoiding a strike Monday morning, according to a news release from the union.

    Nurses at two other area hospitals, Mount Sinai Hospital and Montefiore Bronx, are still due to strike after not reaching agreements.

    Both hospitals are back at the bargaining table with New York State Nurses Association nurses today – if a tentative agreement is not reached, then approximately 3,625 nurses at Mount Sinai and approximately 3,500 nurses at Montefiore Bronx will strike at 6 a.m. Monday. The union said during a news conference Sunday morning that negotiations could go into the early morning.

    The new tentative agreement at Morningside and West brings the anticipated number of nurses to strike down from 8,700 to about 7,125. The tentative agreement improves staffing, protects benefits and increases salaries over three years.

    That brings seven of the 12 New York hospitals in negotiations to reach tentative agreements or new contracts.

    “The time is now to settle fair contracts that help nurses deliver the care that all New Yorkers deserve. We are fighting to improve patient care and will do whatever it takes to win,” NYSNA President Nancy Hagans said in a statement Sunday.

    New York City’s Mount Sinai Hospital is continuing to move infants out of intensive care units to other area hospitals, is diverting ambulances to other facilities and postponing elective surgeries and heart surgeries ahead of a planned nursing strike Monday.

    In a statement late Saturday, the hospital said it has been negotiating “in good faith” with the nursing union on a new contract. Mount Sinai has agreed to meet with NYSNA nurses after walking out on a bargaining session Thursday, the union said Sunday.

    A Mount Sinai spokesperson told CNN on Saturday the hospital system is actively bargaining with the Mount Sinai Morningside and West campuses under separate union agreements.

    But if agreements aren’t reached at several New York City area hospitals, thousands of nurses will strike on Monday morning.

    The hospital said Sunday its current wage offer “is identical” to ratified agreements at NewYork-Presbyterian and Maimonides – and would increase a Mount Sinai nurse’s base salary by 19.1 percent over three years.

    “But NYSNA’s inconsistent bargaining, unwillingness to accept this offer, and insistence on moving forward with a strike has left us no choice but to take significant actions to care for our patients,” the hospital statement said.

    Seven neonatal intensive care unit infants were safely transferred Saturday to partner hospitals in New York City, a hospital spokesperson told CNN on Sunday. Another six will be transferred Sunday from the NICUs at Mount Sinai Hospital and Mount Sinai West, the spokesperson said.

    “In addition, we have transferred close to 100 patients from the affected hospitals – The Mount Sinai Hospital, Mount Sinai West and Mount Sinai Morningside – to unaffected hospitals within the Mount Sinai system and partner hospitals in NYC and we continue to safely discharge patients who were schedule to go home.” All elective surgeries have been postponed, the spokesperson said.

    The NYSNA hit back Saturday at comments from Mount Sinai, which said Friday it was transferring infants in its neonatal intensive care units to other area hospitals because of the strike notice, adding the hospital was dismayed by the union’s “reckless” actions.

    “As a labor and delivery nurse who helps mothers to bring babies into this world, I find it outrageous that Mount Sinai would compromise care for our NICU babies in any way. We already have NICU nurses caring for twice as many sick babies as they should,” Matt Allen, the union’s regional director, said.

    “It’s unconscionable that Mount Sinai refuses to address unsafe staffing in our NICU and other units of the hospital but is now stirring fears about our NICU babies in contract negotiations,” he added.

    In a statement Saturday, the NYSNA said nurses at BronxCare and The Brooklyn Hospital Center reached tentative agreements that will improve safe staffing levels and enforcement, increase wages by 7%, 6%, and 5% annually during their three-year contract, and retain their healthcare benefits.

    On Saturday, nurses at NewYork-Presbyterian announced they had agreed to ratify their deal, but it was a close vote – 57% nurses voted yes and 43% were against.

    “Voting on whether to ratify a contract is a key component of union democracy. Just like in any democracy, there is rarely 100 percent consensus,” Hagans said in a statement.

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  • Amid negotiation gridlock between Mount Sinai Hospital and the nursing union, newborns in intensive care are caught in the middle, one nurse says | CNN Business

    Amid negotiation gridlock between Mount Sinai Hospital and the nursing union, newborns in intensive care are caught in the middle, one nurse says | CNN Business

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    CNN
     — 

    Crucial union negotiations between Mount Sinai Hospital and the New York State Nurses Association appear to be at a standstill and both parties say the other is refusing to return to the bargaining table.

    As the impasse continues between the hospital and union, the most vulnerable patients – newborns in Mount Sinai’s neonatal intensive care unit – are caught between the opposing sides, causing worry among families, one Mount Sinai nurse, who declined to provide her name out of fear of repercussions, told CNN.

    With thousands of New York nurses poised to strike early Monday morning, one of Manhattan’s famed hospitals announced Friday it would transport newborns in its intensive care unit to other area hospitals in preparation for the strike.

    A Mount Sinai Health System spokesperson confirmed to CNN Friday that neonatal intensive care unit infants would be transferred to other area hospitals because of the strike notice.

    “We are seeking a resolution [to the strike.] The impact is great,” the spokesperson told CNN.

    A NICU nurse at Mount Sinai Hospital told CNN that families of patients in the unit have been deeply concerned about moving their sick infants from one hospital to another. Moving the babies to a different facility can be “very stressful” for a NICU patient, the nurse said, as well as the parents.

    “They’ve asked us all week what’s going to happen to their babies, and what’s going to happen next week,” the nurse said.

    “It’s a big journey for a baby who’s never been outside the hospital,” she told CNN. “It’s not anything that we want to happen. We want our babies to stay. We want to be taking care of them. And it’s kind of shocking, and actually a little infuriating, that the hospital is letting it get to this point.”

    The more critical the baby’s condition is, the more complicated and riskier a transfer to another hospital becomes, the nurse explained.

    “You would need at least a doctor or nurse practitioner, a respiratory therapist if the patient is on respiratory support and a transport nurse to work the pumps and administer medicine if needed,” she said.

    The nurses who care for the sick infants often grow close to the families and develop a trusting relationship with them, especially because some babies spend weeks or even months in the NICU, the nurse told CNN.

    “They’re comfortable leaving their babies with us when they aren’t able to be there,” she said. “We keep in contact with the families after their babies have gone home – so we really do develop a close bond to these families.”

    “We treat our babies in the hospital like they’re our own kids. We’re very protective of them,” she added.

    New York State Nurses Association President Nancy Hagans has said the goal of the negotiations is to improve patient care and staffing, get fair wages and to recruit and retain nurses.

    Negotiations between the health system and the nurse’s union have been ongoing since September, a Mount Sinai Health System spokesperson told CNN Saturday, but low staffing levels have afflicted the NICU unit for years, the nurse told CNN.

    “For over three years now, we’ve been understaffed,” she said.

    The number of patients in the unit surges and falls regularly, according to the nurse, but as patient levels rise, staffing levels stay the same. The unit can surge to 64 patients, she said.

    “You feel like you’re not actually giving your all to your patients,” she said. “You’re really pulled very thin.”

    Paying close attention to infant patients is especially important, according to the nurse, because unlike other patients – even small children – they can’t verbalize pain or discomfort.

    “You really have to be on top of their vital signs and general assessment. And when you’re not able to spend as much time as you need to with them, some things do get missed,” she said. “And it’s very unfortunate.”

    CNN has reached out to the hospital regarding the nurse’s comments on low staffing.

    More than 8,700 nurses are prepared to strike Monday morning if tentative contract agreements are not reached at several hospitals, Hagans, the union president, said at a virtual news conference Saturday morning.

    As of Saturday, negotiations across New York’s hospitals were continuing at Montefiore Bronx and the Mount Sinai Morningside and West campuses, according to the nurse’s union.

    But the president of the nurse’s union told reporters Saturday the main Mount Sinai Hospital complex left the bargaining table late Thursday and no further bargaining sessions have been scheduled since.

    A Mount Sinai Health System spokesperson told CNN that hospital management is “waiting for the union to come back to us” to resume negotiations.

    The hospital said it put forth a deal at Thursday evening’s bargaining session was the same one the union agreed to for nurses at the NewYork-Presbyterian Hospital. Tentative agreements have also been reached with union nurses at Maimonides Medical Center in Brooklyn and Richmond University Medical Center in Staten Island.

    Mount Sinai also said it has offered a 19.1% compounded pay raise over three years, which is the same offer other hospital systems in the city have made.

    The NICU nurse at Mount Sinai said that nurses in her unit don’t want to strike and are hoping that they can come to an agreement with the hospital before Sunday night.

    “It truly breaks our heart having to strike and leave our patients, but unfortunately you have to do some drastic things sometimes,” she told CNN.

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  • World Cup security guard dies after ‘fall’ while on duty at the Lusail Stadium | CNN

    World Cup security guard dies after ‘fall’ while on duty at the Lusail Stadium | CNN

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    CNN
     — 

    A Kenyan security guard who reportedly fell while on duty at Qatar’s Lusail Stadium has died in hospital, his family and officials have confirmed to CNN.

    His employer had notified the migrant worker’s family on Saturday that 24-year-old John Njue Kibue had fallen from the 8th floor of the stadium while on duty, his sister Ann Wanjiru said.

    “We don’t have the money to get justice for him, but we want to know what happened,” she told CNN.

    A medical certificate obtained by CNN shows he was admitted at the Intensive Care Unit (ICU) at Hamad General Hospital in Doha. The document says Njue had a “severe head injury, facial fractures and pelvic fractures.”

    In a statement, the organizers of the World Cup – the Supreme Committee for Delivery and Legacy – announced Kibue’s death.

    “We regret to announce that, despite the efforts of his medical team, he sadly passed away in hospital on Tuesday 13 December, after being in the intensive care unit for three days,” the statement added.

    “His next of kin have been informed. We send our sincere condolences to his family, colleagues and friends during this difficult time.”

    Earlier this week, the committee announced that Kibue suffered a serious fall while on duty.

    “Qatar’s tournament organisers are investigating the circumstances leading to the fall as a matter of urgency and will provide further information pending the outcome of the investigation, ” it said in its statement.

    “We will also ensure that his family receive all outstanding dues and monies owed.”

    He had been unconscious since Saturday and was connected to a machine to help him breathe, his medical records showed. A family member was informed on Monday morning of his death.

    But the security guard’s family says his Qatari employer, Al Sraiya Security Services, has not explained how he fell or any of the circumstances surrounding his death.

    “We want justice. We want to know what caused his death. They have never sent us a picture to show where he fell from or given us any other information,” his sister Wanjiru told CNN.

    CNN has contacted Al Sraiya Security Services for comment after the guard’s death and is yet to receive a response.

    In a statement to CNN, the Kenyan embassy in Qatar said it was aware of the matter and “undertaking necessary consular assistance whilst awaiting official communication from Qatar’s Supreme Committee and competent authorities.”

    The guard’s family says he moved to Qatar last November for a contract with Al Sraiya Security Services.

    A WhatsApp message seen by CNN was sent to his colleagues at other World Cup stadiums soliciting for contributions.

    “He came here to support his family back home but by bad luck his dreams came to an end today,” it reads in part. “Let’s do something for our beloved comrade.”

    He is the second migrant worker reported dead since the tournament began in the Gulf nation after another was reportedly killed in an accident at a resort used by Saudi Arabia during the group stages.

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  • Desperate for heart surgery for their baby, a family feels the effects of pediatric hospital shortages | CNN

    Desperate for heart surgery for their baby, a family feels the effects of pediatric hospital shortages | CNN

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    CNN
     — 

    Even before their daughter was born in June, Aaron and Helen Chavez knew she would need heart surgery. Doctors expected her to have an operation around 6 months of age.

    When it became apparent in September that it would have to happen much sooner than expected, the Chavezes said, they endured an agonizing monthlong wait for a bed to open at their local children’s hospital so baby MJ could have the procedure she needed.

    “They said, ‘Well, we would love to get her in as soon as possible. However, right now, we don’t have beds,’ ” Aaron said.

    Space for children in hospitals is at a premium across the country. Data reported to the US government shows that as of Friday, more than three-quarters of pediatric hospital beds and 80% of intensive care beds for kids are full. That’s up from an average of about two-thirds full over the past two years.

    Federal data shows that the strain on hospital beds for kids began in August and September, which is right around the start of the school year in many areas.

    Hospitals are seeing higher than normal numbers of sick infants and children due to a particularly early and severe season for respiratory infections in kids, including respiratory syncytial virus, or RSV, and influenza.

    As of Friday, Golisano Children’s Hospital in Rochester, New York, the facility that treated the Chavezes’ daughter, was over capacity. Federal data shows that it has been consistently more full than the national average over the past few months. Golisano went from having 85% of its beds occupied in August to over 100% now.

    Like many other hospitals across the country, Golisano has seen a sharp increase in children who are severely ill with RSV. Dr. Tim Stevens, the chief clinical officer, said 35% of the hospital’s current patients – excluding those in the neonatal intensive care unit – have RSV.

    A lack of available beds means patients are sometimes held in the emergency department to wait for a bed to open so they can be admitted, Stevens says.

    It may also mean children who have chronic conditions and need procedures or hospital care, but whose conditions are stable, may have to wait.

    MJ was born in June with a ventricular septal birth defect – a hole between the pumping chambers of her heart. It’s a relatively common problem affecting about 1 in every 240 infants in the United States, according to the US Centers for Disease Control and Prevention.

    Doctors could see the defect on prenatal ultrasounds, but because MJ was never in the right position to get a good image, they weren’t sure of its size.

    If they’re small enough, these holes usually close on their own soon after birth. But the hole in MJ’s heart was not small.

    It caused the oxygen-rich blood coming from her lungs to mix with oxygen-poor blood returning from the rest of her body. Too much blood got squeezed back into her tiny lungs with each heartbeat, straining her respiratory system.

    Everything exhausted her, even nursing or drinking from a bottle. “She would stop eating before she was full and before she got the calories that she needed,” Aaron said.

    Typically, babies will take a bottle for 15 to 20 minutes at a time, but MJ would doze off after six or seven minutes, her mother recalls.

    They didn’t worry, Helen says, because they were trying hard not to be anxious newbies. “All those websites, they say sometimes you just have a sleepy baby, and it’s OK,” she said.

    Other signs that MJ might be hungry could be explained away, too. They mistook her constant fussing for colic. Her scalp started to get dry and flaky, and they thought it might be a common skin condition called cradle cap.

    As first-time parents, the Chavezes didn’t realize at first that MJ wasn’t eating enough. Doctors didn’t immediately catch it, either. MJ got three checkups during her first month, one within a few days of coming home from the hospital, the other at two weeks and another at one month.

    It’s normal for babies to lose weight after birth, especially if Mom got IV fluids during labor and delivery. They typically return to their birth weights by 2 to 3 weeks of age. And at first, MJ did regain weight, climbing back to her birth weight by 2 weeks old.

    But babies with heart conditions like hers can have faster-than-normal metabolisms, and it was between weeks two and four that her parents say the feeding issues really began to cause problems.

    “We were frustrated and we were scared, because she looked like she was losing weight, not gaining weight. She was very thin for a baby,” Aaron said.

    The doctors had advised them to count the number of wet and dirty diapers she was having each day as a way to judge whether she was eating enough. Her parents didn’t know it was not as much as she should have been.

    “One day, I was holding her, sitting in our recliner. I looked down at her and I was like, ‘this baby looks puny. Like, she does not look like she feels good,’ ” Helen said.

    She called their pediatrician, who saw them the same day. The pediatrician immediately notified their cardiologist, who arranged for a feeding tube to help MJ get more nutrition.

    Helen says they had been told MJ would need surgery to repair the hole in her heart around 6 months of age.

    “Once the feeding issues started, though, that I think that we all kind of realized that, OK, she’s probably not going to hit that six-month mark,” she says.

    MJ got the feeding tube when she was around 6 weeks old, in August. Her doctors started talking about moving the operation up but advised her parents that she would need to gain some weight first.

    The feeding tube helped for a time, but by the time MJ was 3 months old, her condition had deteriorated.

    “Every breath came with a grunt,” Aaron said. “She was fairly regularly sweating, no matter the ambient temperature in the room or whether we were holding her or not.”

    Every time MJ drew a breath, the skin around her collarbone would suck in and her abdomen would pull under ribcage, a symptom known as a retraction. Retractions are a sign that someone is working very hard to breathe.

    “It looked like her chest was almost scooping under her lungs with each breath. The retractions were getting really bad. It was around that point that they told us, ‘Hey, yeah, this is accelerating faster. We’re going to need to get her in for surgery soon,’ ” Aaron said.

    Helen said their cardiologist first discussed getting MJ’s case reviewed – a key step her doctors needed to prepare for her surgery – on September 14.

    “He said, ‘it might take a couple of weeks to get her in because we’ve been really slammed with emergencies, but we’ll get her in,’ ” Helen said.

    Doctors put MJ on medications called diuretics to help drain excess fluid off her lungs and ease her breathing – but then, at the end of September, she caught a cold.

    It wasn’t a bad cold, and Helen Chavez, a pharmacist, thinks that if the baby had been healthy, she probably could have fought it off at home with no problems. But Helen was worried, so she took she MJ to the ER.

    The doctors checked her, determined she was stable and sent the family home with supportive care.

    At a follow-up doctor’s visit, Helen said, she asked again, “Where are we on the surgery?”

    Helen said the cardiologist said they had not been able to review MJ’s case.

    “And they said, ‘Well, we would love to get her in as soon as possible. However, right now we don’t have beds,’ ” Aaron said.

    “Throughout that time, she kept getting worse. More symptoms would pop up in terms of the breathing would get worse, the retractions would get worse, that kind of a thing. Like there was more and more and more piling up,” Aaron said.

    Helen said she understood that MJ’s condition was still stable, but she was worried it wouldn’t stay that way.

    “I was like, ‘I’m worried she’s going to crash and that’s how we’re going to get in for this surgery is, it’s going to take this kid crashing and burning before we can get her in,’ ” Helen told the doctor, who reassured her.

    ” ‘No, no, no, she is not going to get to that point before we get her in,’ ” she says they were told.

    On October 10, things took a turn.

    The baby slept in a bassinet beside her parents’ bed. Helen nudged Aaron awake around midnight to look at their daughter, and his first thought was to reassure his wife that yes, the doctors had told them that her breathing was going to look bad. But then he rolled over and peered at MJ, who was asleep.

    “That was the moment that I was wide awake,” Aaron said, and he was terrified.

    “It was the raggedness of her breathing and the noise. Every breath, there was a strange sound coming from her. It sounded like she was fighting for, like, struggling for every breath.”

    They raced to the hospital.

    “We were sitting in the ER, and every other kid in that pediatric ER was hacking, coughing, sneezing,” Helen said. “Clearly, respiratory viruses hit Rochester early and very hard.”

    Helen said it was clear by the end of that visit that medications had done all they could do and that MJ would continue to get worse without the operation.

    “Our understanding is, it took an extra ER visit to push the timeline,” Helen said.

    That visit prompted an emergency appointment with the cardiologist.

    “That’s where they were like, ‘OK, we’ve got her in for conference,’ ” Helen said.

    The hospital says it can’t comment on the specifics of MJ’s case.

    “The Golisano Children’s Hospital cardiology and cardiac surgery teams review the status of all pediatric patients who need heart surgery twice a week,” the hospital said in a statement to CNN. “We cannot comment on a specific case, but once surgery becomes necessary, it is scheduled as quickly as needed based on the medical condition of the child. The current high census of pediatric inpatients at our hospital has not affected our ability to schedule non-elective pediatric cardiac surgeries in a timely way.”

    Stevens, the chief clinical officer, says those decisions are made on a case-by-case basis.

    “Each of those are reviewed by our medical and surgical team to determine whether or not they’re time-sensitive,” he said. “Things that are time-sensitive or certainly urgent or emergent, they get done.”

    When it becomes clear that a child needs to be admitted, Stevens said, hospital officials find ways to open beds, and they try to do it so it doesn’t exhaust their nurses.

    Stevens says he’s hopeful the situation will improve, that infections will die down, “because this is not sustainable.”

    Aaron Chavez agrees that there was no delay once MJ’s case got the necessary review – but says that review itself kept getting put off.

    “We were essentially told that her case review was being delayed because they simply didn’t have the beds,” he said.

    The surgical team reviewed MJ’s case on October 13, and she had surgery 12 days later, according to Aaron.

    Aaron says the family has no complaints about the quality of care their daughter received, and they’re grateful to the entire team of doctors, nurses and other staff who treated their daughter.

    “Once push came to shove, they definitely got her in, but the last four weeks were really, really harrowing,” Helen said. “It was just kind of hard to watch your baby have trouble breathing and know that there’s not a whole lot you can do.”

    On the morning of October 25, the Chavezes brought MJ to the hospital, where doctors walked them through the operation. A piece of synthetic material would be sewn into her heart to patch the hole. Over time, the material would allow her own cells to grow on it and cover the defect.

    The procedure could take as long as 12 hours. But it went faster than anticipated, and MJ was finished in half that time. The surgeon came out to tell them the good news: The operation had been a success.

    “Her surgeon said that it was the biggest hole that he has seen in 2022 and one of the biggest he has ever seen,” Aaron said.

    The Chavezes then went to the pediatric intensive care unit to wait for MJ. As soon as they saw her, they could see she was better.

    Before the surgery, her skin had been pale and mottled; after, she was a healthy pink.

    “Just in that short amount of time, her skin had that pinkness and redness in places that you expect like the nose, and her fingers were proper pink,” he said. “That color you expect out of a healthy baby. It was really nice to see that.”

    She was in the hospital for six days, and her recovery amazed her care team.

    “She kind of crushed recovery milestones like it was her job,” Aaron said.

    Now back home, MJ is playing catch-up with the developmental milestones she missed while she was sick. Her muscles are weak, she can’t sit up or roll over yet, and she may never switch back from the feeding tube to a bottle. A team of occupational and physical therapists comes over to help. They expect she will eventually make up for the time she missed, but it will take some work.

    Still, Aaron says the surgery has had an amazing effect.

    Before her operation, MJ was very uncomfortable and always tired.

    “The baby that I have now, that returned from surgery, is constantly smiling at us. She’s almost laughed three different times in the last couple of days, right? She’s so close to a laugh. She seems like an entirely different baby,” Aaron said.

    The Chavezes were nervous about sharing their story, but in the end, they decided it was important to shed light on the effects of the ongoing hospital bed shortage.

    “Everybody we have told about the bed shortage, that we have told about the nurses and the staff and the doctors telling us how burnt-out and frustrated they are and how tired they are, everybody’s surprised,” Aaron said.

    “Everybody’s shocked. Everybody thinks that this is over. The pandemic is over. Our health care system’s back to normal. ‘What are you talking about? What shortages?’ “

    In the end, they felt powerless. What could they – two exhausted working parents with a sick infant – do to solve a national crisis?

    After all, after nearly three years of a viral pandemic, doesn’t everyone already know what to do? Stay home if you’re sick. Put on a mask in public places while viral illnesses are running rampant. Get vaccinated.

    “I don’t know how I’m supposed to help tell 330 million people, ‘Hey, you should care about each other,’ ” Aaron says.

    Their story is one reminder of why all those simple but effective measures are important.

    “In the end, we believe the information getting out there is better than not,” Aaron said. “Hopefully, it will help push those in power to do better.”

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  • The Worst Pediatric-Care Crisis in Decades

    The Worst Pediatric-Care Crisis in Decades

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    At the height of the coronavirus pandemic, as lines of ambulances roared down the streets and freezer vans packed into parking lots, the pediatric emergency department at Our Lady of the Lake Children’s Hospital, in Baton Rouge, Louisiana, was quiet.

    It was an eerie juxtaposition, says Chris Woodward, a pediatric-emergency-medicine specialist at the hospital, given what was happening just a few doors down. While adult emergency departments were being inundated, his team was so low on work that he worried positions might be cut. A small proportion of kids were getting very sick with COVID-19—some still are—but most weren’t. And due to school closures and scrupulous hygiene, they weren’t really catching other infections—flu, RSV, and the like—that might have sent them to the hospital in pre-pandemic years. Woodward and his colleagues couldn’t help but wonder if the brunt of the crisis had skipped them by. “It was, like, the least patients I saw in my career,” he told me.

    That is no longer the case.

    Across the country, children have for weeks been slammed with a massive, early wave of viral infections—driven largely by RSV, but also flu, rhinovirus, enterovirus, and SARS-CoV-2. Many emergency departments and intensive-care units are now at or past capacity, and resorting to extreme measures. At Johns Hopkins Children’s Center, in Maryland, staff has pitched a tent outside the emergency department to accommodate overflow; Connecticut Children’s Hospital mulled calling in the National Guard. It’s already the largest surge of infectious illnesses that some pediatricians have seen in their decades-long careers, and many worry that the worst is yet to come. “It is a crisis,” Sapna Kudchadkar, a pediatric-intensive-care specialist and anesthesiologist at Johns Hopkins, told me. “It’s bananas; it’s been full to the gills since September,” says Melissa J. Sacco, a pediatric-intensive-care specialist at UVA Health. “Every night I turn away a patient, or tell the emergency department they have to have a PICU-level kid there for the foreseeable future.”

    I asked Chris Carroll, a pediatric-intensive-care specialist at Connecticut Children’s, how bad things were on a scale of 1 to 10. “Can I use a Spinal Tap reference?” he asked me back. “This is our 2020. This is as bad as it gets.”

    Read: The strongest signal that Americans should worry about flu this winter

    The autumn crush, experts told me, is fueled by dual factors: the disappearance of COVID mitigations and low population immunity. For much of the pandemic, some combination of masking, distancing, remote learning, and other tactics tamped down on the transmission of nearly all the respiratory viruses that normally come knocking during the colder months. This fall, though, as kids have flocked back into day cares and classrooms with almost no precautions in place, those microbes have made a catastrophic comeback. Rhinovirus and enterovirus were two of the first to overrun hospitals late this summer; now they’re being joined by RSV, all while SARS-CoV-2 remains in play. Also on the horizon is flu, which has begun to pick up in the South and the mid-Atlantic, triggering school closures or switches to remote learning. During the summer of 2021, when Delta swept across the nation, “we thought that was busy,” Woodward said. “We were wrong.”

    Children, on the whole, are more susceptible to these microbes than they have been in years. Infants already have a rough time with viruses like RSV: The virus infiltrates the airways, causing them to swell and flood with mucus that their tiny lungs may struggle to expel. “It’s almost like breathing through a straw,” says Marietta Vazquez, a pediatric-infectious-disease specialist at Yale. The more narrow and clogged the tubes get, “the less room you have to move air in and out.” Immunity accumulated from prior exposures can blunt that severity. But with the pandemic’s great viral vanishing, kids missed out on early encounters that would have trained up their bodies’ defensive cavalry. Hospitals are now caring for their usual RSV cohort—infants—as well as toddlers, many of whom are sicker than expected. Infections that might, in other years, have produced a trifling cold are progressing to pneumonia severe enough to require respiratory support. “The kids are just not handling it well,” says Stacy Williams, a PICU nurse at UVA Health.

    Coinfections, too, have always posed a threat—but they’ve grown more common with SARS-CoV-2 in the mix. “There’s just one more virus they’re susceptible to,” Vazquez told me. Each additional bug can burden a child “with a bigger hill to climb, in terms of recovery,” says Shelby Lighton, a nurse at UVA Health. Some patients are leaving the hospital healthy, only to come right back. There are kids who “have had four respiratory viral illnesses since the start of September,” Woodward told me.

    Pediatric care capacity in many parts of the country actually shrank after COVID hit, Sallie Permar, a pediatrician at NewYork-Presbyterian and Weill Cornell Medicine, whose hospital was among those that cut beds from its PICU, told me. A mass exodus of health-care workers—nurses in particular—has also left the system ill-equipped to meet the fresh wave of demand. At UVA Health, the pediatric ICU is operating with maybe two-thirds of the core staff it needs, Williams said. Many hospitals have been trying to call in reinforcements from inside and outside their institutions. But “you can’t just train a bunch of people quickly to take care of a two-month-old,” Kudchadkar said. To make do, some hospitals are doubling up patients in rooms; others have diverted parts of other care units to pediatrics, or are sending specialists across buildings to stabilize children who can’t get a bed in the ICU. In Baton Rouge, Woodward is regularly visiting the patients who have just been admitted to the hospital and are still being held in the emergency department, trying to figure out who’s healthy enough to go home so more space can be cleared. His emergency department used to take in, on average, about 130 patients a day; lately, that number has been closer to 250. “They can’t stay,” he told me. “We need this room for somebody else.”

    Experts are also grappling with how to strike the right balance between raising awareness among caregivers and managing fears that may morph into overconcern. On the one hand, with all the talk of SARS-CoV-2 being “mild” in kids, some parents might ignore the signs of RSV, which can initially resemble those of COVID, then get much more serious, says Ashley Joffrion, a respiratory therapist at Baton Rouge General Medical Center. On the other hand, if families swamp already overstretched hospitals with illnesses that are truly mild enough to resolve at home, the system could fracture even further. “We definitely don’t want parents bringing kids in for every cold,” Williams told me. The key signs of severe respiratory sickness in children include wheezing, grunting, rapid or labored breaths, trouble drinking or swallowing, and bluing of the lips or fingernails. When in doubt, experts told me, parents should call their pediatrician for an assist.

    Read: The great pandemic hand-washing blooper

    With winter still ahead, the situation could take an even darker turn, especially as flu rates climb, and new SARS-CoV-2 subvariants loom. In most years, the chilly viral churn doesn’t abate until late winter, which means hospitals may be only at the start of a grueling few months. And still-spotty uptake of COVID vaccines among little kids, coupled with a recent dip in flu-shot uptake and the widespread abandonment of infection-prevention measures, could make things even worse, says Abdallah Dalabih, a pediatric-intensive-care specialist at Arkansas Children’s.

    The spike in respiratory illness marks a jarring departure from a comforting narrative that’s dominated the intersection of infectious disease and little children’s health for nearly three years. When it comes to respiratory viruses, little children have always been a vulnerable group. This fall may force Americans to reset their expectations around young people’s resilience and recall, Lighton told me, “just how bad a ‘common cold’ can get.”

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    Katherine J. Wu

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