San Antonio, Texas NP Joseph Vine must be a descendant of the Unsinkable Molly Brown. After a brutal bout with Covid-19 left him in a medically induced coma for two months last year, our Nurse of the Week proceeded to push through a lengthy recovery period. Now, glad to be back treating youngsters at his pediatric urgent care clinic, he says, “I’m almost back to where I was before.”
But Vine endured a frightening ordeal in the interim between “before” and now. In June 2020, Covid entered the life of the 41-year-old father of three. Coughing and gasping for breath, he reached the ED at Northeast Baptist Hospital – just barely. “I was feeling so horrible,” he told News 4 San Antonio. “I was sure I had Covid, and basically as soon as I got to the ER, they were telling me they were going to have to intubate me.” His prospects for survival were dubious. In fact, Vine’s wife Anayuri said, “They thought he was not going to make it.” The couple had been married less than two years and Anayuri had recently given birth to a girl when Vine was admitted. Suddenly, her husband was inaccessible, lying comatose in the ICU and breathing with the aid of machines. For Anayuri and the baby, he had effectively vanished. “I couldn’t see him for two months,” she recalled.
Vine survived, after spending 56 days on a ventilator. His return to consciousness in August 2020 was met with relief – and relieved surprise – by his wife, friends, and doctors. He recalls, “I actually came out of it, which they never thought I would do… They were like, ‘Wow, he’s actually awake!’ A lot of people didn’t expect that to happen.”
When Northeast Baptist finally discharged him in October last year, Vine, like many post ICU patients, was almost as helpless as a newborn infant. (The NP, who has no insurance, had to cope with financial helplessness as well. He emerged with nearly $2 million in medical costs, and friends helped raise the funds for his rehabilitation treatment).
When he came home, Vine was suffering from nerve damage, and his right foot was entirely out of commission. Doctors warned that the foot might never regain its function. “They said,” he recalled, “If it’s not going to be here in 48 hours from when we first observed it, it’s most likely not coming back at all.” However, drawing upon the special reserves of discipline, determination, and “Yes I can” attitude that allows nurses to do what they do, the NP learned to walk again before his baby daughter Charlotte had mastered crawling. Charlotte – who was born just five months before Vine entered the hospital and is now 21 months old – had to become reacquainted with her father when he finally came home. She will be able to keep pace with Dad better than most toddlers, as he’s still wearing a foot brace, but Vine cheerfully remarked, “… I’m a lot more mobile now. I’m very encouraged. I think it’s going to come back even more.”
As his recovery progressed, Vine started treating patients via telehealth while still on a walker. By January 2021, he returned to the clinic on a part-time basis and transitioned to full-time two months later. “Being here and making a difference and helping people was a motivating goal to get back to. I missed the connections with my patients.” Since his recovery from Covid, Vine is also well-positioned to comfort families when one of his young patients contracts the disease. “When I talk to families, they’re often nervous, scared. It may be their first time that this has touched their family. I’m able to give them advice or help relieve some of the symptoms and talk about the course, and then also follow up with them… kind of being part of their process to make sure that nothing’s getting worse for them. That seems to really help them.”
New data from the Texas health department released on November 7 proves what health officials have been trying to tell vaccine-hesitant Texans for months: The COVID-19 vaccine dramatically prevents death and is the best tool to prevent transmission of the deadly virus.
“We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
—Dr. Jennifer A. Shuford, state epidemiologist
Out of nearly 29,000 Texans who have died from COVID-related illnesses since mid-January, only 8% of them were fully vaccinated against the virus, according to a report detailing the Texas Department of State Health Services’ findings.
And more than half of those deaths among vaccinated people were among Texans older than 75, the age group that is most vulnerable to the virus, the study shows.
“We’ve known for a while that vaccines were going to have a protective effect on a large segment of our population,” said Dr. Jennifer A. Shuford, state epidemiologist. “By looking at our own population and seeing what the impact of the vaccines have been on that population, we’re hoping just to be able to reach people here in Texas and show them the difference that being fully vaccinated can make in their lives and for their communities.”
The state health department study covers most of the positive cases and COVID-19 deaths reported in Texas among residents from Jan. 15 to Oct. 1. It’s the first time state officials have been able to statistically measure the true impact of the vaccine on the pandemic in Texas — which has one of the highest death tolls in the nation. The majority of Texans ages 16 and up didn’t become eligible for the vaccine until late March.
State health officials also found the vaccine greatly reduced the risk of virus transmission, including the highly contagious delta variant that ravaged the state over the summer.
Only 3% of 1.5 million positive COVID-19 tests examined since mid-January occurred in people who were already vaccinated.
State researchers matched electronic lab reports and death certificates with state immunization records and measured cases and deaths since mid-January, a month after the first shots were administered in Texas.
The study was done using data similar to those used by other states that conducted similar studies and methods recommended by the U.S. Centers for Disease Control and Prevention, Shuford said.
And while the outcome was not particularly surprising, Shuford said, officials hope that the new data will increase trust in the benefits of the shot.
“Texas is a unique place; it’s got a lot of diversity, geographic and population-wise,” Shuford said. “We know that some people want to see actual numbers and that they want to see it for their own community. And so we are hoping that this reaches some of those people who have been hesitant and really just questioning the benefits of the vaccines.”
In Texas, it literally requires a disaster — like a pandemic — before the state records precise information about vaccinations. As a result, there is a record for every single COVID-19 vaccine dose of the name and age of the person who received it plus the date it was administered. Normally, vaccination records are shown to schools by parents, but details of all vaccinations are not regularly kept by a state registry in Texas, unlike nearly every other state, because it’s a voluntary system.
However, state officials still don’t have official numbers on how many vaccinated people were hospitalized with COVID-19 because hospitals are not required to report that level of data under state law.
But the state’s largest hospital districts and counties have reported that at least 90% of the hospitalized Texans with the virus were unvaccinated.
The state’s new health data comes as Republican state leaders grapple with local cities and school districts about masking, which has been proven to reduce transmission of the virus, and with federal officials over vaccine mandates.
About 53% of the Texas population is fully vaccinated. More than 70,000 Texans have died from COVID-19 since the pandemic began.
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Mandi Cai contributed to this report.
Disclosure: University of Texas System has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
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About 40% of Texas nursing home workers are unvaccinated and could face dismissal or quit their jobs under a federal vaccination requirement for the industry..
Texas nursing homes, crippled by a pandemic that ravaged their residents and decimated their workforce, are asking the state for $400 million in federal coronavirus relief to address a staffing crisis in the system that cares for the state’s oldest and most fragile residents.
Industry advocates fear the federal vaccination mandate could mean the potential exodus of tens of thousands of workers from facilities across the state before Halloween.
“We know we are going to lose additional staff when that vaccine mandate comes out,” said Becky Anderson, head of clinical operations for Focused Post Acute Care Partners, which runs 31 nursing homes and employs about 2,500 workers in Texas. “We just have some staff that are very adamant that they will not get the vaccine.’”
The federal rule comes at a time when the industry is already struggling with a shrinking workforce due to burnout, low pay, increased expenses related to the pandemic, and competition from other health care providers, administrators say.
According to recent surveys by the Texas Health Care Association and LeadingAge Texas, two nursing home industry groups in Texas, facilities across the state have seen a 12% decrease in their workforce in the last year. At least one-third of survey respondents are turning away new admissions due to staffing shortages, the survey says.
For the facilities, staffing shortages mean higher costs for overtime and an inability to grow or maintain patient population levels. Facility operators are also facing a pressing need for higher salaries and more money for recruiting tools, industry advocates said.
“The environment providers are operating in today isn’t sustainable,” said George Linial, president and CEO of LeadingAge Texas. “Texas cannot continue to kick this can down the road. A strong commitment and investment by lawmakers will pay huge dividends for the people we serve.”
However, it does not appear that help from Texas officials, either with emergency funding or staff, is imminent.
There is no bill filed in the current special session of the Legislature, which ends in just over two weeks, that would funnel any relief funds to nursing homes.
Texas has about $16.7 billion in American Rescue Plan Act money, and about $7.2 billion is marked in legislation to shore up the state’s unemployment fund, which was overloaded last year by record claims.
The funding request by the nursing homes includes $400 million to help recruit and retain workers, and an additional $350 million to pay for new infection-control measures and maintain them permanently for future crises.
For the remaining $8.5 billion available, requests from everyone else outside the nursing home industry amount to nearly eight times that much, budget officials say.
The nursing homes’ effort to get that funding has not gotten very far, sparking industry concerns that nursing homes will start shutting down.
Already, the nursing home workforce crunch is forcing admission caps, which is having a ripple effect on hospitals that are already at capacity with COVID-19 patients. With nowhere to transport patients well enough to leave a hospital but still too ill to go home, hospitals are now often required to house patients longer than they would have if they’d had a nursing home spot available, said Kevin Warren, president and CEO of the Texas Health Care Association.
It has also placed more burdens on families that may not be equipped to care for an aging relative much longer or older Texans whose medical needs are best met in a skilled nursing facility rather than through costly home care, he said.
“I am concerned that without additional funding necessary to recruit and retain current staff and develop opportunities to bring new employees into the profession, we will see continuously increasing access-to-care issues with expanding admission restrictions, closures, small independent owners being forced to sell, and bankruptcies,” Warren said.
Meanwhile, New York state lawmakers are considering sending medically trained National Guard members to fill vacancies in struggling nursing homes. So far, there are no similar plans underway in Texas to use the military branch to supplement staffing in any of the state’s 1,200 nursing homes.
A spokesperson for the Texas Division of Emergency Management, which oversees the state guard, referred questions about potential help for nursing homes to the Texas Department of State Health Services.
A DSHS spokesperson said that nursing homes with staff who are out sick with COVID-19 or that are overwhelmed with COVID patients can ask the state for help, but the facilities aren’t reporting high numbers of active cases.
While Texas has paid for thousands of relief workers this summer to send to hospitals that are struggling with a similar staffing crisis, Abbott has not announced a similar program for nursing homes.
In an effort to reduce the deadly impact of the virus, both state and federal governments imposed stringent safety mandates on nursing homes that changed daily, sometimes hourly, at the height of the pandemic last year.
The homes struggled to supply tests and personal protective equipment to staffers at their own expense, and some made extensive modifications to their air filtration systems, their building layouts and their staffing plans to respond to the health crisis.
Meanwhile, the cost to run a Texas nursing home has risen dramatically during the pandemic. Safety protocols and the ongoing staffing problems have meant budgets for Texas nursing homes have risen by 25% in the past 18 months, according to the survey released on Tuesday.
And even more trouble lies ahead. About 75% of Texas nursing homes are operating at a loss, the THCA/LeadingAge survey said.
These staffing challenges at nursing homes are not limited to lower-paying or entry level positions. Every one of the 31 facilities run by Focused Care in Texas has openings, and the vacancies go all the way to the top, Anderson said. Three facilities have no administrator, and another handful are without a director of nursing, she said.
Bonuses for referring new employees and extra shifts can help attract and retain staff, but about 90% of nursing home residents use Medicaid or Medicare, which keeps budgets limited and pay for most entry-level positions between $10 and $15 an hour.
There is also a shortage of applicants for work that was already difficult and now that work comes with the extra safety requirements and gear needed to treat a COVID-19-susceptible population. Any new worker finds themself working longer overtime hours because of the hiring shortfalls and all of that contributes to employees quitting within a month or two of being hired, she said. The problem has gotten so bad that the company is updating its orientation program to find a way to better prepare new hires for the difficult environment, Anderson said.
The high turnover, especially among new hires, “is quite alarming,” she said. “It’s always been hard work, but it’s even harder now with everything going on, and just the exhaustion.”
According to the U.S. Centers for Medicare and Medicaid Services, about 65% of nursing home staff are currently vaccinatednationally. A recent rise in cases among nursing home residents, both in Texas and across the country, driven by the highly contagious delta variant, prompted the federal agency to announce in August that all nursing home employees be vaccinated in order for their facilities to continue participating in the Medicare and Medicaid program.
Those rules are expected to come out later this month.
Anderson is casting an anxious eye on that moment, when potentially 40% of her workforce could become ineligible for employment.
About 62% of the staff and 81% of the residents in Focused Care facilities across Texas are vaccinated, Anderson said.
But while the rates of resident vaccinations are fairly high across the system, they range widely among the staff depending on the facility, state numbers show.
Statewide, the vast majority of nursing homes that have fewer than 40% of their staff fully vaccinated are located in rural areas — mainly east Texas, where counties have some of the lowest vaccination rates in the state.
By contrast, most of the nursing homes with more than 90% of staff vaccinated are in the Rio Grande Valley and in El Paso, which have some of the highest vaccination rates in the state.
Warren, the head of the nursing home advocacy group THCA, said that while administrators work every day to convince their staff to get vaccinated, it is a near-impossible task to move them off the belief system that causes them to reject or fear the vaccine even though it’s free and widely available.
Much of it, he said, has to do with where they live.
“There is that relationship between the vaccine rates within the community and within the facility,” Warren said. “When folks in these facilities are working 8, 10, 12 hours a day, on their days off, they’re spending time with their families and friends in the community. So if that same prevalence of concern and distrust of the vaccine is present in that community, it’s only furthering their own hesitation.”
Normally, Beaumont, Texas RN Vaughn Mugol sings to his bedside patients on the Christus St. Elizabeth’s oncology unit. On Monday, though, our Nurse of the Week wowed the likes of Ariana Grande, John Legend, and Kelly Clarkson during his audition for The Voice.
Using vocal chops that have cheered patients since 2017, Mugol performed a moving interpretation of Ed Sheeran’s “The A-Team.” All three judges turned their chairs in support of him, and Mugol chose Grande as his coach. All three judges were also surprised to hear that Mugol’s usual audience is his bedside patients. An admiring Legend remarked, “I feel that what you did required a lot of seasoning that one doesn’t expect from people who haven’t performed on big stages.”
The 27-year-old Mugol has always used his vocal talents on the oncology unit. In his Voice introductory video, he said, “At those vulnerable moments, usually I open up and sing to them when I know that they need it. To be able to help people with the healing process is very rewarding.”
However, John Legend may take some consolation in knowing that the Christus oncology unit has not been Mugol’s sole performance space. Prior to his network debut, Mugol often performed at local parties in Beaumont’s Filipino community – and previous auditors are not surprised that all three Voice judges wanted to be his selected coach. Melanie Lanuza, a family friend who has known Mugol since his childhood, says “We always sing karaoke at our Filipino parties, and I was surprised that he was so young and wanted to sing. None of the other kids were interested, but he wanted to sing. He blew me away even when he was so young.”
Paul Guidroz, chief nursing officer for Christus, proudly says that he spotted Mugol’s talent early. “In their orientation,” he remarked, “I spend time with all the new nurses as they begin their residency program. And in that session… I shared with him that, ‘Hey, I hear that you enjoy singing.’ I said, ‘Don’t lose that passion. You never know where it might take you.’”
Katy Kiser, communications director for Christus Health, cheered on their musical RN, saying of Mugol: “He’s an amazing nurse and he has full Christus support for his courage to go and sing on a national stage… We are all #VoteVaughn over here.”
“Our staff have been cursed at, screamed at, threatened with bodily harm and even had knives pulled on them…. It is escalating.”
—Jane McCurley, chief nursing executive for Methodist Healthcare System
When the security guard at Methodist Hospital San Antonio met the visitor at the door of the children’s emergency room on a Saturday afternoon in early August, the officer’s request was simple: The man needed to get a temperature screening to make sure he showed no early signs of COVID-19 before entering the hospital.
The man refused, became agitated and began angrily shouting, pulling out his camera to record the guard and hospital staff.
The scene got so tense that San Antonio police were called, but the man — whose identity and reason for wanting to enter the hospital weren’t included in a police account of the incident — stormed off in anger before the officer could arrive.
It was, relatively speaking, a small blow-up, but Texas hospital workers and health care officials say incidents like it have been rising in both number and intensity this summer as tensions boil during the delta-fueled fourth surge in COVID-19 hospitalizations.
“Our staff have been cursed at, screamed at, threatened with bodily harm and even had knives pulled on them,” said Jane McCurley, chief nursing executive for Methodist Healthcare System, speaking at a press conference five days after the incident in the children’s ER. “It is escalating. … It’s just a handful at each facility who have been extremely abusive. But there is definitely an increasing number of occurrences every day.”
Nurses and hospital staffers are historically vulnerable to workplace violence due to the nature of their jobs, where they deal with people who are having bad reactions to street drugs or mental breaks and often have to give bad news to patients or family already in extreme pain or emotional distress.
“[We’ve had] people being punched in the chest, having urine thrown on them and inappropriate sexual innuendos or behaviors in front of staff members.
The verbal abuse, the name-calling, racial slurs … we’ve had broken bones, broken noses.”
—Karen Garvey, Parkland Health & Hospital System, Dallas
But the pandemic has exacerbated the stress that can escalate into threats and violence, as people are now contending with not just the virus but also job loss and other stresses, said Karen Garvey, vice president of patient safety and clinical risk management at Parkland Health & Hospital System in Dallas.
Parkland Health & Hospital System, Dallas.
Garvey said confrontations at Parkland just this year have included “people being punched in the chest, having urine thrown on them and inappropriate sexual innuendos or behaviors in front of staff members. The verbal abuse, the name-calling, racial slurs … we’ve had broken bones, broken noses.”
Visitors and patients assaulting hospital staff “was an epidemic before the pandemic — it was just silent to the public,” she added. “Health care workers have been dealing with this for years, and it’s become more pronounced with the COVID pandemic.”
The pandemic-related rise in tensions across the U.S. is not unique to the hospital industry. Airlines are reporting an increase in aggressive passengers as flight attendants take self-defense classes. Police are reporting an increase in violent crime and road rage incidents.
A similar phenomenon emerged last year when retail and grocery workers became front-line enforcers of mask mandates and limits on gatherings and indoor activities. And it resurfaced last month when parents aggressively confronted teachers at schools over oft-changing mask rules.
But unlike airlines, which can permanently ban passengers, hospitals are more limited in how they can respond or prevent those instances.
A 2013 Texas law made it a felony to assault an emergency room nurse, but legislation that would have expanded that to include nurses in other areas of a hospital died in the Texas Senate earlier this year. A bill addressing the issue is currently being considered in Washington by the U.S. Congress.
With hospitals reporting historic nursing shortages as the pandemic drags on, the fear is that the “alarming rate” of escalation will be the last straw for nurses who are physically worn out after fighting a pandemic for 18 months, thin on compassion for people who need care after choosing not to be vaccinated and afraid for their own personal safety, said Houston pediatrician Dr. Giancarlos Toledanes.
“With the escalation of this violence toward health care workers, we’re going to lose the workers that are deemed essential,” Toledanes said. “If the problem continues to compound, then I think it’s going to make it much more difficult to staff these hospitals.”
“Tempers are high”
The Texas Department of State Health Services doesn’t track incidents of aggression against hospital staff outside of its regular surveys, the next of which will be done next year, a spokesperson said.
But as health officials across Texas watch hospital ICUs and pediatric units overflow with record numbers of mostly unvaccinated people, they say the surge in aggression toward health care workers is obvious.
Many of the problems being reported in recent months include disagreements over masking and screening protocols that people don’t have to follow in other places, particularly after most mandatory protocols were banned in recent months by Gov. Greg Abbott, officials said.
Confrontations are sometimes caused by hours- or days-long waits in emergency rooms that are so full of COVID-19 patients that there is no room for anyone else, health care workers said.
“Tempers are high,” said Carrie Kroll, director of advocacy for the Texas Hospital Association. “To the point where some systems are putting a security guard at check-in because family members are getting so abusive over the masking and some of the other screening things they need to do.”
Families are often upset when they can’t visit someone due to COVID-19 rules that limit the number of people who can be bedside or even come inside the hospital, said Serena Bumpus, director of practice at the Texas Nurses Association.
“When our family members are sick, we want to be there by their side, and it’s not that easy to be by our loved one’s side anymore because of this increase in the number of COVID patients in our facilities,” she said.
At the Katy campus of Texas Children’s Hospital west of Houston, Toledanes said some parents get verbally abusive over rules that require them to wait for COVID-19 test results before more than one parent is allowed into a room with a sick child.
“With their child in the hospital and they’re the only ones handling everything, it obviously gets stressful,” he said. “It’s escalated a lot more, especially now that we’ve gotten a little bit stricter with our policies” due to the surge.
Health workers face online harassment
The threats follow health care workers online as well, and often have to do with philosophical differences over what have become political hot buttons such as masking and vaccinations, Toledanes wrote in a recent column for the online medical magazine MedScape.
“Online, healthcare workers, who advocate for masking or vaccination, are often subject to death threats, threats to family members, and verbal abuse on social media,” he wrote. “Veiled threats of ‘we know who you are’ and ‘we will find you’ follow physicians who advocate for masking in schools.”
At Parkland, some of the administration’s actions to protect the workers include a staff of six mental health peace officers — known as the Law Enforcement Intervention for Environmental/Patient Safety staff — who are specially trained to respond to high-risk incidents, Garvey said. Administrators have developed a flagging system in the patient record which identifies patients who have been identified as known risks to staff, she said.
Some hospitals have hung signs in hallways reminding families to be courteous and patient with the overworked staff.
In mid-August, the escalating reports prompted the Texas Hospital Association to take to social media with an image of an exhausted nurse’s face, mask pulled below her chin.
“Don’t forget the person behind the mask,” the image reads.
McCurley said that the increasing violence this year is made worse by the contrast in attitudes workers are seeing now compared with a year ago, when the public seemed to understand that nurses and hospital staff were standing between them and the deadly pandemic.
“We were seen as health care heroes and our community responded with love and support, food and gifts, drive-by parades, buses and motorcycles and airplanes, and we felt so much love and support. It gave us the courage to go in and face our own fears of the unknown in the beginning,” McCurley said at the August press conference. “Today, those health care workers are experiencing abusive behavior by patient families. It’s unfathomable that it’s occurring, and it has to stop.”
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Disclosure: Texas Children’s Hospital and the Texas Hospital Association have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.
An earlier version of this story overstated the number of children who have been hospitalized in Texas recently with COVID-19. The story said over 5,800 children had been hospitalized during a seven-day period in August, according to the Centers for Disease Control and Prevention. That number correctly referred to children hospitalized with COVID-19 since the pandemic began. In actuality, 783 children were admitted to Texas hospitals with COVID-19 between July 1 and Aug. 9 of this year.
Estefani López’s 11-month-old baby was struggling to breathe. The little girl, Ava Rivera, had contracted COVID-19 and began having seizures. Then her pulse weakened. Her mom couldn’t feel her taking breaths anymore.
López rushed her to an emergency room where they began initial treatments, putting tubes down her throat to pump her lungs with oxygen. But the baby’s condition required care at a pediatric hospital and none of the ones in the Houston area could take her in. They were all full.
Instead, López had to watch as hospital staff placed her baby in a helicopter to be airlifted 150 miles away to Temple for emergency care at the nearest children’s hospital with space. López spent the next three hours driving to the hospital, praying her baby would survive.
“I felt like my heart fell out of my chest. I didn’t know what was happening for three hours,” López said. “It felt like it was three days.”
More children are being treated in Texas hospitals for COVID-19 than ever before. But there’s a second factor that is putting pediatric hospitals on the path to being overwhelmed: an unseasonable outbreak of respiratory syncytial virus or RSV, a highly contagious virus that can require hospitalization mostly among children five years and younger and especially infants.
A “Dual Surge”
During the last year, RSV was largely dormant, which experts believe was due to people masking up during the pandemic. Now, in just the last several weeks, thousands of Texas children have tested positive for the virus.
In addition, the delta variant of COVID-19 appears to affect unvaccinated children more often than previous variants. It’s unclear if children are also becoming sicker from it than from other variants of COVID-19. And with the regular flu season approaching, medical experts are concerned over how hospital capacity could be affected.
Over 5,800 children in Texas were newly hospitalized with COVID-19 in the seven-day period ending on Aug. 8, according to the Centers for Disease Control and Prevention, a 37% increase from a week prior. Nationwide, nearly 94,000 children contracted COVID-19 last week, according to the American Academy of Pediatrics and the Children’s Hospital Association.
López’s daughter is doing OK now. Doctors replaced the intubation treatment with a nasal tube, her fever broke, and she was able to go home the next day. But the situation in children’s hospitals continues to worsen. In Texas, it’s getting harder and harder for those hospitals to meet the combined demand for beds for COVID-19 and RSV patients as well as children with other conditions or injuries. And physicians fear what will happen with the reopening of schools, with far fewer children masked and far more attending in person than last year.
“We’re seeing a significantly greater number of children who are being hospitalized with COVID-19. Some are requiring ICU care, more than we’ve seen with previous surges, and that’s related to the increased transmissibility of delta,” said Dr. Seth D. Kaplan, president of the Texas Pediatric Society. “This is just a more aggressive variant. It’s sickening more children and requiring more to be hospitalized. So that, on top of the RSV, is what’s really causing the capacity issues.”
“It is spreading like wildfire,” said Dr. Jim Versalovic, pathologist-in-chief and interim pediatrician-in-chief at Texas Children’s Hospital in Houston. “During the past several weeks, Texas Children’s has been escalating strategies in terms of dealing with this dual surge.”
Texas Children’s Hospital: 25 Kids Diagnosed with RSV and Covid
The hospital has extended its urgent care hours. Doctors are postponing elective surgeries that require a postoperative bed. Staff are opening new units within the hospital and working overtime to meet the demand. Within Texas Children’s, more than 45 children were hospitalized with COVID-19 on Wednesday, and hospital staff have diagnosed over 1,600 cases with RSV. Around 90% of the hospital’s COVID-19 positive patients — all children and adolescents — contracted the delta variant.
Approximately half of Texas Children’s RSV and COVID-19 patients are infants.
The influx of RSV cases during the summer came as a surprise to physicians, who normally see the spread later in the year. Versalovic said southern states are experiencing the surge of RSV, while children’s hospitals in other regions are reacting to increased hospitalizations from COVID-19.
What’s worse, Versalovic said his hospital has identified 25 children who have both RSV and COVID-19. While he’s confident that his hospital system can effectively treat these cases, it’s a new phenomenon, and doctors are unsure of what to expect. Over half of those diagnosed with both viruses have been hospitalized — a hospitalization rate much higher than for either virus alone.
“We’re certainly concerned about it … We’ve never seen this before,” Versalovic said. “We are concerned that [the double-diagnosis cases] may be more severe.”
Meanwhile, adult hospitals are facing a crisis of their own, as rising numbers of COVID-19 patients fill intensive care units across the state. Staff shortages are compounding the problem as more adults — the vast majority of them unvaccinated — are being hospitalized with the delta variant. In the most recent federal numbers reported last week, 53 hospitals in Texas had completely run out of ICU beds; the situation has likely worsened since then.
Last summer, children’s hospitals helped by taking some of the overflow of non-COVID adult patients from nearby hospitals during the worst of that stage of the pandemic. But now that children’s hospitals are facing crises as well, that will likely no longer be an option.
“We are preparing for a very challenging period in the weeks ahead, and we must anticipate, with the beginning of the school year, many more pediatric and adolescent COVID cases,” Versalovic said. “We cannot have any plans to take adult patients and offload neighboring hospitals, because we need to keep those beds reserved for the children and families we serve.”
A Harsh Start to a New School Year
The delta variant is believed to be at least twice as transmissible as previous variants of COVID-19 and has primarily ripped through unvaccinated populations. A large segment of those unvaccinated are children 12 and under who aren’t yet eligible to be vaccinated. Even among 12-to-15-year-olds in Texas, who are old enough to get the shot, less than 27% are fully vaccinated.
Versalovic said that even when the vaccines are approved for children under 12 — with best-case estimates suggesting it could be late September or early October — it would take weeks or even months for that to slow down the surge.
Parents should focus on masking their children and getting them vaccinated if they are eligible, said Kaplan, the pediatric society president. The vaccine remains the most effective defense against the virus. Even in rare breakthrough infections where vaccinated people contract COVID-19, they still are largely protected from hospitalization.
“We know that COVID-19 can be transmitted through populations of children. We know that many of them are not vaccinated, and many aren’t even eligible for vaccination,” Kaplan said. “Anyone who has not been fully vaccinated should be wearing a mask when they’re in an indoor public setting and social-distancing themselves.”
Dr. Mary Suzanne Whitworth, director of pediatric infectious diseases at Cook Children’s hospital in Fort Worth, said her facility has seen sharp upticks in RSV and COVID-19 as well. Cook has seen around 200 cases of RSV each week for the last month.
“I think that really everyone, nationally, was surprised at how much RSV happened this summer. It’s the first time it’s ever happened like this,” she said.
Although earlier in the pandemic, some thought children were less likely to catch COVID-19, Whitworth says parents need to keep their guard up with the emergence of the delta variant. On Tuesday, there were two dozen children hospitalized with COVID-19 in Cook Children’s, according to data from the hospital.
“Children do have some risk of severe disease,” she said. “Children, in general, do pretty well with COVID — but there are plenty of children who do not. And you never know who will or not.”