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D.C.-area children’s hospitals are at capacity

The Washington Post 10/20/2022 Jenna Portnoy
Johns Hopkins Hospital is warning people with CareFirst BlueCross BlueShield that it may no longer accept their insurance starting as early as Dec. 5. © Rob Carr/Getty Images Johns Hopkins Hospital is warning people with CareFirst BlueCross BlueShield that it may no longer accept their insurance starting as early as Dec. 5.

Children’s hospitals in the D.C. area have been full for weeks, with patients stacking up in emergency departments as a surge in respiratory illnesses exacerbates the strain of staff shortages and a dwindling supply of pediatric beds.

Children’s National Hospital in Northwest D.C., as well as the children’s hospitals at Inova Fairfax in Northern Virginia and the Johns Hopkins Hospital in Baltimore, which represent a total of more than 650 beds, are at capacity, physicians at the hospitals said this week.

Pediatricians locally and nationally report a spike in cases of respiratory illnesses such as RSV and rhinovirus — the common cold virus — which for the second consecutive year have hit earlier and made kids sicker than usual. At the same time, the coronavirus continues to circulate, and hospitals are bracing for a severe flu season.

“We are treating a very high number of severely ill children,” said Sarah Combs, an emergency medicine physician at Children’s National.

At one point on Tuesday, 18 children were waiting for a pediatric intensive care unit, or PICU, bed at Children’s National, which has 323 inpatient beds and primarily serves the greater Washington area. The system remotely cares for children farther away, in Virginia and Maryland as well as Pennsylvania and Delaware. Even as they detailed the crunch, officials stressed that hospitals’ inpatient, intensive care and emergency departments remain open and that children in need of care will never be turned away.

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Experts speculate that effects of pandemic shutdowns two years ago, when precautions were in full swing, may mean that children’s immune systems got a break and weren’t ready to fight illnesses this year. Even without the pandemic, they say, some viruses are particularly virulent some years.

When inpatient beds are full, children who come to a hospital via the emergency department and are sick enough to be admitted have nowhere to go and must stay in the emergency room until a bed opens or they improve enough to go home. The situation is especially serious when a child needs intensive care.

Sofia Teferi, a pediatrician at MedStar Montgomery Medical Center, said Wednesday she was treating a 4-month-old in the emergency department because she could not find the patient an intensive care bed in the region.

“The fact that you have to look at the parent and say your kid needs ICU-level care but we have no bed for them: That’s a very hard conversation to have,” she said. “I’m just floored by the whole thing — in the nation’s capital.”

The situation is not unique to the D.C. metropolitan area. At the height of the pandemic, in many cases, hospitals converted pediatric beds to treat adults and never switched them back. Henrico Doctors’ Hospital in Richmond closed pediatric inpatient and PICU beds this spring, citing too few patients. The problem predates covid. MedStar Franklin Square Medical Center closed its inpatient pediatric unit in 2018 for the same reason.

Eric Biondi, chief of pediatric hospital medicine at Johns Hopkins Children’s Center, said the hospital’s 80 pediatric acute-care beds, 20 oncology beds and approximately 28 PICU beds are “completely full.” The hospital reached this point a few times over the pandemic, he said, but this time is different because covid is not the driver.

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“It’s not just a problem of how busy we are at Hopkins, which we are, but it flows out to the remote community emergency rooms that have to move kids,” he said.

Joanna Fazio, vice president for the Pediatric Service Line at Inova, said Inova L.J. Murphy Children’s Hospital is also operating at or beyond capacity at times. Clinicians reported less of the usual lag in illness they typically see in the summer; instead, illnesses began to build in August and September and haven’t let up.

Of the hospital’s 226 pediatric beds, about half are for newborn intensive care and 26 are pediatric intensive care unit beds, she said. On Tuesday, the PICU was on what Fazio called “capacity alert,” or full, meaning doctors seeking to transfer sick kids had to keep searching for a bed.

“We have every strategy in place to try to expand capacity where we can,” she said.

Fazio sees no end in sight. “We’re preparing for it to last through flu season because we know what our disease patterns are. Our predictions are only as good as the next day,” she said.

It’s a fact of emergency medicine that non-urgent cases will present in the emergency room, but given that volumes are higher overall, Johns Hopkins Children’s Center reopened its covid tent to see lower-acuity non-covid patients, and L.J. Murphy Children’s is looking at ways to repurpose spaces. Doctors ask parents to consider calling their pediatricians or visiting urgent care if their child does not need acute intervention. Many have guidelines to help parents decide what to do.

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Combs, of Children’s National, acknowledged that parents are under a lot of pressure coming out of the worst of the pandemic, but she stressed the importance of getting themselves and their children vaccinated for the coronavirus and the flu.

She added that two years ago, covid-prevention measures, such as wearing masks, social distancing, hand-washing and avoiding large gatherings, resulted in very little RSV, flu and rhinovirus — lessons that parents can apply even as new coronavirus infections wane.

“In order to give both a sprout of hope and also some micro sense of control of, ‘Well, what can I do other than panic?’ ” she said. “Go back to basics, do what you’ve been doing over the past couple of years of pandemic: Get your immunizations … and just do your best.”

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