The Imperfect Storm
When it rains it pours! We have been hit by what Dr. Fauci calls the “negative trifecta” – RSV, Flu, and COVID – on top of all the “common colds” of fall and winter. If you have paid any attention to recent news, you have likely heard that the national pediatric medical infrastructure is being overwhelmed. Locally, we are hearing that urgent care wait times are running 3-4 hours and emergency room wait times are 6-8 hours. Hospitals are running above capacity. Our colleagues at other medical practices are sharing our challenges as we work to manage this deluge, resulting in longer than typical triage call back times and not enough “sick visit” appointments availability.
I know this is not comforting to you! But, we are writing this to help you understand what we are facing and what you can do (adapted from HealthyChildren.org 2022).
COVID-19
COVID-19 symptoms include fever, cough, fatigue, congestion, shortness of breath, sore throat, headache, sneezing, vomiting/diarrhea, or loss of taste/smell. COVID-19 symptoms can appear 2-14 days after infection. Although children have been mostly spared the serious effects of COVID-19, it is spread incredibly easily. The CDC is predicting new variants and another “surge” this winter. If you have not already, consider getting your child vaccinated. Although only a small percentage of children experience illness serious enough to be hospitalized from COVID-19, the absolute numbers are still very high. The vaccine WILL NOT necessarily prevent your child from getting COVID-19, but it has been shown to help your child from being one of those unfortunate ones that become very sick. Your child can receive the vaccine during their already scheduled well visit, or you can contact our office to make a vaccine appointment.
The Flu
Flu symptoms include high fever, cough, fatigue, stuffy nose, shortness of breath, sore throat, achiness, and headache. Symptoms show up about 1-4 days after being exposed to a sick person. The infection can cause pneumonia. Unlike COVID, the younger the child, the more vulnerable. GET THE VACCINE! Appointments can be self-scheduled on our website, or the vaccine can be administered during your child’s already scheduled well visit. 2020-2021 were lighter years for Flu related morbidity, but in 2019, 434 pediatric deaths were attributed to the Flu and the number of hospitalizations was in the tens of thousands. We anticipate a very rough 2022-2023 Flu season due to reported strains, widespread unmasking, much more congregating, and lack of developed immunity during the recent “COVID years”. Like the COVID vaccine, the Flu vaccine will not necessarily prevent your child from getting the Flu, but it has been shown to lead to a milder course. We do not routinely test children for Flu unless a child has certain risk factors for serious illness or is in contact with a very vulnerable person. Similarly, we do not believe that Tamiflu’s benefits outweigh harm, typically nausea, unless a child is at risk for serious Flu related illness.
RSV
RSV usually presents as a simple cold with fever, cough, fatigue, stuffy nose, shortness of breath, and sneezing. It is a very regular source for “common colds” and most children – and adult – have mild illness. Testing for RSV typically only happens in hospitals, where knowing the cause for serious illness is necessary. Usually, serious illness is only seen in infants less than one year of age, where RSV can cause fast/short breaths, flaring nostrils, wheezing and grunting, poor feeding/no appetite, and head bobbing or chest caving in between and under ribs with each breath. Symptoms of RSV usually are worst on days 3-5 and last about 5-7 days, but lingering symptoms can last for weeks. Unfortunately, there is no vaccine, and we have no good therapeutics. If your child is feeding well and not showing the “work of breathing” described above, typical “cold care” – including suctioning, Tylenol, using a humidifier – is all you need to do.
Common Colds
How can we forget? – Symptoms may include fever, cough, fatigue, stuffy nose, sore throat, and sneezing. Colds are upper respiratory infections caused by many viruses. Common cold viruses include rhinovirus, adenovirus, human coronavirus, human parainfluenza virus, human metapneumovirus and, lest we forget, RSV. Healthy children get about 6 colds a year. Infants and toddlers may get far more – each lasting a few week – such that they seem sick for months at a time. Like with RSV, as long as they are eating well and not “working hard to breathe”, typical “cold care” is all they need. In the office, we have no “special magic” to make it go away quicker.
What Can Parents and Caregivers Do?
Be prepared. Center City Pediatrics, like pediatric facilities everywhere, is being overwhelmed with calls and requests for visits. We care about your children, and we are working overtime, however, call back times will be longer. We must first call back the patients who describe the most serious symptoms. Appointment availability is tight. While we are actively hiring new providers and other staff, we face the same challenges as service sectors nationwide. Whenever possible, use our vast online medical library and our own provider authored blogs to support your non-urgent needs.
Get vaccinated! We have Flu vaccines for all children over 6 months of age and COVID vaccines, including the Bivalent boosters, for all approved ages. To reiterate, although the vaccines may not prevent infection entirely, they have been clearly shown to lessen severity of the illness.
Know the signs of more serious illness. Check out our own Wait – Worry – Panic chart for common symptoms and how best to react.
Stay calm. Thankfully kids are much more resilient than adults! Most of the illnesses they are contracting now are a normal part of childhood and serve to “condition” their bodies to handle more annoying germs in the future. We know this is hard to remember when your child’s poor sleep leads to your poor sleep and their fussiness makes you fussy. We really do “feel your pain”, both as parents and medical professionals, but we are confident we will get through this together and will be able to continue to enjoy many more years of health and happiness with our precious little, and not so little, ones.
In health,
The Center City Pediatrics Team
