With the holiday season now in the books, doctors, other healthcare workers, and hospitals are facing a so-called “tripledemic” of contagious, respiratory viruses.
“Tripledemic” or “tridemic” refers to COVID-19, influenza, and RSV (respiratory syncytial virus). RSV is a common respiratory bug, which usually causes mild, cold-like symptoms.
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Young children and older adults, especially those with certain underlying health conditions, are at higher risk for severe illness from RSV.
“And it's not a new virus," said Dr. Jason Foland, chief pediatrician at Ascension Children’s Hospital. "It's been around for really quite as long as medicine is known about viruses and looked into this with a reason for causing diseases."
Foland adds that young kids have the most trouble coping with RSV because of how the virus affects their breathing.
“Because children are smaller," he said. "Instead of kind of breathing through a garden hose like you and I are, children are effectively breathing through a straw. And when that straw gets inflamed with RSV, it makes it even more difficult to breathe. Much like sipping coffee through a coffee stirrer.”
RSV symptoms are what Foland calls “age-dependent.” He points to, as an example, a kid over three years of age.
“Most of those children have runny nose," he explained. "Some will have fever and they have earache. As the nose gets inflamed, the passages to the ears don't drain very well. And when you get into that three months to three year age group, that's when kids can start to have difficulty breathing.”
Under three months, infants get a fever from RSV, may not eat or drink well, and may not be as awake or conscious as an older child. Foland says newborns are a completely different matter, thanks to a unique susceptibility to RSV called apnea.
“It affects their ability to breathe, not just in the lungs, but in the brain itself," he said "So they'll just stop breathing; their brain will forget to tell them to breathe. That is something to be concerned about. So, if you see your baby not breathing for 20 seconds or more, that's a problem [and] you need to call 911.”
Dr. George Smith, Chief Medical Officer atCommunity Health Northwest Florida in Pensacola, which serves the area’s low-income and much of the communities of color, says the clinic is seeing more flu and COVID patients than RSV.
The clinic introduced measures to help their patients protect themselves against all three viruses. The reaction has been driven in large part by age.
“Our older patients did. Well, most of them,” Smith said. “They lined up and were first in line for vaccines. But the younger folks had lots of conspiracy theories that they felt they were chicks in the vaccine or they're just not going to introduce anything in their body.”
That said, Smith added that the vaccines have not necessarily proved to be the end-all be-all of treatments.
“The vaccines have not necessarily prevented patients from getting COVID,” he said. “It certainly prevented hospitalization and maybe death. So, we still are seeing COVID. It always pops up, now on an uptick in the community.”
And as with other healthcare facilities, Community Health is wrestling with both financial and personnel challenges brought about by the tripledemic. But Smith says all told, they’re managing well.
“In terms of staffing, sometimes when COVID is high in the community, we tend to have more staff that's out,” said Smith. “The feds and the state have been pretty good in keeping us supplied with vaccines, with testing kits. We had some additional funding which was distributed to all the federally qualified health centers.”
On the subject of money, hospitals are also businesses with their own bottom lines to consider, whether they’re for-profit or non-profit, such as Baptist Health Care.
“We're under 20 right now that are positive for COVID. And that's been a number that's been consistent over the last week,” said Mark Faulkner, Baptist president and CEO. “Higher than it was two weeks ago, but not increasing. In fact, it seems to be plateauing.”
Faulkner says from a patient volume standpoint, the viruses have provided a busy time for them in treating patients with COVID or the flu. RSV is not an issue, because Baptist doesn’t handle in-patient pediatrics, except for behavioral health.
“We certainly have seen quite a bit of volume, and that keeps the place busy,” Faulkner said. “And it often creates challenges with moving patients through the system, being admitted, cared for, being discharged. And when those links of stay get extended, it causes challenges in terms of an overall patient care delivery standpoint.”
Baptist has been working with another major issue — construction of the new hospital at I-110 and Brent Lane, which is scheduled to open in September. Faulkner says the new facility will have the know-how to tackle current and future pandemics, such as creating “negative air flow” to help control the airborne viruses.
“We've got the ability to create units and floors that have negative airflow, as opposed to having to create those room by room,” he said. “That's one example. Ninety percent of the equipment at the new campus will be new, cutting-edge technology, much of which has been adapted coming out of the pandemic.”
One of the gauntlets thrown down before Baptist — and health care entities across Florida and the U.S. — is how their workforce has borne much of the brunt of treating the viruses. Faulkner says part of that is one out of four nurses in Florida left the vocation last year. Work is underway, he adds to fight fatigue and burnout.
“Staffing with extra shifts and creating extra incentives for that,” Faulkner said. “We've sort of tapered off the need for travel nurses that we saw over the last six months or a year, and we're in a much better position today. Although the problem is not completely solved, we still are seeing some of that, especially these high volume spikes. It's not over, but we're certainly responding.”
But Faulkner concedes that there has been a shortage of registered nurses, which the pandemic has exacerbated. Hospitals in particular, and the health care industry in general, are encouraging people to consider such a career, to help avoid similar workforce shortages in the future — pandemic or not.