'Tridemic' Surge Strains ERs, Some Ambulances Told To Limit Services

CALIFORNIA — Colliding with the season of family gatherings, work parties and travel, spiking cases of RSV, COVID-19 and influenza are straining emergency rooms all over California.

It appears that the "tripledemic" or "tridemic," an alarming phenomenon experts have been warning of, has hit children's hospitals hard in California.

"R.S.V. has just surged: We keep thinking it’s peaked, but then it keeps on going up," Dr. Tami Hendriksz, a pediatrician and the dean of Touro University’s College of Osteopathic Medicine in Vallejo, told the New York Times this week. "We still haven’t seen the top of this peak yet."

In Central California, a major surge in patients suffering from the three circulating viruses has forced hospitals to limit emergency medical services, ABC30 reported.

Across Fresno, Kings, Madera and Tulare counties, an "assess and refer" policy was triggered. Counties are urging residents to avoid calling an ambulance or going to the emergency room unless they are experiencing a life or limb-threatening emergency. If a call is made, first responders will have the authority to decide whether a patient is transported.

On Wednesday, 125 patients were admitted to the ER at Community Regional Medical Center in downtown Fresno, ABC30 reported.

"What we're seeing across the four counties, most of the hospitals are working at disaster levels with very high capacity issues within their facilities," Fresno County EMS Director Dan Lynch said.

What's more, the Orange County Board of Supervisors Tuesday voted to extend its emergency declaration to help the Children's Hospital of Orange County cope with an ongoing flood of young patients afflicted with upper respiratory viruses.

The children's hospital is so packed that hospital staff are setting up beds wherever there is space, CHOC's chief medical officer, Dr. Sandip Godambe told the board. Hospital beds are being set up in discharge lounges, an oncology playroom gym and surgical playrooms, he said.

"Every children’s hospital that I’m aware of is absolutely swamped," Dr. Coleen Cunningham, the pediatrician in chief at Children’s Hospital of Orange County, told the New York Times. “This is our March 2020."

The average number of visits in the emergency room during the RSV wave is 410 with a high of 489 — double the usual, Godambe said.

READ MORE: OC Extends RSV Health Emergency As Cases Rise In Children

To date, two children under 5 years old have died from RSV in California. The state's second pediatric RSV death of the season occurred in Riverside County, according to the county's health department.

The child, under 4 years old, died after a short illness, according to health officials. The death came in late November as hospitals around the state started to see twice as many patients with cold and flu symptoms than is typical this time of year.

"This tragic event serves as a stark reminder that respiratory viruses can be deadly, especially in very young children and infants," State Public Health Officer and California Department of Public Health Director Dr. Tomás Aragón said in a statement. "We are entering a busy winter virus season — with RSV, flu and COVID-19 spreading — and urge parents and guardians to vaccinate their children as soon as possible against flu and COVID-19."

READ MORE: 2 Children Under 5 Die From RSV As Severe Cold And Flu Season Slams CA

RSV detections declined nationally during the week ending Saturday, after sharp rises since mid-October, according to the Centers for Disease Control and Prevention. At the same time, seasonal influenza cases are ticking up in all but a handful of states, and COVID-19 cases, hospitalizations and deaths are all trending upward as well.

In all, children’s hospitals across the country are seeing a surge of sick kids.

In California, hospital bed occupancy was running at nearly 83 percent full-capacity as of Thursday, according to the Department of Health and Human Services data. The tracker is updated daily at 1 p.m. EST.

Nationally, the most overwhelmed states are Idaho at 104 percent, Arizona at 98 percent, Utah at 97 percent, Nevada at 96 percent, Rhode Island at 93 percent and Kentucky at 91 percent.

Overall, U.S. hospitals beds are at about 83 percent capacity, with 7.5 percent used by COVID-19 patients, according to HHS data.

No Health Emergency Yet

Last month, pediatricians asked the Biden administration to declare a public health emergency that would give hospitals and providers more flexibility to care for children.

In their joint letter to President Joe Biden and Health and Human Services Secretary Xavier Becerra, the Children's Hospital Association and American Academy of Pediatrics said “significant capacity issues in pediatric hospitals and communities require flexibilities that can only be provided through a formal emergency declaration.

The flexibilities were provided to care providers at the height of the coronavirus pandemic, and “children’s providers require the same capacity support as they strive to keep up with increasing needs of infants, children and adolescents.”

As of Thursday, the Department of Health and Human Services had not declared the health emergency. It would allow for the waiver of certain Medicare, Medicaid or Children’s Health Insurance Program requirements that would allow hospitals, physicians, and other health care providers to share resources and access emergency funding to keep up with the growing demands, specifically related to workforce support.

The reason for the so-called “tripledemic” threat? Months of hunkering down and avoiding contact with others during the COVID-19 pandemic weakened Americans’ immune systems, according to health experts.

“Public health officials have been bracing for this possibility since early in the pandemic,” Dr. Michael Mina, chief science officer at eMed and one of the nation’s leading epidemiologists, said in a statement to CBS MoneyWatch.

“The recent surges are fully expected ramifications of a new virus that caused massive swings in human behavior,” Mina said. “We know that immunity is working exactly as it was supposed to, and in this case, it means that we drained population-level immunity by not having exposures.”

Most children get an RSV infection by the time they’re 2, but people can be infected at any age and more than once in a lifetime, according to the CDC. The symptoms are typically similar to the common cold. But for the extremely young whose lungs aren’t fully developed, the very old and people whose immune systems are compromised, RSV can lead to breathing difficulties.

“Right now, the problem really is just the volume of sick children, Dr. Thomas Murray, a pediatric infectious diseases physician at Yale Medicine, said in a news release, “but we know how to help them.”