Children sick with COVID and other bugs flooded hospitals in the fall. Doctors worry what winter will bring.

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Nurse Kristen Brown cares for 6-year-old Jaxon Philiph, of Cedar Rapids. Jaxon was in the PICU after contracting COVID-19.

IOWA CITY, Iowa – It feels like winter came five months early to the University of Iowa's Stead Family Children’s Hospital, and the staff fears darker times could be coming soon.

The 190-bed facility is about two-thirds full during a typical fall. This year, it has been jammed with young patients since July.

Dozens have come in coughing, wheezing and feverish with COVID-19, which is sickening more kids than it did in the pandemic’s early months. Many more young patients have arrived with severe infections from other respiratory viruses, which normally do not strike in full force until late autumn or early winter.

Flu season is coming up, and no one is counting on a repeat of last winter’s reprieve from that annual scourge.

Jennifer Erdahl, nurse manager of the pediatric intensive care unit, said her staff is bracing for the current surge of young patients to continue deep into the winter. “It feels daunting and a little overwhelming that we're two months into it and we're still very busy — and we think we have months more to go.”

Jody Feipel, a nurse at the University of Iowa Stead Family Children’s Hospital, talks with 10-year-old COVID Beau Harvey, who was admitted to the pediatric intensive care unit.

Jason Carberry holds his son Rohen as he coughs and fusses in the pediatric intensive care unit. Rohen was hospitalized with RSV.

Early in the pandemic, she said, many of the children who were listed as hospitalized with COVID had come in to be treated for something else and happened to test positive for the coronavirus when they were admitted.

“That's not the case anymore,” she said. “We have completely healthy children who are not eligible for vaccination yet, getting COVID and being very sick here in the ICU. I think a lot of the population doesn't realize those things are happening.”

The 28-bed unit cares for many of Iowa’s sickest kids. During a normal autumn, it averages nine empty beds per day, but it has often been full lately. “It has been extremely stressful and emotionally taxing for all of us,” said Dr. Aditya Badheka, the unit's medical director.

The packed ward is familiar to many hospitals contending with a crush of young patients as the coronavirus and other bugs surged in late summer and early fall.

Iowa's largest children's hospital has allowed few outsiders to visit during the pandemic. Its leaders invited a USA TODAY team into the pediatric intensive care unit in early October to document how its staffers cope with the startling wave of young patients.

The children’s hospital, which moved to a new building in 2017, is designed to keep bustle behind the scenes. The intensive care unit's halls and nurse stations remain quiet, except for frequent beeps and tones alerting staff to possible problems.

Tubes and wires connect sick kids to machines that monitor their conditions and provide them with oxygen, medicine and food.

Patient rooms are fronted by glass walls and doors, which are kept closed when the rooms contain infectious disease cases. Doctors and nurses put on fresh gowns, goggles, gloves and face masks before entering those rooms. When they're done visiting a patient, they take the protective garb off and discard it, only to suit up again outside the next door.

Every morning, doctors, nurses, medical residents and other staffers gather in the hall outside each room to go over how the child is faring and what treatment is needed. A dozen or more people can be involved in each consultation, and the patients’ parents are invited to listen in and ask questions.

As soon as a child is released from the intensive care unit, housekeepers go in to clean. They can turn some rooms around in a half-hour or less, but it can take an hour-and-a-half to sanitize a room where a COVID-19 patient stayed. There is no time to waste, because another sick child probably will need the room as soon as it’s available.

Dr. Christopher Monson wears PPE as he resets a monitor to prepare for a COVID patient coming to the PICU at the University of Iowa Stead Children’s Hospital.

A rebound of infections

Many Americans hoped stories of packed hospitals would fade as the pandemic waned in early summer. The introduction of vaccines for adults was followed by plummeting case rates and soaring optimism. The late summer surge deflated such hopes.

Melanie Wellington, an epidemiologist for the hospital, said she expected COVID-19 and other respiratory ailments to rebound as the weather got colder, but she didn’t foresee the diseases spiking again so quickly.

Wellington blames the COVID-19 wave on the delta variant of the coronavirus and on the disappointing number of Americans who declined to be vaccinated. “When delta came along with increased transmissibility, we still had enough people who were vulnerable to infections that we’re seeing these very high case counts now,” she said.

Those cases include many more children than were infected in previous waves, she said. The official COVID-19 patient numbers don't include some patients who no longer test positive for the coronavirus but who struggle with the aftereffects of the disease, which can include inflammation of the heart and lungs.

The delta variant does not appear to be more dangerous to individual children, Wellington said, but kids are more likely to be infected because they’re out in the community and in school, mixing with people who might spread the virus. Kids younger than 12 aren’t eligible for vaccination, so they’re vulnerable.

Wellington acknowledged that most children infected with the coronavirus suffer few serious symptoms, but she said problems become more numerous as case counts climb. “Any time you have a group of people being infected, some portion of them are going to end up with severe disease,” she said.

A mother’s plea for public caution

Nearly 100 children have been hospitalized for COVID-19 at the University of Iowa Hospitals this year.

Beau Harvey is among them.

The 10-year-old from the northeast Iowa town of Independence is an energetic, vigorous kid, but he was born with heart malformations that required surgery. The family knew his condition made him susceptible to dangerous complications if he caught COVID-19.

Beau made it 19 months into the pandemic without being infected. He almost reached the day when children his age will be eligible for Pfizer-BioNTech COVID-19 shots, likely to happen this fall. His parents plan to have him vaccinated as soon as possible.

Then the delta variant ripped through Iowa as public precautions were relaxed. Masks were no longer required in his school, and kids exposed to the virus no longer had to stay home from classes.

First, one of Beau's sisters tested positive for the coronavirus. Then, on Oct. 4, he woke up with a sore throat. By that afternoon, he had a small fever. An at-home test showed he had the virus. Within two days, he was having trouble breathing.

His mother, Kelsey Harvey, asked Beau’s doctor if she should take him to the emergency room. No, the doctor said. Because of Beau’s underlying health issues, he advised her to take Beau straight to the University of Iowa Hospitals, 65 miles to the south.

That’s what she did.

The next evening, she sat by her son’s bedside.

“It’s hard, because he’s not comfortable. He’s sick, and he doesn’t want to be here,” she said. He’d been hospitalized before, but this time felt tougher. Pandemic-era visitor limits meant no other family members were around for moral support.

Beau, dressed in a gray baseball T-shirt, slept fitfully. He moaned and coughed underneath a clear plastic face mask, through which a hissing hose pushed oxygen to his mouth and nose.

Harvey said her son's infection shows why everyone should try to limit the spread. You can’t easily tell who might be susceptible to COVID-19 complications because they have a condition like Beau’s heart issue.

“He’s just like everybody else,” she said. “He can run around and play. He can play baseball. He can do all the things that other kids can, but he just takes five medications a day, and he has extra appointments.”

Harvey cried as she talked about lackadaisical public attitudes that allow the virus to run rampant, until it catches up with children such as her son. She’s stunned at how unwilling many people are to do their part. “It’s easy. Just wear a mask, try to stay away from people. Try. Just do small things,” she said, her voice cracking. “Just try a little bit.”

She noted how skeptics discount the seriousness of the situation, since the majority of people who catch COVID-19 survive. It feels like they don’t care about the minority who might die or suffer lasting symptoms, Harvey said. “If it doesn’t affect them directly, they’re not worried, you know what I mean?”

Her son would wind up spending more than a week in the hospital before being released to recover at home.

RSV adds to crush of patients

The other main respiratory bug filling pediatric hospital wards this year is RSV, respiratory syncytial virus. RSV usually causes mild cold symptoms, but it can bring on dangerous breathing problems in infants and toddlers, especially if they have underlying health conditions. Scientists have not perfected a vaccine against it.

In severe cases, kids with RSV wind up in hospitals, where they are put on oxygen lines or even ventilators. The Centers for Disease Control and Prevention estimates 58,000 American children are hospitalized for RSV in a typical year.

This is not a typical year. Hospitals have reported unusual numbers of RSV patients during the summer and fall.

Dr. Cody Tigges discusses the care plan for Rohen Carberry with his father Jason Carberry. Rohen, who was born with Down Syndrome, was hospitalized with RSV.

Wellington, the epidemiologist, said the Stead Family Children's Hospital recorded 596 positive RSV tests from July through September, compared with zero and 10 during the same months in 2020 and 2019. She cautioned that health care providers may test more often for RSV this year, and the total could include children who were tested multiple times. But she said the figures reflect the current wave's sweep.

Wellington said RSV may be spiking because the virus was stymied earlier in the pandemic, when more people stayed home, wore masks and kept their distance from others in public. RSV and other viruses are roaring back, and there’s no sign they’ll let up before flu season threatens to add another wave of patients to the mix.

The spread could be especially bad if parents let children with symptoms continue normal activities, Wellington said. “If your kid has a head cold or is sick, don't take them out. Don't send them to school. Don't send them to the birthday party that they're desperate to go to. Don't take them shopping,” she said. “If a kid is sick, they should be at home.”

Hospital leaders have contingency plans to add beds if the crush worsens. The biggest challenge would be finding more staffers to care for the additional patients.

Like hospitals everywhere, the University of Iowa Hospitals struggle to hire and retain enough workers, from nurses and respiratory therapists to housekeepers and food-preparation workers.

The Stead Family Children’s Hospital, which has about 1,000 total employees, had 58 open nurse positions in mid-October, said Pam Johnson-Carlson, the facility's chief administrative officer. Because of short staffing, many nurses and other workers volunteered to take overtime shifts. Some postponed vacations. The hospital fills some shifts with temporary “travel nurses,” employed via national agencies, who cost about 50% extra per hour.

“This team has pulled together for what our patients currently need and what the team needs for support. So it’s tight, but they’re bonded together to help each other out,” Johnson-Carlson said. “How long they can continue to do this is another question.”

Nurse Mackenzie Riordan and Mike MacCormick an ECMO specialist help 6-month-old Evrett Sheffield, after a mechanical valve was placed in his heart. Evrett ‘s mother, Abby, created an Facebook group called “Evretts fight with Truncus Arteriosus!” to help raise awareness about his condition and long-term PICU stays. Evrett passed away Oct. 15, 2021.

‘It was ghostly for a while’

In the early months of the pandemic, the children’s hospital saw fewer patients than usual.

The original version of the coronavirus caused relatively few severe illnesses among children. Many surgeries were postponed, and the flu and other infectious diseases were reined in when schools were closed and many Americans stayed home or wore masks when they went out. By early summer 2021, it seemed like the crisis was fading.

“It was ghostly for a while,” said Kayla Kenady, a nurse in the pediatric intensive care unit. “Obviously, now those tables are turned.”

The influx of patients shows no sign of letting up, she said. “It is nerve-wracking to anybody to think about what the winter might look like.”

Nursing in a pediatric intensive care unit is always stressful, because the young patients are so fragile, Kenady said. Some patients stay for several weeks or even months, and nurses spend hour after hour with the children and their families. They come to know each other on a deep level.

As she spoke, an eight-person team walked past, wheeling a hospital bed containing a baby hooked up to an ECMO machine, which takes over lung functions.

Kenady, who has worked in the unit two years, is used to such scenes. She has seen many amazing recoveries but also tragedies.

At first, she found it hard to accept when children in her care died. She said she can’t talk much about it to her outside friends, because doing so would violate patient confidentiality. So she journals about her experiences and finds comfort in her Lutheran faith.

“I believe there is a God. I believe there is an afterlife,” she said. “I believe there is a good place that they go to.”

One of Kenady's colleagues in the pediatric intensive care unit has firsthand experience with the stress patients' families face. Veteran nurse Mike MacCormick lost his daughter, Gabriella, to COVID-19 last January.

Evrett was born with Truncus Arteriosus, a congenital heart defect where the blood vessel coming out of the heart fails to separate.

Veteran nurse Mike MacCormick builds an ECMO pump for 6-month-old Evrett Sheffield. MacCormick lost his daughter, Gabriella, to COVID-19.

Gabriella was 24 and had developmental delays. She lived in a group home in Illinois when she caught the coronavirus in November 2020. The family had her transferred to the University of Iowa Hospitals, where she was placed on an ECMO machine.

The machines have been lifesavers for many COVID-19 patients. But Gabriella died Jan. 2.

MacCormick has worked 13 years in the pediatric intensive care unit and helps run ECMO machines on the adult side of the hospital. He took several weeks off work after his daughter died, but he never considered quitting and looking for another profession.

He often thinks of Gabriella as he helps try to save others, including from the disease that took her life.

“These people are sick, and I need to take care of them. That's what I do. It's what I'm supposed to do,” he said. “I love this job. Being a PICU nurse, coming to this unit every day, is one of my greatest joys.”

This article originally appeared on USA TODAY: Kids with COVID, RSV flooded hospitals. Why doctors worry about winter

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