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Inpatient occupancy rates at the Children’s Hospital of Philadelphia are soaring with sickness and behavioral related cases.

Credit: Serena Jankovic

After long pandemic isolation periods, weak immune systems and the spread of non-COVID-19 viruses among kids are causing inpatient occupancy rates to soar at the Children’s Hospital of Philadelphia — reaching near or above capacity.

Despite only one percent of all inpatients testing positive for COVID-19 in early October, which amounted to six total inpatients, CHOP’s Chief Medical Officer Ron Keren said the increased occupancy rates are a result of a surge in the transmission of non-COVID-19 respiratory viruses and behavioral health issues worsened by pandemic stress. 

CHOP is not alone in its struggle: children’s hospital occupancy rates have been on the rise across the United States. The main virus causing this surge is respiratory syncytial virus, a respiratory virus that typically only causes minor cold-like symptoms, according to the Centers for Disease Control and Prevention.

Some cities, like Chicago, with high vaccination rates, have experienced a similar problem of heightened RSV transmission. More than 73% of Chicago residents over 12 are vaccinated, while more than 65% of all eligible Philadelphians ages 12 and older are fully vaccinated. The Delta variant has also taken a direct toll on children’s hospitals in COVID-19 hotspots, which are now experiencing a surge in cases that began to develop over the summer, in the wake of loosened pandemic restrictions. 

To address the issue, Keren said CHOP increased its capacity in recent weeks to 585 inpatient beds, an increase of about 14 beds. However, Keren said that even with this move and other changes, the facility has been forced to rearrange inpatient room assignments.

“We were frequently having more kids needing beds than we actually have beds to offer, and we're having to spill those kids over into other sites within the hospital, using treatment rooms, and having to double up kids in rooms where we usually try to avoid it,” Keren said. “The last couple months have been really challenging.”

CHOP spokesperson Kaila Revello said nobody else was available to comment on the hospital’s recent inpatient surge.

Keren said that because of pandemic precautions and isolation, many kids have not been sick since the start of the pandemic, and infants haven’t encountered viruses at all, making their immune systems more vulnerable — a phenomenon Keren called “immunity debt.” 

He added that infants and kids with chronic medical conditions have been the bulk of CHOP's RSV cases.

“Normally, my kids when they were infants and toddlers, they were in daycare. They built up their immunity by the time they were one, two years old,” Keren said. “So you have kids whose immune systems are completely naive, and you have kids who may have seen viruses in the past but they've gone the last two years with hardly any … The thought is that the kids are just more vulnerable right now.”

In the early months of the pandemic when stay-at-home orders were enacted across the U.S., Keren said the only virus circulating was COVID-19, which did not dramatically affect kids. But the surge in other respiratory diseases that began in July has continued into the fall season, Keren said, which is now the leading cause of higher inpatient volumes.

An additional problem CHOP has been seeing with patients is the psychological impact of the pandemic and related isolation, Keren said, which has led kids to spend more time online and on social media — leading to more suicidal ideation.  

“We've seen a lot of kids presenting with suicidal ideation, or even suicide attempts, and we ended up hospitalizing them. We have to hold on to them until we can find an inpatient psychiatric facility that can take them,” Keren said.

Of the 585 inpatient beds, 15 to 30 beds in early October were occupied by children with behavioral health issues — even though Karen said CHOP is typically not an inpatient psychiatric facility. 

In response to the high inpatient volumes and in anticipation of flu season, Keren said that CHOP is focusing on hiring more doctors and physicians, as well as specialists, front desk workers, and other staff members. This has been especially challenging, he added, because of the health care labor shortage in the United States, which likely is a direct result of the pandemic, according to the American Hospital Organization. 

Recent studies shows the U.S. will experience a shortage of up to 122,000 physicians by 2032. A recent Morning Consult poll reported that 79% of health care professionals said the worker shortage has affected them and their place of work, with 18% of health care workers having left their professions during the pandemic.

“Health care workers are really exhausted from what's happened during the pandemic, and many have left for other professions,” Keren said. “We haven't had as much of that in pediatrics because COVID-19 didn't affect kids the same way as it did adults, but we've definitely had some attrition, and so we're in a hiring mode to make sure we're fully staffed,” he said.

Keren said CHOP will open a new hospital facility with 52 beds in King of Prussia that will ensure sufficient space to support the increase in patients.

With flu season approaching, Keren added that he hopes the circulation of RSV and similar viruses this winter may be less severe than usual since many children have already been infected with those viruses. 

Keren still worries that isolation has caused “one and a half flu seasons with very little flu,” amplifying the immunity debt phenomenon and causing the volume of inpatients to rise. He advised parents to make sure their kids get their flu shots, specifying that all children over the age of six months are eligible to get the shot and those who have never gotten it before need two shots. 

“I'm worried that if we have 50% more kids who are vulnerable than we did in previous years, that the number of kids we're going to see hospitalized will be 50% higher, which is a really big number,” Keren said.