11/22/22 Health Advisory: Pediatric respiratory illness increasing in Western Washington

On Nov. 18, Washington State Department of Health (DOH) issued a high-level alert on a surge in respiratory syncytial virus (RSV) causing remarkable strain on pediatric emergency departments (EDs) and intensive care units (ICUs). This alert followed Centers for Disease Control and Prevention’s (CDC’s) Nov. 4 Health Alert Network (HAN) advisory on multiple viruses causing an early surge in pediatric respiratory illness. With increased transmission and impacts on healthcare systems, we are sharing information and resources with providers.

Situation update

• Western Washington pediatric hospital ED volumes are 200%–300% of capacity, with record high wait times and waiting room volumes.
• A significant increase in flu activity in Western Washington is compounding pediatric respiratory surge/capacity issues.
• Several facilities report record high levels of pediatric behavioral health patient boarding, a worsening trend.

Information for healthcare providers

• Multiple respiratory viruses that impact children are circulating in Washington. No FDA-approved vaccine against RSV exists. Vaccinating against flu and COVID-19 is the best available strategy to ease the burden of respiratory illness on our overstrained healthcare system.
• To better prepare families for treating bronchiolitis at home, Seattle Children’s Hospital developed a Bronchiolitis Care Packet for providers to share with families.
• Proactively share information with patients about the surge in respiratory illness. Encourage appropriate levels of care—i.e., at home vs. primary care vs. emergency department. Emphasize the importance of children getting up to date on vaccines. You can use this template letter to communicate with patients.
• When evaluating children for respiratory illness, consider using a multiplex panel to better inform isolation and quarantine, and prevent further spread of illness.
• Families can use Mary Bridge Children’s Hospital Where To Seek Care page to decide if they should go to the ED, urgent care or treat at home.
• Encourage adults to get flu and COVID-19 vaccine to help stop the spread to children.
• DOH convened the Health and Medical Multi-Agency Coordination Group including local health jurisdictions (LHJs), Tribal partners, healthcare coalitions, Washington State Hospital Association, healthcare providers and other state agencies to coordinate strategies for mitigating this pediatric RSV surge.
• Washington Medical Coordination Center (WMCC) is activated and working closely with healthcare facilities on pediatric load balancing. Harborview Pediatric ICU team is helping with triage. WMCC is working with regional “non-pediatric” hospitals with pediatric capacity to manage and receive appropriate transfers in support of the region.

Nurse advice lines

Additional resources

• Pediatric surge annex, Northwest Healthcare Response Network.
• Flu information for public health and healthcare, DOH.
• Weekly flu surveillance report, CDC.
• Communicable disease surveillance data, DOH.