Over the last week, health systems and emergency physicians across Virginia have sounded the alarm over a surge of COVID-19 hospitalizations threatening to overwhelm many emergency rooms.
But the rise of the delta variant, coupled with the start of the new school year, is also creating chaos for pediatricians, who are struggling to treat an unprecedented swell in patients. On Friday, the Virginia chapter of the American Academy of Pediatrics issued a “call for help,” saying practices have been unable to keep up with “surging demand” for office visits and COVID-19 testing.
“Our volumes are through the roof,” chapter president Dr. Michael Martin said in a phone interview on Friday. “I don’t know anyone who’s not over capacity. This is the worst I’ve seen it, and I’m in my 40s. When you talk to older physicians, they’ve never seen this either.”
According to Martin, a combination of factors have created a “perfect storm” for pediatricians over the last several weeks. First, the end of statewide restrictions and dramatic decline in cases over the spring and summer led more Virginians to return to life as normal. Many children returned to daycare and summer camp — often unmasked — leading to a rise in non-COVID-19 respiratory illnesses.
In a late August letter to clinicians, Virginia Health Commissioner Dr. Norm Oliver reported that nine percent of ER visits among infants to four-year-olds in the previous week were due to respiratory syncytial virus, or RSV — a common illness that generally causes cold-like symptoms but can be much more serious for young children. Parainfluenza and rhinovirus infections have also been on the rise, leading to an increase in office visits.
“So you’ve got that going on, and then you just have regular care that needs to occur,” Martin said. Pediatric visits declined sharply in the early days of the pandemic, but the start of the school year has led to a run on appointments for wellness visits and to catch children up on routine vaccinations. That’s created a major backlog in cases, with many offices scheduling appointments out through November.
The single biggest stressor, though, has been the demand for COVID-19 testing, Martin said. The U.S. Centers for Disease Control and Prevention recommend students are tested for the virus whenever they show potential symptoms — which can be as mild as coughing or a runny nose — and when there’s been an exposure from a confirmed positive contact. That’s happened regularly since the start of the year, with some districts quarantining hundreds of students.
But a statewide program for in-school testing won’t launch until October, and the vast majority of divisions across Virginia aren’t doing it on their own. That’s left pediatricians to handle the bulk of requests. And with capacity that varies widely across offices — Martin said his practice typically performs 20 to 25 a day — the overflow demand is spilling over to hospitals.
Last week, Inova’s children’s hospital sent an email to local pediatricians asking them not to refer patients to the emergency room for testing. The request came as the facility was reporting a 35 percent increase in patient volume compared to the same period in 2019.
“We are also seeing a significant number of patients who are NOT sick, but are presenting to the ED with school forms and a request for COVID-19 testing in order to return to school,” wrote Joanna Fazio, vice president of the Inova L.J. Murphy Children’s Hospital. “We are asking for your help with this population and advising parents to please seek testing at other locations.”
The challenge, Martin said, is that pediatricians are also struggling to meet demand amid growing caseloads and major staffing shortfalls. When he polled members of the state chapter, more than 90 percent of practices reported shortages of nursing and administrative staff. Health care hasn’t been immune to the same challenges faced by schools, restaurants and other businesses struggling to find workers. But nursing burnout has compounded the problem amid a seemingly endless pandemic.
“As this stress continues, people are not wanting to work,” Martin said. “Because it’s bad. Parents and families are getting frustrated. There aren’t always wonderful conversations being had.” Emergency room doctors, too, have said the intense work of caring for patients and rising frustrations with health system delays are causing workers to leave the field.
“So we’re all competing for a very small pool of people,” Martin said. “So it’s hard — a lot of us are just really focusing on retention.”
The growing pressure on hospitals and doctor’s offices isn’t expected to ease anytime soon. Earlier this week, the Virginia Hospital and Healthcare Association launched a statewide vaccination campaign “as Virginia finds itself in the midst of a more than two-month surge of new COVID-19 cases and hospitalizations that began in July and has continued on an alarming upward trajectory since,” a release from the industry group stated. There are already signs that the growing demand for testing is straining available supply, with order limits becoming more and more common, Martin said.
Some doctors are calling for more assistance at the state level. The Virginia Department of Health recently expanded testing events across the state, but Martin said local health districts could boost capacity to take on more of the demand. Other physicians say stricter restrictions are needed until more of the population is fully vaccinated.
“I do think at the state level, we’re at the point where we need to reimplement an indoor mask mandate,” said Dr. Taison Bell, an infectious disease specialist at UVA. “Our numbers are high — they’re about the worst that we’ve seen — and we have a staffing crisis on top of that.”
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