How steep is California’s RSV surge? Sacramento hospitals prepare for early virus season
Infections and pediatric hospitalizations for respiratory syncytial virus, or RSV, have jumped to levels not usually seen for another two to three months in California, where the virus usually peaks around mid-winter, state health data show.
The early spike has some doctors and health officials concerned that a sharp surge in RSV could help send the state into a “tripledemic” this autumn and winter, as the virus intersects with still-spreading COVID-19 and the arrival of flu season.
The latest figures from state health officials show just how early, and rapidly, California’s RSV season has started.
More than 2,500 patients tested positive for RSV the week ending Oct. 29, according to a weekly report from the California Department of Public Health, with 16.8% of RSV tests returning positive, up from 15.6% the previous week.
Both percentages are well above the same weeks in 2021, of 9.3% and 7%, respectively; and far higher than 2017 through 2020, during which positivity for RSV never exceeded 1.5% in October.
Positivity as of late last month is comparable to the peaks typically seen in January or February, CDPH data show.
According to the RSV Virus Hospitalization Surveillance Network from the U.S. Centers for Disease Control and Prevention, California’s cumulative hospitalization rate for RSV among children during the 2022-23 flu and respiratory virus season, as of Oct. 29, was 8.1 per 100,000 residents.
That’s triple the rate for the same time in 2021, of 2.7 per 100,000. The same figure was zero in 2020, 1.6 per 100,000 in 2019 and 1.0 per 100,000 in 2018.
Mild cases of RSV are common in all age groups, and can cause congestion, cough, a low-grade fever, sore throat and headaches.
Severe cases of RSV, most common among infants, can cause pneumonia or bronchiolitis. Symptoms can include a high fever, wheezing and difficulty breathing.
Two Californians have died of RSV this season, according to the weekly report — a juvenile and a person age 65 or older.
Carmichael hospital plans for possible surge
Mercy San Juan Medical Center in Carmichael, part of Dignity Health, is the only Mercy hospital in the region with pediatric beds, according to Michael Korpiel, market president of Dignity Health’s greater Sacramento region.
The hospital has eight pediatric beds, Korpiel said, and all eight were occupied at one point last week, though the pediatric patient total dropped to five over the weekend.
“We have seen a little bit of a surge over the past week in our patient population,” Korpiel said in an interview Monday morning. “Nothing unusual at this point, but clearly … we’re seeing an increase in RSV.”
Korpiel said the hospital is “very comfortable” with its physician resources, and that Dignity Health is identifying nurses trained in pediatrics who can be at the ready.
“We have plans to expand beyond our eight beds if necessary,” he said. “We could take over one of our adult units, and go up to a potential of 23 beds, if we needed to.”
Kaiser, Sutter Health and UC Davis all preparing
Pediatric hospitalizations are increasing at the other Sacramento-area health systems, as well.
The latest weekly CDPH report showed that RSV comprised 1.1% of hospital admissions at Kaiser Permanente Northern California facilities for the week ending Oct. 29 — more than double the percentage from the corresponding week of last year, and climbing on a steeper trajectory than recent, pre-pandemic years.
RSV never made up more than 0.1% of admissions in October, or more than 0.2% in November, from 2017 through 2020.
Kaiser in Northern California had recorded 129 hospitalizations for the current RSV season through Oct. 29 across its 27 facilities, according to the recent CDPH report. Of those, 97 have been children, 24 of whom were treated in pediatric intensive care units.
Forty of the 97 pediatric patients were admitted the week of Oct. 29, compared to 31 the previous week.
“We are seeing an uptick in the number of pediatric patients in our Roseville hospital,” Kaiser Permanente said in an emailed response to The Sacramento Bee. “We have contingency plans in place to expand our capacity for pediatric patients if needed.
“We also encourage everyone to get their flu shot this year and bivalent COVID-19 booster when eligible.”
Sutter Health is also managing its bed availability, officials said.
“At the Sutter Medical Center, Sacramento Children’s Center, we are seeing a rise in hospitalizations of children, especially ages 3 and younger, with viral respiratory illnesses,” a Sutter Health spokesperson said in an emailed statement. “These primarily include continuing enterovirus cases as well as increasing cases with RSV.”
UC Davis Medical Center in Sacramento “has multiple contingency plans” in case additional hospital beds are necessary for an influx of patients, UC Davis Health spokesman Edwin Garcia said in an email.
“Viruses we normally see later in the fall and into winter have arrived earlier this year, including RSV,” Garcia said. “We have not had to increase bed space due to an increase in patients.”
Korpiel said the Sacramento region’s four main health systems are working together closely, along with county health officials, to prepare for potential surges of pediatric viruses.
“All the professionals are coming together ahead of time to make sure that our kids are safe in the Sacramento region and that we can handle the volume here.”
RSV seen in older children than usual
“We are seeing more RSV cases, and RSV in older children,” said Dr. Lindsey Demetral, a pediatrician at Mercy San Juan.
Pediatric cases of RSV requiring clinical treatment usually involve infants, but Demetral said the hospital has seen cases in children up to about age 5.
“Lots of nasal congestion, lots of coughing, fevers,” Demetral said. “And the kids who need admission are having respiratory distress.”
Demetral said there are no signs of any increase in severity this year with RSV, but that it “seems to be more prominent.”
Demetral and Korpiel said Mercy San Juan has not seen many child COVID-19 cases in recent weeks. The hospital swabs for flu, RSV and COVID-19 simultaneously, Demetral said.
Korpiel said that because COVID-19 patients are handled in a different part of the hospital and by “completely different staff,” a winter coronavirus surge among concentrated in adults would not have a big impact on handling pediatric RSV.
The bigger concern for pediatric resources is influenza.
“We are nervous about flu and the impact of the flu on the pediatric population this winter,” Korpiel said. “That could help to complicate things this year.”
Demetral emphasized flu shots, hand-washing and keeping kids home from school when they are sick.
“Whenever we have respiratory viruses overlap, we can have similar presentations for the flu and RSV in children,” Demetral said. “So it’s important for those who are eligible to get the flu shot, because we don’t have a vaccine for RSV.”
This story was originally published November 7, 2022 at 11:12 AM.
