The “triple threat” is real. Thanks to the combined impact of COVID-19, the flu and RSV among children, hospitals are pitching tents outside their emergency rooms. Wait times can stretch as long as 36 hours, forcing kids to get treated in hallways or sent back home. In some rural areas, young patients have been airlifted to major cities. There’s always a degree of bad luck when it comes to the spread of respiratory illness. But precautions against this latest episode — what’s been called the “worst pediatric-care crisis in decades” — also went unheeded. It’s time for a better emergency playbook.

For most people, RSV, or respiratory syncytial virus, is no more than a common cold. But it can be dangerous for infants and very young children because it fills up their tiny, underdeveloped airways with mucus. (Imagine trying to breathe through a coffee straw.) RSV is estimated to cause up to 80,000 hospitalizations among children under five and 100 to 300 deaths each year in the US alone. It’s also a serious threat to the elderly.

While RSV isn’t a new problem, cases have been soaring this year. For one thing, immunity is low after two years of isolation. Thanks to masking and remote learning, many children never had exposure to what would’ve otherwise been relatively common ailments. A related challenge is that, absent COVID-era restrictions, rapid spread seems inevitable. Health experts anticipate the worst flu season in more than a decade as holiday gatherings pick up, to say nothing of COVID’s lingering impact on overstretched doctors’ offices and hospitals.

Unfortunately, the most straightforward and effective way to slow transmission — vaccination — has hit a wall. Less than 5% of children under five have received two COVID shots, and flu vaccination rates are below pre-pandemic levels. (There is no vaccine for RSV, though one could be available by next season.) And while some studies suggest masking and social distancing might be effective, both remain deeply unpopular if not impractical for the very young. That leaves commonsense practices such as washing hands and keeping children home when they’re unwell.

It would be shortsighted to leave things there, however. While COVID’s severity may be subsiding, viruses will continue to circulate. To prevent another blow to the health-care system, officials need a better way to anticipate and respond to concurrent threats.

They can start by reading data differently. The Centers for Disease Control and Prevention should develop a “risk threshold” based on local reporting of peak weekly deaths, hospitalizations and community prevalence for all respiratory viruses combined, as recent research recommends. Crossing a certain threshold would trigger specific policy responses, such as freeing up beds or sending a surge of medical staff, and could help project hospitals’ future needs.


Of course, models are worthless without workers, who have been quitting in droves, partly because of the pandemic. In the short term, hospitals can get creative by tapping physicians’ assistants, nurse practitioners, residents and even virtual nurses for a wider range of emergency-room duties. Enlisting school nurses and community health workers to test and administer vaccines during surges could also help slow the rate of hospital admissions. Longer term, the Biden administration should consider developing a national strategy to boost the health-care workforce, including targeted loan forgiveness and tying residency funding to fields or regions that are short of personnel. Left unaddressed, a hollowed-out workforce will continue to have a cascade of negative consequences for patients.

It’s too early to tell whether immunity will be stronger next year. But better data, coupled with a more resilient workforce, will help health systems scale up and down. With luck, viruses will go back to being a simple seasonal nuisance.

Editorial by the Bloomberg Opinion editorial board


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