A sharp increase in the number of children showing up at local emergency rooms lately for treatment of respiratory problems has prompted a chain of local medical centers to ask parents to assess carefully before rushing their child to the hospital.
In a dilemma reminiscent of the COVID-19 pandemic, and one related indirectly to it, Dignity Health's Memorial Hospital called on parents Wednesday to help avoid unnecessary crowding at the facility on 34th Street by treating kids at home unless the patient is having trouble breathing. Even then, visiting the pediatrician's office or an urgent care clinic might be more appropriate, it said in a news release.
A trip to the hospital is in order, said Dr. Les Burson, Memorial's medical director of emergency services, if the patient is struggling to breathe, experiencing high fever, having shortness of breath or showing a bluish skin tint indicating lack of oxygen.
Other signs of serious illness that he said deserve emergency attention include nasal flaring, a sinking chest, reliance on abdominal muscles to breathe and taking more than about 45 breaths per minute. He noted such symptoms generally affect people most prone to complications, like infants born prematurely and young children or adults with heart or chronic lung disease, as well as people with compromised immune systems.
Short of those more serious symptoms — even if a slight wheeze is present, he said — the best treatment may be to stay home and rest, drink plenty of fluids and take an over-the-counter medicine such as Tylenol or Motrin.
If it's just a fever, cough or runny nose, Burson added, "nothing needs to be done. They're OK."
The reason Memorial put out word about the varying degrees of respiratory illness, and the importance of discerning among them, is that visits to its Robert A. Grimm Emergency Pavilion for Children's Services are averaging of late more than 150 per day, or about 75 percent greater than what Burson called normal. On Nov. 8, he said, the pavilion's daily total hit 203.
"We've never seen anything like this," he said, except when COVID-19 adult hospitalizations peaked during the pandemic.
Three illnesses have coincided this fall, giving rise to the term "tripledemic": seasonal influenza, an uptick in COVID-19 cases and respiratory syncytial virus, or RSV, which often leads to infection of the smallest lung passageways.
Especially rampant lately is RSV, which cannot be treated with antibiotics and which is the only one of the trio for which no vaccination exists. State data relayed Wednesday by the Kern County Public Health Services Department suggest testing for RSV is resulting in more than five times the normal positivity rate for this time of year, while the incidence of positive flu tests is about three times normal.
Although COVID-19 is on the rise again, a spokeswoman for the department said, the county is not seeing children becoming infected any more frequently than normal.
Memorial noted that it can be challenging to distinguish among the three viruses, and that the important thing is to take precautions like masking up, keeping hands washed, getting vaccinated for the flu and COVID-19 and avoiding crowds.
Infants less than 6 months old showing signs of respiratory illness — irritability, sluggishness, trouble breathing — should be taken to a pediatrician or advanced practice provider as soon as symptoms appear, which generally occurs four to eight days after infection, Memorial stated.
Burson offered a theory that RSV is more common among children lately because kids born just before or during the pandemic had little opportunity to build their immunity at a time when many people wore masks or abided by social-distancing guidelines.
He estimated about a third of the children the hospital receives lately are very sick and in need of treatments such as supplemental oxygen, intravenous fluids or a ventilator. Another third are moderately sick but may be treated with steroids or some other breathing treatment, he said, adding that the last third were better off recovering at home rather than sitting in a room next to the severely ill.
Local health-clinic chain Clinica Sierra Vista said by email it has not seen an increase in the number of pediatric patients needing high levels of medical care. It indicated it has noticed more patients being seen for influenza A, but "nothing out of the ordinary."
Burson urged people to disregard misinformation on social media about vaccinations and get vaccinated.
"Vaccines work," he added.
