Shetal Shah, MD, FAAP
Shetal Shah, MD, FAAP is neonatologist at Maria Fareri Children’s Hospital and Immediate Past President of the NYS AAP-Chapter 2. He is the Chair of the Pediatric Policy Council. This op-ed was published in Tampa Bay Times on December 29, 2022.
We want higher rates of flu and COVID vaccinations, more children’s hospital beds and relief from chronic shortages of children’s medications.
This past year hasn’t been a good one for your child’s doctor. We are three years into a once-in-a-lifetime pandemic that reached a milestone 100 million US COVID cases last week and have witnessed 1.1 million people die. We continue to tackle an exploding pediatric mental health emergency. Now a surge of three major viral illnesses: influenza, COVID-19 and Respiratory Syncytial Virus — a “triple-demic” — is again straining our capacity to treat your child.
As we enter 2023, child health physicians are asking for: higher rates of influenza and COVID vaccinations, increased pediatric space in hospitals within a system that equitably values children and relief from chronic shortages of children’s medications.
Rates of pediatric viral illness are at biblical proportions. The Centers for Disease Control and Prevention estimate 15 million cases of influenza already, with 150,000 hospitalizations and almost 9,300 deaths. Hospitalizations are at levels normally not seen until February, and outpatient rates of disease are greater than in 2019-20, the last pre-pandemic season — with especially high rates in children under 4 years of age. Nine children are dead from flu this year.
Meanwhile, child COVID cases continue to rise. The American Academy of Pediatrics reports that in the first weeks of December, 47,581 children contracted COVID, more than double the number of cases in the first weeks of October, and not including unreported at-home testing. Nationwide, pediatric COVID hospitalizations have risen steadily since fall, with children under 4 years disproportionately hospitalized. Unsurprisingly, only 11% of kids in that age group have received even one COVID immunization, leaving too many children susceptible to hospitalization at a time when a bed might not be available under the current burden of disease.
Families of young children received an early Christmas gift in December with the Food and Drug Administration Emergency Use Authorization of the bivalent COVID vaccine for kids older than 6 months, but not enough children are getting immunized, even though these vaccines have been available for 2 years, 13 billion doses have been given worldwide and the bivalent vaccines creates a strong immune response similar to those of older children.
Too many parents succumb to “COVID-fatigue.” They tell me “COVID is over,” so there’s no point vaccinating a young child, forgetting COVID vaccine is the best way to protect children. Add cases of RSV and it’s no surprise hospital beds are unavailable. Colleagues report that 25 to 30 children await beds in pediatric emergency rooms. That’s the size of a whole pediatric ward. Babies may need to be transported to another children’s hospital, which could be hundreds of miles away or out-of-state. Nationally, 78% of children’s beds are full, an unprecedented number for this time in the winter virus season. Last month, six states were above 90%, meaning hospitals may soon be forced to turn patients away.
It’s easy to dismiss this current crisis as unintended fallout of the pandemic, but the current “No vacancy” signs are the end result of a health care system that prioritizes adults over your children. From 2010-2020, pediatric hospital beds declined 20% nationwide, mostly at community hospitals. The facilities buffer large academic children’s centers by caring for common, less acute illnesses. As federal and state governments continue to pay only 40 to 60 cents on the dollar for pediatric care compared to adults, financially strained community hospitals closed pediatric wards, preferring more profitable adult bed space.
A simple fix — aligning Medicaid and Medicare payments — would seismically re-balance this uneven system. Without increased support for Medicaid — the nation’s largest insurer of children — things will only get worse. Last week’s $1.7 trillion dollar federal spending bill included a two-year extension for the Children’s Health Insurance Program, another major plan covering children. This is a promising step, but without an increase in the payment, front line doctors and nurses know pleas for space for your sick child will be ignored.
More sick kids mean greater demand for medications. For 2 months, common child health remedies and certain antibiotics have been in short supply. Parents of my patients’ report going to seven or eight pharmacies to find pediatric medicine. Walgreens now limits the sale of bottles of fever reducing drugs and at CVS, the quota for all children’s pain relievers is two.
Unlike the baby formula shortage several months ago, which originated from reduced supply when a factory went offline, the problem here is surging “triple-demic” demand. The FDA could take similar action to that shortage and allow overseas import of medications until spot shortages improve, as some congressional leaders have urged. Once these viruses naturally subside in spring, a thorough review is warranted to prevent parents from going on a retail and internet treasure hunt to control their baby’s fever.
Our national health care system has always been fragile when it comes to children’s care, but the “triple-demic” reveals it is damaged. These changes to our system will make 2023 better for children, families and the doctors and nurses who care for them.