Why Are So Many Little Kids Sick Right Now?

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Lizzie O’Leary: Since my kid was a newborn, I’ve been in a group chat with other parents. It’s eight mothers, all of whom have two year olds. We talk about our kids, their tantrums, their development, the kind of mundane stuff that other adults probably don’t want to hear about.

Speaker 2: Yeah, it’s. It’s. What do I feed my child for? Lunch, Halloween costumes, interspersed with my kids sick. My kids had a runny nose for six months. My kid has had a thousand ear infections and everyone at my kid’s school is sick. Half the class out. That’s basically our conversation.

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Lizzie O’Leary: That’s my friend Best 11. She’s part of the group chat.

Speaker 2: I’m a writer at Vanity Fair. I’m a mother and I have a sick child like every other parent in America right now.

Lizzie O’Leary: Tell me what happened with your daughter.

Speaker 2: So she this was a few weeks ago. She was kind of like a little bit snotty. One day it was like a Sunday and she had a low grade fever. But, you know, nothing crazy. It was probably like, you know, 100.0, which is like not cancer, like anything for for toddlers. And then it was kind of the same thing on Monday. But I mean, we really just thought it was a cold. And then that night I picked her up and she was so hot. She was like burning up. And her fever. She had a fever of 100.100 and 4.5. Yeah. So that was very scary. We ended up going to the pediatric E.R. and they said, this is probably RSV. Everybody, everybody we’re seeing has RSV.

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Lizzie O’Leary: That’s respiratory syncytial virus.

Speaker 2: And they did a swab that tested for everything, you know, COVID, RSV, etc., and it confirmed that it was RSV. And they said, you know, just give her Motrin, give her Tylenol, you know, just keep her comfortable. And they said, follow up with your pediatrician. So we went to the pediatrician the next day and they said, right, it’s RSV and also a double ear infection and also a mild case of pneumonia.

Lizzie O’Leary: Was it scary?

Speaker 2: Oh, yeah. You know, it was I would say the scariest part of it was that really high fever. You know, we’ve never taken her to the E.R. before, and maybe. Maybe I was. Maybe I was jumping the gun on that. I don’t think so. It was you know, that was that was scary. That was the scariest part. And then when they also said mild case of pneumonia, you you never want to hear that this is the sickest she’s ever been.

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Lizzie O’Leary: Bess and her family aren’t alone. Children across the country are being hit with a huge wave of viruses RSV, flu, COVID, and regular old colds. It’s so bad that many pediatric facilities are at or over capacity.

Lizzie O’Leary: So today on the show, why are kids so sick and why now? I’m Lizzie O’Leary and you’re listening to What Next TBD a show about technology, power and how the future will be determined. Stick with us. In my household. We have been sick since the beginning of October, just one virus after another. You might even be able to hear some lingering scrappiness in my voice. And my child, thankfully did not get as sick as Bassey’s, but he did get sick. And maybe it’s a fool’s errand to try to interview a two year old. But I did it anyway.

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Lizzie O’Leary: What about your nose? How did your nose feel? It felt very funny, I think. Very tickly. And what about your throat? Could be true. Could be this. That was about all I could get out of my son, Sam, to get a more scientific understanding of what’s happening right now. I reached out to Katherine Wu, a science writer for The Atlantic. She recently wrote a story titled The Worst Pediatric Care Crisis in Decades.

Speaker 3: It is just a viral maelstrom out there right now. And, you know, I guess we’ve been used to hearing some version of that line the past three years because, surprise, surprise, we have been in a viral pandemic. But it is definitely not just COVID circulating right now. Maybe this is not a total shock because as the weather cools and autumn and as we head into winter, it’s pretty common for a lot of respiratory viruses in particular to pop up. Flu and RSV being two of the most common ones, but also rhinovirus and enterovirus. So that’s not weird. But I think the volume of infections and the relentlessness of co-infections and subsequent one after the other infections is really pummeling everyone as your household is learning the hard way. And the reasons for that are kind of interesting.

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Lizzie O’Leary: RSV, which my friend Bess’s daughter had, is surging pretty dramatically right now.

Speaker 3: It is another one of these respiratory viruses that circulates quite frequently. It is not new. It has been around for a long time. And in fact, researchers have been working on a vaccine for this for a long time. And it looks like we may be getting one quite soon from Pfizer. So that is a bit of good news to drop in here. But RSV, it’s not always perfectly on schedule, but it is one of those that kind of rises in the colder months. It primarily affects really young kids and much older adults. And that’s thought to be because, you know, you can build up immunity after you’ve had a couple infections. So people at the middle of the age spectrum do well. But it’s really tough when your immune system is still learning to recognize what RSV is and learning to fight it off as well as at the other end of the spectrum, when your immune system has done decades of work and it’s starting to get a little tired and more weak.

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Lizzie O’Leary: Is this sort of explosion of viruses everywhere in the country or is it just in places where it’s getting cold and people are inside more and breathing air together?

Speaker 3: Yeah, it’s a little complicated to answer. I think any time you see a wave of respiratory illness, it is going to be a little patchwork. Right now there’s been a ton of RSV and in the Northeast especially, but it really is everywhere. You know, I talked to physicians at hospitals in the middle of the country, the West Coast. So the tricky thing is that we have so many things going at once. And I think that’s primarily the overwhelming thing. It’s not just RSV, it’s not just flu. It’s that we have this especially large and kind of early arriving swell of respiratory viral illnesses, and now we have another virus in the mix. SARS-CoV-2 What’s been causing COVID these past few years?

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Lizzie O’Leary: I want to understand if this actually is worse or if it just feels worse. Like I think sometimes as the the parent of a toddler, you can get myopic, but it sounds like you’re saying it actually is worse.

Speaker 3: Yeah. I mean, it’s been really, I think, humbling and honestly flooring to hear a lot of the accounts coming in from pediatricians and people who work in pediatric ICU use in emergency departments the past couple of weeks. They are calling it one of the worst surges they have seen in their careers. And some people have been working, you know, for decades. It is pretty bonkers right now.

Speaker 3: You know, some of the accounts I’ve been hearing, the current RSV surge in Connecticut is like 2 to 4 times what they would have considered a super severe season three years ago before the pandemic. Another place in Baltimore has pitched a tent outside of their pediatric emergency department to accommodate overflow. Other places have considered calling in the National Guard to assist them. This is definitely a big surge, and I don’t think every single hospital in the country is overwhelmed. We’re not at that point, but beds are very full on the whole, and it seems to be this collision of super high demand and maybe not the sort of supply of care that that demand would require.

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Lizzie O’Leary: You know, what are the leading theories as as to why there are so many viruses circulating right now?

Speaker 3: Yeah. So I mean, it’s so difficult to say for sure, especially because we’re still in the midst of it. We’ll have more information when we sort of do the the rearview analysis. But there’s a couple of things going on. I think if we sort of look at what’s happened over the course of the pandemic, it becomes a little more intuitive. Right? You know, at the beginning of the pandemic, we took all these behavioral measures to tamp down on COVID transmission, but that also happened to work marvelously against all these other respiratory viruses.

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Speaker 3: Yeah, flu actually almost completely disappeared in the winter that spanned 2020 to 2021. Like it was the quietest flu season that. Pretty much everyone I talked to you had ever seen in their entire lives. There was a similar impact on RSV. A bunch of these other respiratory viruses, we just sort of drove them out. And now that I think those behavioral measures have been lifting possibly more than they have throughout the entirety of the pandemic, you know, this is probably the most normal looking autumn we’ve had since 2019. Those viruses have taken every opportunity to come back, and they’re sort of overlaying themselves onto a population, especially of kids who didn’t have the opportunity to be exposed to these viruses during the pandemic and build up the immunity that might have dampened the severity of their first infections.

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Lizzie O’Leary: Yeah, I was wondering, is is this just kids like mine who were born during the pandemic or is this all kids who maybe were were just slightly sequestered more or had, you know, non-pharmaceutical interventions like masks in their lives?

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Speaker 3: Yeah, it’s a really great question and also, unsurprisingly, a tough one to answer. I think the main thinking right now, and this is definitely still a hypothesis, is that the kids who were born right before the pandemic, as well as during the pandemic, are some of the most vulnerable, especially with RSV, which is a very useful example to use here, especially since there’s no RSV vaccine yet. First, RSV infections tend to be really, really, really rough, especially for infants. You know, their airways are small. They don’t have, you know, the chest muscles to cough really forcefully and get out, you know, tons of mucus that might be clogging the the little tubes that make up their airways. It’s just really, really rough for them. But as they accumulate exposures, their immune systems learn to fight the virus off more and more readily.

Speaker 3: So a lot of hospitals are seeing the infants they would kind of expect having their first exposures, but they’re also seeing toddlers who are actually having their first exposures later who normally they would expect toddlers to be able to mostly recover at home because they were able to build up those first infections when they were one or one and a half. But now it’s kind of like we’re playing all this catch up with these viruses.

Lizzie O’Leary: After the break, what this viral surge means for doctors and hospitals. We’ve already had a very tough few years.

Lizzie O’Leary: You talked a little bit about what doctors who you have talked to have have seen. And I wonder what kind of effect this, you know, surge in sick kids has on on care, on getting care and and how clinicians have to think about kind of who to treat and how to treat them.

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Speaker 3: Yeah, it is such a great question because I think something that I wanted to come back to was that we’re not just seeing increased demand for pediatric care right now. It’s also hitting at a really unfortunate time when pediatric care capacity has actually shrunk a little bit in this country for a couple of reasons. One is that, you know, many hospitals, you know, because there was this massive decrease in sort of more run of the mill respiratory infections, the rhinovirus flu RSV crowd, definitely not talking about COVID specifically. There are a lot of pediatric hospitals actually shrunk their capacity.

Speaker 3: And, you know, health care is also been going through a bit of a funding crisis. Some hospitals, you know, took away beds in their pediatric ICU, for instance. And also there was been a pretty large exodus of health workers amid the pandemic. You know, there’s been a lot of burnout, a lot of stress. Health workers have been threatened and they have just been working nonstop for three years. Nurses especially have been leaving their professions or taking traveling jobs, which means a lot of hospitals are short on core staff. That really, I think, emphasizes how how tough it is to care for kids when there’s this extreme imbalance in the number of kids that need treatment and the number of health care workers that can actually provide that care.

Speaker 3: And, you know, absolutely. It’s just so stressful. I think health care workers are now having to make really tough decisions about, you know, who gets this bed. We only have this one better. We only have this one bed that can be staffed by enough of our health care workers. They’re maybe having to consider canceling elective procedures. There may be having to open up new space in other parts of the hospital that would otherwise be used. Something else used for something else. They’re even, in some cases, sending specialists, you know, sprinting across the hospital to deliver care because they can’t bring the kids to the ICU where these specialists normally work. It is a really rough time. And remember that this is coming after three years of a pandemic that has been incredibly difficult for everyone.

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Lizzie O’Leary: You know, there was a doctor, I think, in a story you wrote about this, who described this as what, their 2020.

Speaker 3: Yeah, that really hit me, you know, because I think there was this kind of. I guess we could call it a blessing that COVID did not affect many kids as badly as it could have. You know, kids do still get incredibly sick from COVID, and we know Mis-c at long COVID are huge issues for kids who catch this virus. But many kids were able to recover very safely at home and are doing well. And a lot of pediatric hospitals saw decreased demand during the pandemic. Now, it seems like, you know, it’s not directly COVID per se that’s catching up with them, but some of the ripple effects of the pandemic and the way that we have lifted mitigation measures, you know, this super fast disappearance of masks without a lot of, I guess, fallback measures has really allowed this surge to take place. And I think that’s been incredibly rough.

Speaker 3: Pediatric hospitals are absolutely overwhelmed right now, and I think that was a really apt description to compare this to some of the worst of 2020 for adult hospitals.

Lizzie O’Leary: Is pediatric care more vulnerable than than adult health care to this kind of thing? I mean, is it more thinly staffed or less profitable Like it? It’s just so striking that this seems to have happened so quickly and that so many pediatric care centers are struggling.

Speaker 3: I mean, I think there was a couple of ways to think about that. One is if you sort of stack the adult numbers and the pediatric numbers in terms of staff and patients being seen, the pediatric staff is usually smaller, right? Like kids are generally healthier. The specialties are usually smaller in terms of the number of people coming into them and the number of jobs that are open. But also I think it’s important to consider that when there are these staffing shortages, hospitals may try to call in reinforcements or call in staff from other departments in the hospital, but it’s not so simple a lot of the time.

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Speaker 3: Kids are not just tiny adults, you know, their bodies are still growing. They have different anatomy and different physiology. They have different sets of drugs that are approved for use in them. There are different sorts of safety and efficacy considerations, and we’re talking about different interventions. And so, you know, as one physician put it to me, like it’s not so easy to just immediately train someone to care for a two year old. And so when you have something super hyper specialized, like a pediatric ICU doctor, it’s not so easy to find a replacement for them or especially a nurse who are delivering a ton of the care.

Lizzie O’Leary: I think if you’re listening to this and you’re a parent, it might be really scary. And if you’re not a parent, you might think like, gosh, it still sounds kind of intense. What should you be thinking about both for your own family, but then kind of larger community questions.

Speaker 3: Yeah. So I will try to break that into a couple parts. And you are the parent in this conversation, so let me know if I’m missing anything. Like, you know, first off, if your kid is sick right now, you know, I’m sorry, it is probably going to be okay. I think the really encouraging news coming out of hospitals is that really like the vast majority of kids are doing super well. Pediatricians know how to care for these kids and a ton of like they are leaving the hospital healthy.

Speaker 3: That said, you know, there are key things to watch out for. A kid that needs hospital level care is going to exhibit like very clear signs of, you know, what they generally refer to as respiratory distress, like wheezing, really rapid breaths, Like they’re using their chest muscles, like they’re struggling to use their whole body to breathe. If their lips are turning blue, if their fingernails are starting to turn blue, like those are the types of signs that indicate, you know, maybe call your pediatrician, make absolutely sure that this is like emergency level care and then take them to the nearest E.D. We don’t want parents bringing their kids in for every single cough or every single sniffle because hospitals are already overwhelmed right now. But we also don’t want them to wait too long to bring their kids in. This can really take a turn for the worse quite quickly.

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Lizzie O’Leary: But it’s also important to strike a balance, Catherine says, to remember that little kids do get sick, especially if they’re in school or daycare, but also to be aware that health care systems are stretched thin right now.

Speaker 3: It’s probably not a bad idea to make sure your kids are up to date on whatever vaccines they can be getting right now. That includes COVID shots and flu shots. Now is really the time to be getting those. That RSV vaccine is coming soon. And the hope is that that’s going to be available to pregnant people so that their infants can be born with some of that immunity because the highest risk is really for those youngest infants. It’s not here yet, though.

Speaker 3: And in the meantime, you know, things like masking, avoiding like super packed gatherings, not going to school or work when you’re sick. That all contributes immensely. And handwashing is also a really big deal for RSV. And also, even if you’re not a parent, those measures can really reduce the spread of these viruses in the community. Adults, too. You can catch all of these viruses and they don’t tend to get sick, especially with RSV, but they can transmit them. They can bring them home. And so I think it’s really a great time for the community to come together and just try to tamp down on transmission on the ways that we have really learned how to the past two years. We kind of drove a ton of these viruses out of the community the first year that SARS-CoV-2 was here. So we know how to do this. I hope we can replicate some of that this fall.

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Lizzie O’Leary: You mentioned the the potential RSV vaccine on the horizon. Do you think that’s really going to happen? Because that sounds wonderful.

Speaker 3: It it’s looking like it will. You know, I wish I had more control over this than I do. But it does have to get through all the regulatory bodies, the FDA, CDC. But this has been such a long time coming. I mean, every pediatrician and parent that I’ve talked to as of late is really excited for this vaccine. And the top line results look really good. I think once we see more data, once the FDA and CDC see more data, I’m optimistic that this vaccine could be available as early as sometime next year.

Lizzie O’Leary: Katherine Wu, Thank you so much for talking with me.

Speaker 3: Thank you for having me.

Lizzie O’Leary: Katherine Wu is a staff writer at The Atlantic. And that is it for our show today. What next? TBD is produced by Madeline Ducharme.

Lizzie O’Leary: Our show is edited by Jonathan Fisher. Joanne Levine is the executive producer for What next? Alicia montgomery is vice president of Audio for Slate. TBD is part of the larger What Next Family and it’s also part of Future Tense, a partnership of Slate, Arizona State University and New America. And if you like us, I have a request for you. Become a Slate Plus member. Just head on over to Slate.com Slash what next?

Lizzie O’Leary: Plus, to sign up. All right. We will be back next week with more episodes. I’m Lizzie O’Leary. Thanks for listening.