For the past week, health systems and emergency room physicians across Virginia have sounded the alarm about a surge in COVID-19 hospitalizations that threatens to overwhelm many emergency rooms.
But the emergence of the delta variant, combined with the start of the new school year, is also causing chaos for pediatricians, who are struggling to treat an unprecedented swell in patients. On Friday, the Virginia chapter of the American Academy of Pediatrics issued a “call for help” and said practices could not keep up with the “rising demand” for office visits and COVID-19 testing.
“Our volumes are through the roof,” said chapter president Dr. Michael Martin in a phone interview on Friday. “I don’t know anyone who doesn’t have excess capacity. This is the worst I’ve seen, and I’m in my forties. If you talk to older doctors, they’ve never seen this either.”
According to Martin, a combination of factors has created a “perfect storm” for pediatricians in recent weeks. First, the end of statewide restrictions and the dramatic drop in cases in the spring and summer led to more Virginians returning to normal life. Many children returned to daycare and summer camp – often unmasked – leading to an increase in non-COVID-19 respiratory illnesses.
In a letter to clinicians in late August, Virginia Health Commissioner Dr. Norm Oliver said nine percent of ER visits in infants to four-year-olds in the past week were due to the respiratory syncytial virus, or RSV — a common illness that generally has cold-like symptoms, but can be much more serious for young children. Parainfluenza and rhinovirus infections are also on the rise, leading to an increase in office visits.
“So you have that going on, and then you just have the regular care that has to take place,” Martin said. Pediatric attendance declined sharply in the early days of the pandemic, but the start of the school year has led to a flood of appointments for wellness visits and overtaking routine childhood vaccinations. This has led to a large backlog of cases, with many offices planning appointments until November.
However, the biggest stressor has been the demand for COVID-19 testing, Martin said. The U.S. Centers for Disease Control and Prevention recommend that students be tested for the virus when they show possible symptoms — which can be as mild as a cough or runny nose — and when there has been exposure through confirmed positive contact. That has happened regularly since the beginning of the year, with some districts quarantining hundreds of students.
But a statewide program for school testing won’t start until October, and the vast majority of departments in Virginia aren’t going it alone. That leaves pediatricians to handle most of the requests. And with capacity that varies widely between offices — Martin said his practice typically performs 20 to 25 per day — overflow demand is spilling over into hospitals.
Masked teachers care for children in the nursery of a daycare center run by The Children’s Center, a nonprofit childcare program in the Hampton Roads area. (The children’s center)
Last week, Inova Children’s Hospital sent an email to local pediatricians asking them not to refer patients to the emergency room for testing. The request came as the facility reported a 35 percent increase in patient volume compared to the same period in 2019.
“We also see a significant number of patients who are NOT sick, but submit school forms and a request for COVID-19 testing to the ER to return to school,” wrote Joanna Fazio, vice president of Inova LJ Murphy Children’s Hospital. “We are asking for your help with this population and are advising parents to get tested in other locations.”
The challenge, Martin said, is that pediatricians are also struggling to meet demand amid a growing caseload and large staff shortages. When he surveyed members of the state chapter, more than 90 percent of practices reported shortages of nursing and administrative staff. The healthcare industry is not immune to the same challenges faced by schools, restaurants and other businesses struggling to find employees. But nursing burnout has exacerbated the problem amid a seemingly endless pandemic.
“While this stress continues, people don’t want to work,” Martin said. ‘Because it’s bad. Parents and families get frustrated. Nice conversations are not always held.” Emergency room doctors have also said the intensive work of caring for patients and mounting frustrations over delays in the health system are driving workers out of the field.
“So we’re all competing for a very small group of people,” Martin said. “So it’s hard — a lot of us just really focus on retention.”
The growing pressure on hospitals and doctors’ offices is not expected to abate anytime soon. Earlier this week, the Virginia Hospital and Healthcare Association launched a statewide vaccination campaign “as Virginia is in the midst of a more than two-month wave of new COVID-19 cases and hospitalizations that began in July and continues an alarming upward trend. trajectory since then,” said a press release from the industry group. There are already signs that growing demand for testing is putting pressure on available supply, with order limits becoming more common, Martin said.
Some doctors are asking for more state-level help. The Virginia Department of Health recently expanded testing events across the state, but Martin said local health districts could increase capacity to accommodate more of the demand. Other doctors say stricter restrictions are needed until more of the population is fully vaccinated.
“I think at the state level we are at the point where we need to reintroduce a mandate for indoor masks,” said Dr. Taison Bell, infectious disease specialist at UVA. “Our numbers are high — they’re about the worst we’ve seen — and on top of that we have a staffing crisis.”