Headlines regarding a recent surge in respiratory illnesses in children are grim. And once again, provider communities are beginning to worry about a shortage of hospital beds – and what that could mean for patients.

What is Causing this Viral Surge?

According to the CDC, the increase in ER visits due to rhinovirus and enterovirus began over the summer. Doctors are specifically concerned about enterovirus D68, which on rare occasions can cause acute flaccid myelitis (AFM), leading to paralysis in the arms and legs.

This spike is clearly related to several factors: the seasonal transition to cooler weather, the reopening of schools, a large-scale drop in masking, and a waning virus-specific immunity in the community over the past two years.

Solving Surge-Related Bed Shortages

Although the viral surge is real, the healthcare backlog does not have to be.

During normal, non-crisis operations, there are typically enough ER and PICU beds to meet patient volumes, making the usual, one-size-fits-all treatment of oxygen and respiratory support while a virus runs its course sufficient.  However, with viral surges, “waiting out the virus” with extended hospital stays ultimately result in ER traffic jams.

As an emergency medicine physician, I have seen so many solutions at hand that could reduce these striking numbers and ease any mounting backlog. But this low-hanging fruit is all too often ignored.

Patients are repeatedly treated based on their respiratory test findings rather than their personal medical history. And it’s easy to understand why.

Today, providers can receive viral panel test results faster than ever before. What may have once taken days or weeks is now readily available in just minutes or hours. A simple nose swab upon a patient’s arrival can reveal the cause of infection in moments.

The problem is that once the pathogen (whether COVID, influenza, RSV, or other) is determined, critical thinking seizes up. Why? Because the culprit has been successfully identified. Popular thought then mandates the only course of action is to provide supportive care, as steroids, Albuterol, and other medications show no impact.

The missing link, however, is that the disease caused by these viruses results from an interaction between the virus’s inherent cytotoxicity and the individual’s immune response. And although viral cytotoxicity is shared equally among all children, the magnitude of the immune response can vary greatly from child to child.

Identifying Atopic Individuals Can be the Key to Relief

Inflammation, in the most basic sense, is the body’s repair mechanism. When we cut a finger when preparing dinner, inflammation causes a build-up of redness and fluid that promotes healing and repair. Similarly, when we catch a cold, inflammation induces cough and congestion to help clear our airways, remove germs, and help us recover.

Unfortunately, this defense mechanism overreacts in some children, a predisposition referred to as “atopy.” Atopic individuals tend to have higher degrees of inflammation or reactivity. They are bitten by a small mosquito but have a huge reaction with redness, swelling, and itching.  Atopic individuals may catch the same cold as others but react with greater cough and congestion. The external trigger is the same for everyone. The degree to which the inflamed person reacts is drastically different.

Those with atopy appear to have more colds. In reality, they only have more symptoms.

In the ER, if the condition of a hospitalized child is neither improving nor deteriorating, the familiar call soon goes out: “Let’s check a viral panel!” The idea is that there must be another virus to blame. But that entirely overlooks the pathophysiology of the individual.

The bottom line? Most children who present to the ER do so because their unique inflammatory response made them disproportionately symptomatic. And it is these children who can be easily identified by simply asking a few questions about their family and personal medical history.

Is Your Child Atopic?

Before hospitals become overrun and at capacity, take this short, three-question quiz. It can help you determine if your child is an atopic individual and at a higher risk for increased symptoms.

  1. Is your child “a mosquito magnet?” Do bites result in significant redness, swelling, and itching?
  2. When everyone else in your house has a cold, does your child have the worst symptoms?
  3. Does your child suffer from bad seasonal allergies and/or eczema?

If you answered “yes” to more than one of the questions above, Culex Wellness may be able to help. We offer a unique, personalized approach. We get to know our patients, their families, and their social and environmental context to provide more accurate diagnoses, more effective treatments, and more targeted management for health issues.

By approaching healthcare as an ongoing conversation, we can identify highly sensitive individuals early and initiate treatment at an earlier stage.  Connecting the dots of what may seem to be unrelated symptoms helps our patients avoid the aggravation and uncertainty of revolving-door office visits and prevents unnecessary ER traffic jams.

Call us at (410) 656-4775 to learn more or visit our website at www.culexwellness.com to schedule an initial consultation.