Respiratory infections on the rise in WA, leading to long waits in hospitals

Respiratory infections are rising early in Seattle and Washington this year, filling pediatric emergency rooms and worrying doctors about the severity of fall and winter outbreaks.

Public health and hospital leaders say after enduring two winters of widespread masking, distancing, and distant school and work, our immune systems will be caught off guard this year in a flurry of seasonal infections. Now, outbreaks are hitting earlier and potentially harder than the region saw before the pandemic began.

A particular virus, called RSV, or respiratory syncytial virus, has been responsible for much of the concern in many hospitals, especially hospitals for children, resulting in a sharp increase in admissions and four to five hour emergency room wait times.

While RSV is a generally mild respiratory virus that causes a cold in adults and lasts for a week or two, it can be more serious in children, infants, and older adults, according to the Centers for Disease Control and Prevention. The worst infections can sometimes lead to bronchiolitis, inflammation of the smallest airways in the lungs, or pneumonia.

Last month, Washington jumped from at least 160 infections per week to more than 220 infections per week, according to the state’s weekly flu update, which also includes data on other respiratory viruses. However, the figures are not representative of statewide laboratory testing for RSV, as laboratory reporting is optional.

Still, sharp increases were also noticed in King County, which reported rising from 25 infections in early September to over 200 this month, with about 18% of laboratory tests coming back positive.

Hospital spokeswoman Susan Gregg said UW Medicine virologists are detecting 150% to 200% more RSV in the population than last year.

Cases of rhinovirus, another common virus that can cause mild cold symptoms, also increased in King County, with about 19.5% testing positive.

Flu season has been pretty mild so far in King County and Washington, but two people have died from flu infections this month.

Physician and clinical leader of emergency services, Dr. Russell Migita said at Seattle Children’s, paramedics doubled the number of patients they typically see for October, and increased emergency room levels to 200% of capacity on any given day.

As of this week, more than half of Pediatric emergency patients said they had respiratory virus symptoms. Staff treat about 20 to 30 RSV infections per day.

“In typical years, children get many viral infections that spread throughout their first two years of life,” Migita said. “Due to the success of masking and social distancing, these viral infections are all clustering at the same time. Having more than one infection at the same time can cause more serious illness. The fact that so many children get their first RSV infection adds to the volumes.”

This month, 30% of respiratory viral tests performed in the Pediatric emergency department were positive for RSV. Usually, the hospital considers the RSV season to be at its peak when tests are 30-40% positive.

Besides being early, Migita said this year’s respiratory virus season will be severe.

At Mary Bridge Children’s Hospital in Tacoma, emergency room patients wait up to five hours for a hospital bed. Hospital spokeswoman Kalyn Kinomoto said that on average, about six to eight children expect beds at any given time.

While the flu season has remained fairly mild over the past few years, there was a significant wave of RSV infections in King County last year. At its peak in mid-December, the county recorded about 200 cases per week, according to county data.

Statewide, Washington labs reported seeing more than 250 RSV infections per week in late November, though the numbers were much lower in the fall and winter of 2020.

This year, higher respiratory infection levels will likely worsen the burden on the state’s already strained hospitals and clinics.

“Our hospital is chronically full and the inpatient rooms are always full, meaning patients sit in the emergency room and wait for inpatients,” Migita said. “However, we are increasing the staffing and ancillary care space.”