As the season of respiratory illness begins, anxiety builds over Alaska’s pediatric hospital capacity

dr. Matt Hirschfeld in front of Alaska Native Medical Center in Anchorage on Oct. 7, 2021. (Jeff Chen/Alaska Public Media)

Last year, as Alaskans braced for a COVID-19 wave that could strain the state’s medical system, Dr. Matt Hirschfeld at the Alaska Native Medical Center in Anchorage.

Hirschfeld works in pediatrics. And the typical respiratory viruses that send kids to the hospital — flu and respiratory syncytial virus, or RSV — were temporarily overcome. Alaskans’ compliance with COVID-19 masking and social distancing recommendations nearly eliminated other viruses as well.

“The doctors at our pediatric intensive care unit offered their services in the adult ICU,” Hirschfeld said. “They were so much busier than pediatrics.”

This year, with children returning to school and communities in Alaska easing their coronavirus prevention measures, Hirschfeld and his colleagues across the state expect a very different winter — though not quite sure how much different.

They expect RSV and the flu, which in normal years can stress the limited capacity of the state’s children’s hospitals, to return. And now there’s the extra layer of COVID-19, which generally hits adults harder, but in rare cases can send small children to the hospital as well.

“How good is your crystal ball?” asked Dr. Laura Brunner, a pediatrician in Fairbanks. “The biggest concern is the combination of all of this.”

Pediatricians in Alaska say they still expect to control the wave of respiratory viruses hitting them this winter. But the COVID-19 pandemic adds a degree of uncertainty to those expectations because of the potential to sicken more children and divert scarce staff to the mass of sick adults that nearly overwhelm state hospitals.

For those reasons, doctors say it’s especially important this year for children and their family members to get the COVID-19 and flu vaccines, which can help them stay out of the hospital and reduce transmission through households. Wearing masks, washing hands and social distancing all help too.

“It would be unimaginable to have a self-inflicted respiratory catastrophe when we have months and months and months to prepare and see it coming,” said Dr Rob Lovrich, who cares for children in two intensive care units from Anchorage. “The solution is there. It hangs right in front of us.”

Alaska’s system of hospital care for children is uniquely small and fragile. Only two hospitals — Anchorage’s Providence Alaska Medical Center and the Alaska Native Medical Center — have pediatric intensive care units.

Providence Alaska Medical Center in Anchorage. (Jeff Chen/Alaska Public Media)

Staff of both doctors and nurses can also often be a disability. There are only four pediatric intensive care specialists living in Alaska, Lovrich said.

“If one of us gets sick, we have an obvious staffing problem,” he said. “If one of us makes the mistake of going to the other’s house for dinner and we both get sick, we’re in crisis.”

Alaskan pediatricians are used to being creative with those limitations.

Sometimes they take the unusual step of taking children from Anchorage to hospitals with lower levels of care to make more space in the hospitals with ICUs.

And during a particularly strong wave of respiratory virus on the North Slope, the stressed-out hospitals in Anchorage once sent specialists to the region to train health care providers in treatments so fewer children had to be transferred to Anchorage, Hirschfeld said.

Pediatricians said in interviews that the coronavirus pandemic threatens to further expand their capacity. Nurses or respiratory therapists, already in short supply, may have moved away to care for adults.

And hospitals in Seattle, Oregon and Utah, which sometimes serve as pressure relief valves when Anchorage’s pediatric units get too busy, are tighter than in the past, Hirschfeld said.

“It can be more difficult to send children outside,” he added.

As Alaska experiences one of the country’s worst COVID-19 outbreaks, pediatricians say they are already seeing more children being hospitalized with the coronavirus.

But it is not clear how much additional burden COVID-19 will cause over the winter. And both the flu and RSV, which mainly affects newborns and infants, are also great unknowns.

U.S. pediatricians can look to Australia — where the seasons are different from North America’s — as a preview of what kind of respiratory viruses to expect here in the winter. And RSV cases in Australia rebounded sharply as residents moved out of home and quarantine orders.

Leaders of the U.S. Centers for Disease Control and Prevention, meanwhile, warned this week of a seriously looming flu season, possibly because Americans built up less immunity than usual last winter.

“What worries us with this upcoming season is that we already have so much COVID. And we haven’t even reached the peak or the start of our flu and RSV season yet,” said Dr. Mishelle Nace, a Fairbanks pediatrician who works with the state health department. “It’s like a storm, and we don’t know how to predict it, just like the weather.”

What pediatricians do know is that vaccines will help mitigate any impending spikes.

Anyone six months and older can get the flu shot. And the Pfizer-BioNTech vaccine is available for children ages 12 and older.

Those drug companies also filed their formal request this week with drug regulators to start giving the injections to children between the ages of five and 11. The approval could come as soon as possible next month.

But pediatricians emphasize that the more family members aged 12 and older who can now get vaccinated, the less likely they are to transfer COVID-19 from schools or other institutions to their unvaccinated relatives.

And more vaccinations for adults will cause less stress for hospital staff, she added.

“It’s a community,” Nace said. “It’s not just the adults. It’s not just the kids. It’s everyone.”

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