Evan J. LancasterA rise in pediatric respiratory infection, specifically Respiratory Syncytial Virus cases among children and adults, prompted Orange County’s chief health officer to declare a local health emergency on Nov. 1.
Since then, the Orange County Board of Supervisors has extended the local health emergency at the request of the Orange County Health Care Agency and Children’s Hospital of Orange County.
Meanwhile supervisors have reassured residents that while severe respiratory infections are on the rise, the latest health emergency will not result in lockdowns or face mask mandates.
Leon Page, County Counsel for the Board of Supervisors, explained that the difference between this local health emergency and the order issued during the COVID-19 pandemic is, instead of ordering quarantine and isolation, this order works to appeal the regulation and licensing required to convert adult beds to pediatric beds at hospitals throughout Orange County.
Health experts at CHOC say pediatric cases involving influenza A and RSV are worsening while case volumes are increasing earlier than expected.
Dr. Regina Chinsio-Kwong, Chief Medical Officer of the HCA, said that the county’s emergency departments are being filled with both pediatric and non-pediatric cases of severe respiratory illness, with no guarantee beds will be available.
During a recent Board of Supervisors meeting, O.C. Fifth District Supervisor Lisa Bartlett asked about the possibility of adding medical tents to bring in additional space for hospitals to care for patients during bad weather.
Chinsio-Kwong acknowledged that medical tents are a last resort due to the fact that tents require additional staffing.
“Our emergency departments are full and sometimes are housing patients that should be in an inpatient bed. So they are exhausted and overwhelmed,” Chinsio-Kwong said.
At its pre-pandemic capacity, CHOC’s Orange facility has a total of 334 pediatric beds, with 104 NICU beds and 54 pediatric beds, plus 22 NICU beds at Mission Viejo, according Dr. Sandip Godambe, Chief Medical Officer at CHOC.
In a presentation to the Board of Supervisors on Nov. 29, Godambe said emergency departments are being overrun, and in some cases causing CHOC to divert ambulance delivery to other facilities.
“At this point we do not know what Jan. and Feb. 2023 will bring — traditionally our busiest months,” he said. “We’ve declined 300 to 350 transfers from neighboring hospitals in the last 30 days. This is reevaluated every three hours, so we are able to call some of them back when space opens up.”
Godambe added that the state of emergency has helped CHOC get critical medications it would otherwise not require.
Irvine Weekly emailed CHOC on Tuesday, Dec. 5, to confirm the total number of beds available at both facilities — Orange County and Mission Viejo — and to confirm what percentage of beds are being occupied by pediatric RSV patients at CHOC. CHOC did not provide Irvine Weekly with a total number of RSV cases in Orange County, nor the total number of pediatric beds available within CHOC facilities.
In response to questions from Irvine Weekly, a CHOC PR representative wrote the following in an email sent on Wednesday, Dec. 6:
“Unfortunately, no one is available at this time. We can tell you that as of yesterday, we had 42 patients at CHOC Hospital in Orange with RSV and today we have two at CHOC at Mission Hospital.”
Local health experts say the current epidemiological data is pointing to an earlier-than-normal flu season, and if paired with heightened RSV and COVID, could be a gut punch to an already stressed healthcare system.
Andrew Noymer, Associate Professor of Population Health and Disease Prevention Public Health at UC Irvine, said he is unsure how this combination of respiratory illnesses will play out this winter, but said it could be troubling.
“There’s three epidemics intermingled here — RSV, flu and COVID,” he said. “COVID tends not to send kids to the hospital, but the other two do. Both flu and RSV levels are unusually high for this time of year, because these diseases peak in early February.”
Noymer said the worst case scenario is that all three of these viral infections continue to proliferate throughout the community.
“The real unknown is whether these diseases are peaking early this year. One possibility is that the epidemic of these two diseases that normally happens every winter is happening, except it’s happening earlier this year, so it’ll start to go down,” he said. “Another option is that it’s going to plateau off, and remain high for much longer than it normally does – that can’t be ruled out.”
Noymer suggested a third scenario in which this is just the beginning of what could become unprecedented levels of illness.
“The third possibility is that the early start is not a signature feature of this, but it’s a flu and RSV season on steroids and it’s going to keep going up, reaching new heights,” Noymer said. “That’s the scariest of these three possibilities.”
While it is unclear what current staffing levels are at CHOC facilities, the shortage in health care workers has proved to be a growing concern for health care providers.
Greg Adams, Chair and CEO of Kaiser Permanente, referenced the nationwide shortage of health care workers in an email to members on Dec. 1.
“Across the country, health care organizations are struggling to deliver three years of delayed care and address the dramatic increase in demand for mental health services, while continuing to manage care for COVID-19 patients,” Adams wrote. “At Kaiser Permanente, we’re also experiencing a high demand for care with fewer staff members available to work in our facilities, due to a nationwide shortage of healthcare workers.”
CHOC did not immediately respond to Irvine Weekly’s request for comment on the nationwide shortage of healthcare workers nor did it confirm staffing levels at its Orange County facilities.
In terms of other illnesses, the HCA’s COVID-19 dashboard indicates that between Nov. Dec. 1 and Dec. 7 there were 388 patients hospitalized in Orange County. Of that number 48 required ICU care. It is important to note that HCA’s COVID-19 dashboard includes incidental case numbers, in addition to COVID-19 cases.
Statewide RSV continues to show steep increases in the number of cases requiring hospitalization, especially in children less than four years old.
In the week ending on Dec. 3, the Centers for Disease Control and Prevention’s RSV-Net Interactive Dashboard showed children under four are being hospitalized in California at a rate of 109.9 cases per 100,000.
Nationwide, RSV cases involving cases in children four and under are being hospitalized at a rate of 382.6 per 100,000, while adults between 18 and 49 are being hospitalized by RSV at 2.8 per 100,000.
The local health emergency order will stay in place until it is terminated by the Board of Supervisors.
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