November 17, 2022 • 20 mins
Typically, respiratory syncytial virus (RSV) sends thousands of children to the hospital over fall and winter, peaking in January and February. But for the second year in a row cases have spiked early and continue to grow. This has led to unprecedented cases of the common respiratory virus across the U.S. On this episode, Cohen Children's Medical Center leaders Joshua Rocker, MD, and Margaret Duffy, PhD, RN, NEA-BC, discuss what they are seeing on the front lines in New York, the impact flu will have leading into the winter months, and how hospitals are responding to the need. They explain what parents need to know about RSV, and what steps they can take to reduce transmission within the home, particularly for those with children under the age of 1, who are at the greatest risk.
Meet our guests
- Dr. Joshua Rocker is the chief of the Pediatric Emergency Medicine Division at Cohen Children's Medical Center
- Margaret Duffy is associate executive director for Patient Care Services and chief nursing officer at Cohen Children’s Medical Center.
Chapters:
- 00:01 - Intro
- 01:31 - Why are we seeing an RSV surge now?
- 03:27 - What is RSV?
- 05:04 - RSV symptoms
- 05:56 - How is RSV transmitted?
- 09:58 - Diagnosing RSV
- 11:52 - A view from the frontlines
- 13:23 - The RSV surge in context
- 16:15 - Flu, Covid-19 and RSV
- 16:51 - Can you prevent RSV?
- 17:53 - Coping with RSV
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
We've gone through other types of infectious processes, but
you know, to have so many children, particularly concentrated at a
very young age to become so acutely, ill, almost at the
same time; and I've been practicing for decades.
It's been unprecedented.
(00:28):
Hello, and welcome to 20-Minute Health Talk
I'm Sandra Lindsay, today we speak with
Dr. Josh Rocker
and Margaret Duffy about the unprecedented surge of RSV cases
hitting hospitals across the U.S. as well as other winter viruses
(00:48):
Dr. Josh Rocker is the chief of pediatric emergency medicine at
Cohen Children's Medical Center.
Dr. Duffy serves as the chief nursing officer
At Cohen Children's Medical Center.
Doctors Rocker and Duffy welcome.
Dr. Rocker (01:09):
Thank you.
Dr. Duffy (01:11):
Thank you for having us today
Host (01:13):
In normal years RSV, sends thousands of children to the hospital over fall and winter
but for a second year, in a row cases of spiked early and leading to surges
of the common respiratory virus across the u.s.
So, Peg typically RSV peaks in January and February.
(01:38):
Why are we seeing this increase in the number of cases and
hospitalizations now?
Dr. Duff (01:44):
Sandra, that's a great question, and we're not 100% sure what is causing
this sudden surge in RSV but most likely it is due to what happened
during covid.
So, as everyone recalls during covid
We all went into lockdown schools were closed.
Children were really pretty much sequestered at home, so many of those
(02:05):
younger children
school-age children have had the past two years where they really
have not had the exposure that children normally do during childhood,
to have the chance to get these viruses, and to develop the
immunity.
So as we've emerged from the covid pandemic, and now we're in an
endemic phase masks are coming off.
(02:26):
We're just so happy to have socialization again.
Going to see our loved ones, our family.
Taking trips.
Many of the transportation hubs are not requiring mask.
So basically with masks off we are seeing just a resurgence in it.
The other interesting feature to it is that we've seemed to have lost
(02:46):
some seasonality.
We were seeing respiratory illnesses in July that we would normally
see around the holidays.
We believe that that's what's causing this, along with that flu.
So, we, I'm, we're going to make on behalf of
Dr. Rocker and myself a shameless plug for that flu vaccine.
So flu is very much, you know, we see in other areas of the world, our
(03:08):
conversion from moving out of RSV to flu and we are seeing our
share, our fair share of flu illnesses as well.
So get your flu vaccine.
Host (03:18):
I'm also going to make a shameless plug for the covid vaccine and the
covid boosters as well, Peg.
So thank you for that.
So, Dr. Rocker.
Can you explain
what our listeners should know about RSV.
Dr. Rocker (03:33):
So RSV stands for respiratory syncytial virus, it is a virus
we commonly see every fall and winter. For children above the age of 2,
it generally causes a cold. Adults get it as well.
And it cold causes a cold, congestion runny nose, plus, or minus
fever.
But in children under the age of 2 and more specifically under the
(03:56):
age of 1, they get something called bronchiolitis.
And bronchiolitis is different than bronchitis.
Bronchitis is when you get mucus and the bronchi and that's when
you're coughing up, you know, loogies, you know, and green mucus, but
bronchiolitis is lower down, it's in the lungs.
And so what these children get is they get fever often, cough
(04:21):
congestion.
But then they get the wheezing.
They have difficulty breathing as well.
Not everyone, but it is frequent.
So bronchiolitis is
Different than just a regular upper respiratory tract infection.
It's something that involves the lower respiratory tract as well, and
these kids can get sick.
So it's very important for people to realize because there's a lot of,
(04:43):
you know, messaging in the news about RSV.
And then the hospital's, this is a completely different entity than
covid. RSV is extremely common.
Yes, is making kids sick but it
does not carry with it, the same
Mortality or anything close to covid.
Host (05:04):
So those symptoms must be very scary for children and their parents
Dr. Rocker (05:12):
100%.
When someone is breathing hard
yes, that's very nerve-wracking to watch, and it's challenging for the
kids. And the way I describe it, is it looks like you're running a race,
but you're not running a race.
So you're pulling, you know, your lungs.
These are saying I need help getting air in, in the usual muscles
(05:34):
that work to get air in
It's usually just the diaphragm up and down, but that work isn't
sufficient because there is inflammation inside the lungs.
And so you have to recruit other muscles to help.
So if you're doing that, but there's no reason for you to be exerting
yourself
then that's because the lungs are having difficulty or a little bit to inflamed,
Host (05:56):
How is RSV transmitted?
Dr. Rocker (06:01):
So, I think we learned a lot during covid.
I think we all became, you know, virologist, and epidemiologist and
learned how things got transmitted.
We talk about airborne and, you know, tuberculosis, you know, measles
is Airborne and that's just in the air and it floats.
That is not RSV.
There's respiratory droplets, which kind of land on the ground.
(06:24):
And then there's contact transfer and RSV is mostly contact
transfer.
But a little
bit of respiratory droplet as well.
But it's basically it's on the countertop.
It's not a toy, it sounds something it's on the doorknob and you know,
children the way they interact with the world, they love to touch
things, they'll have to put things in their
(06:46):
mouth and so if you're in day care or if your older sibling, you know,
is in daycare and gets RSV, you know, and then comes home and they
sneezing and touching things.
That's how the child is going to get it as well.
Dr. Duffy (07:00):
Sandra, that's a really good message to the folks who are listening today.
In terms of minimizing the potential for spread for RSV in the
respiratory viruses, hygiene practices are so important.
We do a lot of education with parents and caregivers around hand hygiene
What we all learned in kindergarten washing
(07:21):
your hands is so important.
So making sure when you children come home from school or they come
home from the playground or when they're out with their friends
making sure that they are washing their hands, not touching their face and
minimizing that.
And if that happens then doing this simple hand hygiene, we all get
concerned here at the hospital as we go into holiday season.
(07:43):
We're looking forward to spending our time, with our friends and
family, you know.
We there's so much burnout from covid that you really want to have
those warm family, gatherings, as we look forward to Thanksgiving, and
then the December holidays, but we really encourage families.
Particularly those, with the very young infants, under two months of
age to really think about who's being exposed to the very young and
(08:07):
the Very Old, the opposite ends of the spectrum, are those individuals
at risk.
So as much as we want to be together, I think the message is to try to
be smart and to protect particularly those, those young infants.
Host (08:20):
It also sounds like it would be beneficial to just have a routine of
wiping down or surfaces as well.
Dr. Rocker (08:29):
Yeah, I think that definitely makes sense.
And one thing about the hand hygiene that we talked about, we say
washing hands, but the most important because I think a lot of times
people put the soap in the palm of their hand, rub their palms
together, and then wash it off.
But it's the fingers that come to our noses, come to our mouths, come
to our eyes.
So, it's actually washing fingers that are the most important part
of the hands.
Host (08:51):
What are some supportive
kind of therapies that you're using?
Dr. Rocker (08:57):
That's a term, that's used a lot.
We don't have any treatments
but we give you supportive care, and I just want to clarify
what that means.
So treatments, stop the virus, kill the virus, we don't have that.
But supportive care is, if your oxygen is low, I'll give you oxygen.
(09:17):
If you're dehydrated I'll give you fluids if your lungs are working so hard
I could put you on machines that make breathing easier for you.
So we support you
nd your body until the virus goes away and you recover.
So if there's really poor feeding, difficulty breathing, we definitely
(09:39):
want to see those children, but if it's fever and otherwise they seem
to be doing well, that's certainly something
That we could follow with your pediatrician, but there's
not necessarily the urgency to come to the emergency department,
unless you're, you know, below, a certain age, if you're below 2 months
and you have a fever, you do, once you in the emergency department,
Host (09:58):
So, how do you make the diagnosis?
So the diagnosis of RSV specifically RSV is a respiratory viral swab
that we do and then it will tell us if it's RSV.
However, I don't want the audience to think that RSV is the only virus
that causes bronchiolitis.
(10:19):
Bronchiolitis can be caused by a bunch of other viruses, but right
now, the large majority of the children that we're seeing with chronic
bronchiolitis, are, in fact, RSV
So, who is most at risk for severe RSV?
Dr. Rocker (10:37):
So, great question, those who are most at risk, as we
mentioned, where those, under the age of 1 specifically, even
younger and then premature babies as well are at higher risk.
We are seeing some older kids who may have complex medical conditions
who are a little bit more fragile when they get
(10:59):
RSV, it may be more challenging for them, but it's really the younger
kids that were most concerned about.
Host (11:06):
As an adult, should I be concerned about RSV, generally?
Dr. Rocker (11:13):
No, but as an adult who has children or has children who has
children, that's something that you should be a little bit thoughtful of
And I mean, I just want to stress one thing.
You know, we're busy.
We have never seen higher numbers in our emergency department ever.
(11:36):
And I'm saying, you know, by 50% more than extremely busy times.
So in regards to the public health message to the adult, it's be
thoughtful about the children because we're in a crisis right now.
Host (11:52):
So when did we really start to see RSV hit this year?
Dr. Rocker (11:59):
I would say
four weeks ago is trickling in and then three weeks, it really
started taking off. December, is kind of, when traditionally flu comes
in a little bit more with a Vengeance.
We're expecting even higher numbers then.
So RSV tends to be a little bit of a hump, not a big spike.
So we anticipate RSV to still be around well into December and Jenny,
(12:25):
And we know it's going to be overlapping with flu at that point as well
Host (12:30):
So Dr. Rocker, do you think the high number of infections you're seeing will
be a one-time event or a new normal? Is the pattern of the virus
changing?
Dr. Rocker (12:41):
We're not certain.
We know as Peg mentioned last year was different than this year, this
year is a little bit closer to normal, but definitely abnormal and I
think we suspect that we will Trend back to the old ways just because
the logic with
Covid, is that we weren't socializing?
(13:02):
And now we are socializing. Covid didn't change viruses.
So I suspect strongly suspect that next year.
Barring any other, you know, social bizarre phenomenon, that will
probably be back on par.
Host (13:21):
Peg and Dr. Rocker
Have you seen anything like this in your practice before?
Dr. Duffy (13:28):
No, not at all.
You know, we've gone through H1N1, we've gone through, you know, other
types of infectious processes.
But, you know, to have so many children, particularly concentrated at
the very young to become.
So, acutely, ill and almost, you know, almost the same time and, you
(13:49):
know, sometimes we describe it as a tsunami and it comes in waves, you
know, we might have maybe 12 hours where the volume is a little,
bit less, which actually we say you know we take a breath and we say
well that you know 12-hour volumes
hat's not so bad.
That would have been a busy day
2 years ago, right?
So so everything is relative but to be honest now this is something
(14:11):
I've been practicing for decades, it's been
unprecedented.
Dr. Rocker (14:16):
Yeah, I mean I remember when we set up flu pods in the 2018-2019 flu
season and flu that was really much more an outpatient.
burden where we had so many patients coming in who are
concerned.
And, you know, they generally were fine and they're saying with H1N1,
(14:37):
The Atrium of the Children's Hospital basically became you know, a
testing center and Urgi-center, but it didn't impact the, the
admissions nearly as much as this is right now
To Peg's point
I have never seen us borrow space from the adult side and we just
(14:58):
Really needed it.
When we were
received it
So it's a different entity than we've seen in the past.
Host (15:04):
Can you talk to us a little bit about your strategies to manage the
volume?
Dr. Duffy (15:09):
So last year, we did quite a bit of planning predicting almost what
you can't predict, but seeing that we had lost some seasonality as a
leadership team.
We came together and said how can we if this comes and in a wave that
that may be unexpected, how can we be ready for it?
(15:30):
So we had hired up.
We looked at all of our alternative spaces.
We looked at our surge plans and said, how can we become more flexible
and Nimble?
So what we've ended up doing is having a lot of satellite spaces.
We borrowed a unit from our LIJ Medical Center friends.
They've been very gracious we've repurposed areas here within Cohen's
(15:52):
for the Emergency Department.
We've had to step up, we've been doing this for months now so that we
are positioning ourselves.
Selves to provide that quality care that we are known for and
but it's been challenging.
It's been very challenging and as we see the severity of
illness go up it is a challenging concern
Host (16:15):
Dr. Rocker, what role does
covid and influenza play in this RSV surge?
Dr. Rocker (16:23):
Covid hasn't left us.It is a smoldering virus that is there.
We still have patients who are admitted with covid.
It is certainly not overwhelming our numbers but it's a presence and
influenza currently is on the rise.
We're definitely seeing it in some patients.
I expected to be a much more significant thing in the weeks to come
Host (16:51):
Dr. Rocker, what can parents do to keep their children out of the hospital to
prevent their kids from getting RSV?
Dr. Rocker (17:01):
So with kids going to school, it's hard to prevent RSV, you know,
transmitting in the community and you know, we're happy that kids are
in school and we're happy that kids are without masks and we're happy
that they're developing normally in an appropriate environment.
And it's not just kids, it's specifically the young kids, right?
(17:24):
The ones that are being hospitalized are the ones that are you know,
No, the newborns the, you know, under one year of age, so be more
cautious with those kids and, you know, for those siblings, you know,
in a household who have a child who is, you know, less than one year
of age, they may have a common cold.
(17:44):
They may come in with, you know, a runny nose congestion.
Maybe that's where you should do a little distance thing in the house,
you know, wash the counters, a little bit more.
Host (17:53):
I couldn't end this podcast without asking how are you and the team
coping with the search?
Dr. Duffy (18:03):
So, one thing that we do.
Well, here is really support each other.
We have an incredible support system on each unit.
They really are a family here and I'm really proud.
We've had people who've come here for short stints and they decide to
work here, because the team is just really incredible.
(18:24):
We have holistic nurses, who help support our team members on the
front lines through
Reiki sessions, they go to the units, we have a system called tTeam
Lavender, where we've got specially trained individuals who will go to
the units to help support, particularly if there's a really
challenging case.
And ethical issue, a death of a child to really support that team
(18:47):
through that event, whether it's an emergency department, or on the
inpatient units. Our chaplains
here are just really incredible.
So there's lots of communication among our team both at the senior
level,
Well, as our throughout our leadership level down to, you know, down
to our Frontline team members and throughout all of our disciplines.
Dr. Rocker (19:10):
Yeah.
To just reiterate what Peg is saying
I think the heart in this institution is big and it's big because
we're caring for vulnerable children.
But it's big because people just like working with whom they work
with.
And so I just completely agree with what Peg is saying.
So there's a lot of camaraderie after shifts.
(19:32):
There's a lot of, you know, like oh my gosh, you know, feelings and
there's lots of text messages and, you know, you're sharing of stories
and that's what gets you through the day, is the relationship is the
camaraderie, and knowing that your team has your back.
And I think, you know, our team feels that way.
Host (19:50):
And I felt that camaraderie and teamwork and you know, it was so
palpable when I visited and toured some of the
The units with Peg
Absolutely.
Drs. Rocker and Duffy.
Thanks so much for joining us on 20-Minute Health Talk
IAnd to you the listener
(20:13):
thanks for tuning in.
I'm Sandra Lindsay
Have a great day and be safe.
Get more expert Insight from the leading voices in healthcare today.
You can subscribe to 20-Minute Health Talk wherever podcasts are
(20:35):
available.
We've gone through other types of infectious processes, but
you know, to have so many children, particularly concentrated at a
very young age to become so acutely, ill, almost at the
same time; and I've been practicing for decades.
It's been unprecedented.
(00:28):
Hello, and welcome to 20-Minute Health Talk
I'm Sandra Lindsay, today we speak with
Dr. Josh Rocker
and Margaret Duffy about the unprecedented surge of RSV cases
hitting hospitals across the U.S. as well as other winter viruses
(00:48):
Dr. Josh Rocker is the chief of pediatric emergency medicine at
Cohen Children's Medical Center.
Dr. Duffy serves as the chief nursing officer
At Cohen Children's Medical Center.
Doctors Rocker and Duffy welcome.
Dr. Rocker (01:09):
Thank you.
Dr. Duffy (01:11):
Thank you for having us today
Host (01:13):
In normal years RSV, sends thousands of children to the hospital over fall and winter
but for a second year, in a row cases of spiked early and leading to surges
of the common respiratory virus across the u.s.
So, Peg typically RSV peaks in January and February.
(01:38):
Why are we seeing this increase in the number of cases and
hospitalizations now?
Dr. Duff (01:44):
Sandra, that's a great question, and we're not 100% sure what is causing
this sudden surge in RSV but most likely it is due to what happened
during covid.
So, as everyone recalls during covid
We all went into lockdown schools were closed.
Children were really pretty much sequestered at home, so many of those
(02:05):
younger children
school-age children have had the past two years where they really
have not had the exposure that children normally do during childhood,
to have the chance to get these viruses, and to develop the
immunity.
So as we've emerged from the covid pandemic, and now we're in an
endemic phase masks are coming off.
(02:26):
We're just so happy to have socialization again.
Going to see our loved ones, our family.
Taking trips.
Many of the transportation hubs are not requiring mask.
So basically with masks off we are seeing just a resurgence in it.
The other interesting feature to it is that we've seemed to have lost
(02:46):
some seasonality.
We were seeing respiratory illnesses in July that we would normally
see around the holidays.
We believe that that's what's causing this, along with that flu.
So, we, I'm, we're going to make on behalf of
Dr. Rocker and myself a shameless plug for that flu vaccine.
So flu is very much, you know, we see in other areas of the world, our
(03:08):
conversion from moving out of RSV to flu and we are seeing our
share, our fair share of flu illnesses as well.
So get your flu vaccine.
Host (03:18):
I'm also going to make a shameless plug for the covid vaccine and the
covid boosters as well, Peg.
So thank you for that.
So, Dr. Rocker.
Can you explain
what our listeners should know about RSV.
Dr. Rocker (03:33):
So RSV stands for respiratory syncytial virus, it is a virus
we commonly see every fall and winter. For children above the age of 2,
it generally causes a cold. Adults get it as well.
And it cold causes a cold, congestion runny nose, plus, or minus
fever.
But in children under the age of 2 and more specifically under the
(03:56):
age of 1, they get something called bronchiolitis.
And bronchiolitis is different than bronchitis.
Bronchitis is when you get mucus and the bronchi and that's when
you're coughing up, you know, loogies, you know, and green mucus, but
bronchiolitis is lower down, it's in the lungs.
And so what these children get is they get fever often, cough
(04:21):
congestion.
But then they get the wheezing.
They have difficulty breathing as well.
Not everyone, but it is frequent.
So bronchiolitis is
Different than just a regular upper respiratory tract infection.
It's something that involves the lower respiratory tract as well, and
these kids can get sick.
So it's very important for people to realize because there's a lot of,
(04:43):
you know, messaging in the news about RSV.
And then the hospital's, this is a completely different entity than
covid. RSV is extremely common.
Yes, is making kids sick but it
does not carry with it, the same
Mortality or anything close to covid.
Host (05:04):
So those symptoms must be very scary for children and their parents
Dr. Rocker (05:12):
100%.
When someone is breathing hard
yes, that's very nerve-wracking to watch, and it's challenging for the
kids. And the way I describe it, is it looks like you're running a race,
but you're not running a race.
So you're pulling, you know, your lungs.
These are saying I need help getting air in, in the usual muscles
(05:34):
that work to get air in
It's usually just the diaphragm up and down, but that work isn't
sufficient because there is inflammation inside the lungs.
And so you have to recruit other muscles to help.
So if you're doing that, but there's no reason for you to be exerting
yourself
then that's because the lungs are having difficulty or a little bit to inflamed,
Host (05:56):
How is RSV transmitted?
Dr. Rocker (06:01):
So, I think we learned a lot during covid.
I think we all became, you know, virologist, and epidemiologist and
learned how things got transmitted.
We talk about airborne and, you know, tuberculosis, you know, measles
is Airborne and that's just in the air and it floats.
That is not RSV.
There's respiratory droplets, which kind of land on the ground.
(06:24):
And then there's contact transfer and RSV is mostly contact
transfer.
But a little
bit of respiratory droplet as well.
But it's basically it's on the countertop.
It's not a toy, it sounds something it's on the doorknob and you know,
children the way they interact with the world, they love to touch
things, they'll have to put things in their
(06:46):
mouth and so if you're in day care or if your older sibling, you know,
is in daycare and gets RSV, you know, and then comes home and they
sneezing and touching things.
That's how the child is going to get it as well.
Dr. Duffy (07:00):
Sandra, that's a really good message to the folks who are listening today.
In terms of minimizing the potential for spread for RSV in the
respiratory viruses, hygiene practices are so important.
We do a lot of education with parents and caregivers around hand hygiene
What we all learned in kindergarten washing
(07:21):
your hands is so important.
So making sure when you children come home from school or they come
home from the playground or when they're out with their friends
making sure that they are washing their hands, not touching their face and
minimizing that.
And if that happens then doing this simple hand hygiene, we all get
concerned here at the hospital as we go into holiday season.
(07:43):
We're looking forward to spending our time, with our friends and
family, you know.
We there's so much burnout from covid that you really want to have
those warm family, gatherings, as we look forward to Thanksgiving, and
then the December holidays, but we really encourage families.
Particularly those, with the very young infants, under two months of
age to really think about who's being exposed to the very young and
(08:07):
the Very Old, the opposite ends of the spectrum, are those individuals
at risk.
So as much as we want to be together, I think the message is to try to
be smart and to protect particularly those, those young infants.
Host (08:20):
It also sounds like it would be beneficial to just have a routine of
wiping down or surfaces as well.
Dr. Rocker (08:29):
Yeah, I think that definitely makes sense.
And one thing about the hand hygiene that we talked about, we say
washing hands, but the most important because I think a lot of times
people put the soap in the palm of their hand, rub their palms
together, and then wash it off.
But it's the fingers that come to our noses, come to our mouths, come
to our eyes.
So, it's actually washing fingers that are the most important part
of the hands.
Host (08:51):
What are some supportive
kind of therapies that you're using?
Dr. Rocker (08:57):
That's a term, that's used a lot.
We don't have any treatments
but we give you supportive care, and I just want to clarify
what that means.
So treatments, stop the virus, kill the virus, we don't have that.
But supportive care is, if your oxygen is low, I'll give you oxygen.
(09:17):
If you're dehydrated I'll give you fluids if your lungs are working so hard
I could put you on machines that make breathing easier for you.
So we support you
nd your body until the virus goes away and you recover.
So if there's really poor feeding, difficulty breathing, we definitely
(09:39):
want to see those children, but if it's fever and otherwise they seem
to be doing well, that's certainly something
That we could follow with your pediatrician, but there's
not necessarily the urgency to come to the emergency department,
unless you're, you know, below, a certain age, if you're below 2 months
and you have a fever, you do, once you in the emergency department,
Host (09:58):
So, how do you make the diagnosis?
So the diagnosis of RSV specifically RSV is a respiratory viral swab
that we do and then it will tell us if it's RSV.
However, I don't want the audience to think that RSV is the only virus
that causes bronchiolitis.
(10:19):
Bronchiolitis can be caused by a bunch of other viruses, but right
now, the large majority of the children that we're seeing with chronic
bronchiolitis, are, in fact, RSV
So, who is most at risk for severe RSV?
Dr. Rocker (10:37):
So, great question, those who are most at risk, as we
mentioned, where those, under the age of 1 specifically, even
younger and then premature babies as well are at higher risk.
We are seeing some older kids who may have complex medical conditions
who are a little bit more fragile when they get
(10:59):
RSV, it may be more challenging for them, but it's really the younger
kids that were most concerned about.
Host (11:06):
As an adult, should I be concerned about RSV, generally?
Dr. Rocker (11:13):
No, but as an adult who has children or has children who has
children, that's something that you should be a little bit thoughtful of
And I mean, I just want to stress one thing.
You know, we're busy.
We have never seen higher numbers in our emergency department ever.
(11:36):
And I'm saying, you know, by 50% more than extremely busy times.
So in regards to the public health message to the adult, it's be
thoughtful about the children because we're in a crisis right now.
Host (11:52):
So when did we really start to see RSV hit this year?
Dr. Rocker (11:59):
I would say
four weeks ago is trickling in and then three weeks, it really
started taking off. December, is kind of, when traditionally flu comes
in a little bit more with a Vengeance.
We're expecting even higher numbers then.
So RSV tends to be a little bit of a hump, not a big spike.
So we anticipate RSV to still be around well into December and Jenny,
(12:25):
And we know it's going to be overlapping with flu at that point as well
Host (12:30):
So Dr. Rocker, do you think the high number of infections you're seeing will
be a one-time event or a new normal? Is the pattern of the virus
changing?
Dr. Rocker (12:41):
We're not certain.
We know as Peg mentioned last year was different than this year, this
year is a little bit closer to normal, but definitely abnormal and I
think we suspect that we will Trend back to the old ways just because
the logic with
Covid, is that we weren't socializing?
(13:02):
And now we are socializing. Covid didn't change viruses.
So I suspect strongly suspect that next year.
Barring any other, you know, social bizarre phenomenon, that will
probably be back on par.
Host (13:21):
Peg and Dr. Rocker
Have you seen anything like this in your practice before?
Dr. Duffy (13:28):
No, not at all.
You know, we've gone through H1N1, we've gone through, you know, other
types of infectious processes.
But, you know, to have so many children, particularly concentrated at
the very young to become.
So, acutely, ill and almost, you know, almost the same time and, you
(13:49):
know, sometimes we describe it as a tsunami and it comes in waves, you
know, we might have maybe 12 hours where the volume is a little,
bit less, which actually we say you know we take a breath and we say
well that you know 12-hour volumes
hat's not so bad.
That would have been a busy day
2 years ago, right?
So so everything is relative but to be honest now this is something
(14:11):
I've been practicing for decades, it's been
unprecedented.
Dr. Rocker (14:16):
Yeah, I mean I remember when we set up flu pods in the 2018-2019 flu
season and flu that was really much more an outpatient.
burden where we had so many patients coming in who are
concerned.
And, you know, they generally were fine and they're saying with H1N1,
(14:37):
The Atrium of the Children's Hospital basically became you know, a
testing center and Urgi-center, but it didn't impact the, the
admissions nearly as much as this is right now
To Peg's point
I have never seen us borrow space from the adult side and we just
(14:58):
Really needed it.
When we were
received it
So it's a different entity than we've seen in the past.
Host (15:04):
Can you talk to us a little bit about your strategies to manage the
volume?
Dr. Duffy (15:09):
So last year, we did quite a bit of planning predicting almost what
you can't predict, but seeing that we had lost some seasonality as a
leadership team.
We came together and said how can we if this comes and in a wave that
that may be unexpected, how can we be ready for it?
(15:30):
So we had hired up.
We looked at all of our alternative spaces.
We looked at our surge plans and said, how can we become more flexible
and Nimble?
So what we've ended up doing is having a lot of satellite spaces.
We borrowed a unit from our LIJ Medical Center friends.
They've been very gracious we've repurposed areas here within Cohen's
(15:52):
for the Emergency Department.
We've had to step up, we've been doing this for months now so that we
are positioning ourselves.
Selves to provide that quality care that we are known for and
but it's been challenging.
It's been very challenging and as we see the severity of
illness go up it is a challenging concern
Host (16:15):
Dr. Rocker, what role does
covid and influenza play in this RSV surge?
Dr. Rocker (16:23):
Covid hasn't left us.It is a smoldering virus that is there.
We still have patients who are admitted with covid.
It is certainly not overwhelming our numbers but it's a presence and
influenza currently is on the rise.
We're definitely seeing it in some patients.
I expected to be a much more significant thing in the weeks to come
Host (16:51):
Dr. Rocker, what can parents do to keep their children out of the hospital to
prevent their kids from getting RSV?
Dr. Rocker (17:01):
So with kids going to school, it's hard to prevent RSV, you know,
transmitting in the community and you know, we're happy that kids are
in school and we're happy that kids are without masks and we're happy
that they're developing normally in an appropriate environment.
And it's not just kids, it's specifically the young kids, right?
(17:24):
The ones that are being hospitalized are the ones that are you know,
No, the newborns the, you know, under one year of age, so be more
cautious with those kids and, you know, for those siblings, you know,
in a household who have a child who is, you know, less than one year
of age, they may have a common cold.
(17:44):
They may come in with, you know, a runny nose congestion.
Maybe that's where you should do a little distance thing in the house,
you know, wash the counters, a little bit more.
Host (17:53):
I couldn't end this podcast without asking how are you and the team
coping with the search?
Dr. Duffy (18:03):
So, one thing that we do.
Well, here is really support each other.
We have an incredible support system on each unit.
They really are a family here and I'm really proud.
We've had people who've come here for short stints and they decide to
work here, because the team is just really incredible.
(18:24):
We have holistic nurses, who help support our team members on the
front lines through
Reiki sessions, they go to the units, we have a system called tTeam
Lavender, where we've got specially trained individuals who will go to
the units to help support, particularly if there's a really
challenging case.
And ethical issue, a death of a child to really support that team
(18:47):
through that event, whether it's an emergency department, or on the
inpatient units. Our chaplains
here are just really incredible.
So there's lots of communication among our team both at the senior
level,
Well, as our throughout our leadership level down to, you know, down
to our Frontline team members and throughout all of our disciplines.
Dr. Rocker (19:10):
Yeah.
To just reiterate what Peg is saying
I think the heart in this institution is big and it's big because
we're caring for vulnerable children.
But it's big because people just like working with whom they work
with.
And so I just completely agree with what Peg is saying.
So there's a lot of camaraderie after shifts.
(19:32):
There's a lot of, you know, like oh my gosh, you know, feelings and
there's lots of text messages and, you know, you're sharing of stories
and that's what gets you through the day, is the relationship is the
camaraderie, and knowing that your team has your back.
And I think, you know, our team feels that way.
Host (19:50):
And I felt that camaraderie and teamwork and you know, it was so
palpable when I visited and toured some of the
The units with Peg
Absolutely.
Drs. Rocker and Duffy.
Thanks so much for joining us on 20-Minute Health Talk
IAnd to you the listener
(20:13):
thanks for tuning in.
I'm Sandra Lindsay
Have a great day and be safe.
Get more expert Insight from the leading voices in healthcare today.
You can subscribe to 20-Minute Health Talk wherever podcasts are
(20:35):
available.
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