Estefani L贸pez鈥檚 11-month-old baby was struggling to breathe. The little girl, Ava Rivera, had contracted COVID-19 and began having seizures. Then her pulse weakened. Her mom couldn鈥檛 feel her taking breaths anymore.
L贸pez rushed her to an emergency room where the staff began initial treatments, putting tubes down her throat to pump her lungs with oxygen. But the baby鈥檚 condition required care at a pediatric hospital, and none of the ones in the Houston area could take her in. They were all full.
Instead, L贸pez had to watch as hospital staff placed her baby in a helicopter to be airlifted 150 miles away to Temple for emergency care at the nearest children鈥檚 hospital with space. L贸pez spent the next three hours driving to the hospital, praying her baby would survive.
鈥淚 felt like my heart fell out of my chest. I didn鈥檛 know what was happening for three hours,鈥� L贸pez said. 鈥淚t felt like it was three days.鈥�
More children are being treated in Texas hospitals for COVID-19 than ever before. But there鈥檚 a second factor that is putting pediatric hospitals on the path to being overwhelmed: an unseasonable outbreak of respiratory syncytial virus, or RSV, a highly contagious virus that can require hospitalization mostly among children 5 years and younger and especially infants.
During the last year, RSV was largely dormant, which experts believe was due to people masking up during the pandemic. Now, in just the last several weeks, thousands of Texas children have tested positive for the virus.
In addition, the delta variant of COVID-19 appears to affect unvaccinated children more often than previous variants. It鈥檚 unclear if children are also becoming sicker from it than from other variants of COVID-19. And with the regular flu season approaching, medical experts are concerned over how hospital capacity could be affected.
From the start of the pandemic through Aug. 9, over 5,800 children in Texas have been hospitalized with COVID-19, according to the Centers for Disease Control and Prevention. There were 783 children admitted to Texas hospitals with COVID-19 between July 1 and Aug. 9. Nationwide, nearly 94,000 children contracted COVID-19 last week, according to the American Academy of Pediatrics and the Children鈥檚 Hospital Association.
L贸pez鈥檚 daughter is doing OK now. Doctors replaced the intubation treatment with a nasal tube, her fever broke and she was able to go home the next day. But the situation in children鈥檚 hospitals continues to worsen. In Texas, it鈥檚 getting harder and harder for those hospitals to meet the combined demand for beds for COVID-19 and RSV patients as well as children with other conditions or injuries. And physicians fear what will happen with the reopening of schools, with far fewer children masked and far more attending in person than last year.
鈥淲e鈥檙e seeing a significantly greater number of children who are being hospitalized with COVID-19. Some are requiring ICU care, more than we鈥檝e seen with previous surges, and that鈥檚 related to the increased transmissibility of delta,鈥� said Dr. Seth D. Kaplan, president of the Texas Pediatric Society. 鈥淭his is just a more aggressive variant. It鈥檚 sickening more children, and requiring more to be hospitalized. So that, on top of the RSV, is what鈥檚 really causing the capacity issues.鈥�
鈥淚t is spreading like wildfire,鈥� said Dr. Jim Versalovic, pathologist-in-chief and interim pediatrician-in-chief at Texas Children鈥檚 Hospital in Houston. 鈥淒uring the past several weeks, Texas Children鈥檚 has been escalating strategies in terms of dealing with this dual surge.鈥�
The hospital has extended its urgent care hours. Doctors are postponing elective surgeries that require a postoperative bed. Staff members are opening new units within the hospital and working overtime to meet the demand. Within Texas Children鈥檚, more than 45 children were hospitalized with COVID-19 on Wednesday, and hospital staff members have diagnosed over 1,600 cases of RSV. Around 90% of the hospital鈥檚 COVID-19 positive patients 鈥� all children and adolescents 鈥� contracted the delta variant.
Approximately half of Texas Children鈥檚 RSV and COVID-19 patients are infants.
The influx of RSV cases during the summer came as a surprise to physicians, who normally see the spread later in the year. Versalovic said southern states are experiencing the surge of RSV, while children鈥檚 hospitals in other regions are reacting to increased hospitalizations from COVID-19.
What鈥檚 worse, Versalovic said his hospital has identified 25 children who have both RSV and COVID-19. While he鈥檚 confident that his hospital system can effectively treat these cases, it鈥檚 a new phenomenon, and doctors are unsure of what to expect. Over half of those diagnosed with both viruses have been hospitalized 鈥� a hospitalization rate much higher than for either virus alone.
鈥淲e鈥檙e certainly concerned about it 鈥� . We鈥檝e never seen this before,鈥� Versalovic said. 鈥淲e are concerned that [the double-diagnosis cases] may be more severe.鈥�
Meanwhile, adult hospitals are facing a crisis of their own, as rising numbers of COVID-19 patients fill intensive care units across the state. Staff shortages are compounding the problem as more adults 鈥� the vast majority of them unvaccinated 鈥� are being hospitalized with the delta variant. In the most recent federal numbers reported last week, 53 hospitals in Texas had completely run out of beds in intensive care units; the situation has likely worsened since then.
Last summer, children鈥檚 hospitals helped by taking some of the overflow of non-COVID adult patients from nearby hospitals during the worst of that stage of the pandemic. But now that children鈥檚 hospitals are facing crises as well, that will likely no longer be an option.
鈥淲e are preparing for a very challenging period in the weeks ahead, and we must anticipate, with the beginning of the school year, many more pediatric and adolescent COVID cases,鈥� Versalovic said. 鈥淲e cannot have any plans to take adult patients and offload neighboring hospitals, because we need to keep those beds reserved for the children and families we serve.鈥�
The delta variant is believed to be at least twice as transmissible as previous variants of COVID-19 and has primarily ripped through unvaccinated populations. A large segment of those unvaccinated are children under 12 who aren鈥檛 yet eligible to be vaccinated. Even among 12- to 15-year-olds in Texas, who are old enough to get the shot, less than 27% are fully vaccinated.
Versalovic said that even when the vaccines are approved for children under 12 鈥� with best-case estimates suggesting it could be late September or early October 鈥� it would take weeks or even months for that to slow down the surge.
Parents should focus on masking their children and getting them vaccinated if they are eligible, said Kaplan, the pediatric society president. The vaccine remains the most effective defense against the virus. Even in rare breakthrough infections where vaccinated people contract COVID-19, they still are largely protected from hospitalization.
鈥淲e know that COVID-19 can be transmitted through populations of children. We know that many of them are not vaccinated, and many aren鈥檛 even eligible for vaccination,鈥� Kaplan said. 鈥淎nyone who has not been fully vaccinated should be wearing a mask when they鈥檙e in an indoor public setting and social distancing themselves.鈥�
Dr. Mary Suzanne Whitworth, director of pediatric infectious diseases at Cook Children鈥檚 hospital in Fort Worth, said her facility has seen sharp upticks in RSV and COVID-19 as well. Cook has seen around 200 cases of RSV each week for the last month.
鈥淚 think that really everyone, nationally, was surprised at how much RSV happened this summer. It鈥檚 the first time it鈥檚 ever happened like this,鈥� she said.
Although earlier in the pandemic some thought children were less likely to catch COVID-19, Whitworth says parents need to keep their guard up with the emergence of the delta variant. On Tuesday, there were two dozen children hospitalized with COVID-19 at Cook Children鈥檚, according to data from the hospital.
鈥淐hildren do have some risk of severe disease,鈥� she said. 鈥淐hildren, in general, do pretty well with COVID 鈥� but there are plenty of children who do not. And you never know who will or not.鈥�
Estefani L贸pez said she hopes people hear her and her daughter鈥檚 story and take action to protect their own children and other people鈥檚 children. She fears for other parents now that children鈥檚 hospitals are becoming so overcrowded.
鈥淢y daughter is so small. She could鈥檝e died,鈥� she said. 鈥淚 hope people take this seriously.鈥�
Correction, Aug. 12, 2021: An earlier version of this story overstated the number of children who have been hospitalized in Texas recently with COVID-19. The story said over 5,800 children had been hospitalized during a seven-day period in August, according to the Centers for Disease Control and Prevention. That number correctly referred to children hospitalized with COVID-19 since the pandemic began. In actuality, 783 children were admitted to Texas hospitals with COVID-19 between July 1 and Aug. 9 of this year.