Last year, as Alaskans braced for a COVID-19 surge that could stress the state’s medical system, things were oddly quiet at Dr. Matt Hirschfeld’s unit at the Alaska Native Medical Center in Anchorage.
Hirschfeld works in pediatrics. And the typical respiratory viruses that send children to the hospital — flu and respiratory syncytial virus, or RSV — had been vanquished, temporarily. Alaskans’ adherence to COVID-19 masking and social distancing recommendations nearly eliminated other viruses, too.
“Our pediatric intensive care unit doctors were offering their services to the adult ICU,” Hirschfeld said. “They were so much more busy than pediatrics was.”
This year, with kids returning to school and Alaska communities relaxing their coronavirus prevention measures, Hirschfeld and his colleagues around the state are expecting a very different winter — though they’re not quite sure how much different.
They’re expecting RSV and the flu, which can stress the state’s limited pediatric hospital capacity in normal years, to return. And now there’s the added layer of COVID-19, which generally hits adults harder but in rare cases can send small children to the hospital, too.
“How good is your crystal ball?” asked Dr. Laura Brunner, a pediatrician in Fairbanks. “The biggest concern is the combination of all of it.”
Alaska pediatricians say they still expect to be able to manage whatever surge in respiratory viruses hits them this winter. But the COVID-19 pandemic is adding a measure of uncertainty to those expectations because of its potential to sicken more kids and to divert scarce staff to the crush of sick adults that’s come close to overwhelming the state’s hospitals.
For those reasons, doctors say it’s especially important this year for kids and their family members to get the COVID-19 and flu vaccines, which can keep them out of the hospital and cut down on household transmission. Mask-wearing, hand-washing and social distancing will all help, too.
“To have a self-inflicted respiratory catastrophe, when we have months and months and months to prepare and see it coming, would just be unimaginable,” said Dr. Rob Lovrich, who cares for kids at two Anchorage intensive care units. “The solution is right there. It’s hanging 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.
Staffing by both doctors and nurses can also often be a limitation. There are only four pediatric intensive care specialists who live in Alaska, Lovrich said.
“If one of us gets sick, we have an obvious staffing issue,” he said. “If one of us makes the mistake of going over to the other’s house for dinner, and we both get sick, now we’re in a crisis.”
Alaska’s pediatricians are used to getting creative to manage those limitations.
Sometimes they take the unusual step of medevacing kids from Anchorage to hospitals with lower levels of care to make more room at the hospitals with ICUs.
And during a particularly bad surge of respiratory virus on the North Slope, stressed Anchorage hospitals once sent specialists to the region to train caregivers on treatments so that fewer kids would have to be transferred to Anchorage, Hirschfeld said.
Pediatricians, in interviews, said the coronavirus pandemic threatens to stretch their capacity further. Nurses or respiratory therapists, who are already in short supply, may have been pulled away to care for adults.
And hospitals in Seattle, Oregon and Utah, which sometimes serve as relief valves if Anchorage’s pediatric units get too busy, are tighter than in the past, Hirschfeld said.
“It may be more difficult to send kids out,” he added.
As Alaska experiences one of the nation’s worst COVID-19 outbreaks, pediatricians say they’re already seeing more kids being admitted to hospitals with the coronavirus.
But it’s not clear how much of an additional burden COVID-19 will present over the course of the winter. And both flu and RSV, which mostly affects newborns and infants, are also big unknowns.
American pediatricians can look to Australia — where the seasons are offset from North America’s — as a preview of what kind of respiratory viruses to expect during the winter here. And RSV cases in Australia rebounded sharply as residents emerged from stay-at-home and quarantine orders.
U.S. Centers for Disease Control and Prevention leaders, meanwhile, warned this week of a severe impending flu season, potentially because Americans built up less immunity than usual last winter.
“What concerns us with this upcoming season is we already have so much COVID. And we haven’t even hit the peak or the entrance to our flu and RSV season,” 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 blunt any impending surges.
Anyone six months and older can get the flu shot. And the Pfizer-BioNTech vaccine is available to children age 12 and up.
Those drug companies this week also filed their formal request with drug regulators to start giving the shots to kids between ages five and 11. Approval could come as soon as next month.
But pediatricians stress that the more family members 12 and older can get vaccinated now, the less likely it is that they will bring COVID-19 from schools or other settings back to their unvaccinated relatives.
And more adult vaccinations will cause less stress on hospital staff, they added.
“It’s a community,” said Nace. “It’s not just the adults. It’s not just the kids. It’s everybody.”