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May 13, 2023

COVID plus flu and RSV spike puts Bay Area hospitals under strain

Bay Area pediatric hospitals are seeing a rise in cases of the respiratory

Bay Area pediatric hospitals are seeing a rise in cases of the respiratory syncytial virus, or RSV.

UPDATE: What are the chances of COVID reinfection during the holidays? Here's what you need to know.

Bay Area health officials on Wednesday said a substantial increase in flu activity and other respiratory viruses since the start of the month has led to a spike in emergency department visits and is putting a strain on health systems across the region.

"This is the first year where we’re not only facing COVID but also increased influenza activity and unusually high levels of RSV," Dr. Sarah Rudman, deputy health officer for Santa Clara County, said during a press briefing. "These are two other types of viruses that can also cause possibly the same respiratory symptoms as COVID, but can also cause severe respiratory disease — or even life-threatening disease."

The Santa Clara County health department said that the percentage of emergency department visits for influenza-like illness is three times higher this year than it was during the 2019-2020 flu season, before the start of the COVID-19 pandemic. In response, the agency has launched a wastewater data dashboard to monitor flu concentration in the county — one of the first of its kind in the U.S.

The tool, which is used extensively to monitor coronavirus levels, serves as an early warning system for hospitals and health care systems.

"Right now, the wastewater are showing rising levels of flu in every part of our county — in every sewershed that we monitor," Rudman said.

Bay Area pediatric hospitals are seeing a rise in cases of the respiratory syncytial virus, or RSV, a common viral illness that can cause breathing trouble for infants and young children, and in older adults. It's part of a nationwide surge that has grown particularly severe in some parts of the country.

On Monday, California health officials reported the first death of a child under age 5 who was infected with flu and RSV. The state's public health department did not disclose where the death occurred. and it's not clear which virus caused the death.

"We have seen an abrupt increase in all of our RSV cases," Dr. Vidya Mony, a pediatric infectious diseases specialist at Santa Clara Valley Medical Center, said during Wednesday's briefing. "If you look at a lot of the curves, it's almost linear. This is significantly more than we have seen in quite a few years."

The UCSF Benioff Children's Hospitals are tallying "very high volumes" of respiratory illnesses including RSV, said chief medical officer Dr. Joan Zoltanski.

"As soon as a bed opens right now, there is someone waiting to take that bed," she said. "In the emergency room we have many patients, and the patients who are there without a need for very emergent care are waiting much, much longer than normal."

On Wednesday, Tamalpais Pediatrics, which has several clinics in Marin County, sent out an advisory to its customers that said, "We are experiencing an unprecedented volume of calls, portal messages and visits."

Dr. Nelson Branco, of Tamalpais Pediatrics, said its offices usually receive 200-300 calls and 100-120 visits on a Monday at this time of year. The practice received over 500 calls Monday and is seeing 170-180 patients daily this week, with those for same-day care mostly for respiratory illness, Branco said.

"A couple weeks ago it was high. Now it's at a point that I’ve never seen in my more than 25 years of practice," Branco said.

The volume has not equated to more severe cases of infections, Branco said, but "the few that we’ve needed to send to the hospital, we’ve struggled to find them a place."

Branco noted that after an early surge in RSV cases, the practice saw more flu cases over the past week or two.

"Those who are the sickest in our office, at all ages, have been testing positive for influenza," he said.

"In the past couple of weeks, both in our in-patient and our out-patient settings, we have seen an acute surge of patients," said Mony. "The predominant cause for these hospitalizations are secondary for respiratory viruses, specifically RSV."

RSV cases dropped dramatically in 2020, the first year of the pandemic. But they surged last summer as COVID restrictions eased. While this year's uptick got off to a slower start, positive tests have recently exceeded the numbers from this time last year, according to Centers for Disease Control and Prevention data.

Mony added, "I’ve also seen an uptick in COVID-19 infections in our pediatric patients in the past couple of weeks."

While vaccines for flu and COVID-19 are widely available, there are no shots available to prevent RSV. Health officials instead urge Bay Area residents to follow the measures that also curb the spread of COVID-19 — washing their hands often, wearing masks when indoors, and keeping people who are sick at home as much as possible.

"While all of these viruses can sometimes cause milder illnesses in most older children or younger adults, they’re all especially dangerous for our youngest children, our oldest adult community members, and people with other medical problems," Rudman said. "Right now, we are already seeing these diseases hit our youngest children."

Aidin Vaziri and Matt Kawahara are San Francisco Chronicle staff writers. Email: [email protected]; [email protected]