By Michelle Crouch

Co-published with Charlotte Ledger

Jamie Sweeney of Charlotte, a former pediatric nurse, didn’t worry too much when her 7-week-old baby Sully first developed a cough. But over the next few days, Sully’s coughing got worse, each episode rattling his tiny body.

When Sully stopped eating and started acting lethargic on Oct. 10, Sweeney knew her son needed medical attention.

By the time they got to Atrium Health Levine Children’s Hospital, Sully had spiked a fever. Sweeney tried not to panic. 

The emergency room was “absolutely packed,” she said. “It was a madhouse.”

An hour and a half later, Sweeney was still sitting in an overflow waiting room, and no one had looked at her son.

“I felt completely helpless,” Sweeney said. “It was a nightmare.”  

Two and a half years after COVID-19 first arrived, doctors across the state are now sounding the alarm about surges in other types of respiratory illnesses, especially among children. The percentage of emergency room visits from people with influenza-like illnesses is double what is typical for this time of year, according to state data.

The spike in illness has doctors scrambling to find pediatric hospital beds, as high numbers of sick children land in hospitals. Several health systems across the state, including Atrium and Cone Health in Greensboro, have had to divert kids to other medical centers recently because their beds have filled.  

“All of us have been struggling with capacity,” said Sameer Kamath, a pediatric critical care medicine specialist at Duke University Health System, referring to the limited number of hospitals statewide that have pediatric beds. 

“Every time I think we’ve hit the peak, it keeps rising,” Kamath added. “It’s unrelenting. When you’re in the throes of bed management, it seems like every day is a peak.”

Mike Cinoman, medical director of the pediatric intensive care unit at Cone, described his ICU this way: “We are drowning in children with respiratory illnesses. This has been an onslaught, much earlier than we usually see it.”

Another COVID-19 consequence 

Precautions such as social distancing and wearing masks during the pandemic didn’t just slow the spread of COVID-19; they also prevented the spread of other respiratory illnesses. The 2020 flu season was mostly a non-event, for instance.

Now that most of those measures have been dropped, those illnesses are back.

Young children are particularly susceptible because some of them haven’t had any exposure to viruses at all, said David Weber, a professor of medicine, pediatrics and epidemiology at UNC Chapel Hill.

In a typical, non-pandemic year, the average child picks up eight infections, most of them respiratory, Weber said. Those infections “don’t give you long-lasting immunity, but you do get some immunity that helps protect you,” he said.

A “mixed bag” of viruses

The surge in illness in North Carolina is being caused by several different viruses, including rhinoviruses (responsible for most cold-like illnesses), enteroviruses, respiratory syncytial virus (RSV) and influenza, said State Epidemiologist Zack Moore.

“A couple of months ago, if someone had a cold, I’d tell them, ‘That’s COVID,’” Moore said. “That’s not the case anymore. It’s much more of a mixed bag.”

State and national data reveal that flu activity has been rising for the past few weeks – possibly portending an early flu season that may peak in late 2022 instead of in the early new year, when it usually tops out.  (Australia’s flu season peaked two months early, and what happens there often – but not always – predicts the flu season here.)

StarMed, which has urgent care clinics in Charlotte, Asheville and Jacksonville, has seen a recent spike in patients testing positive for influenza, said Chief Medical Officer Arin Piramzadian. “We always pick up some flu cases in October, but we’re seeing more than normal,” he said.

At Appalachian State University in Boone, significant numbers of people have tested positive for influenza A, said Margaret Bumgarner, administrative director of the university’s student health service. 

“The number of flu cases we have seen from mid-September to mid-October is consistent with numbers we would more typically see in January and February,” she said, noting that the university has offered three flu vaccine clinics for students. 

RSV and why it’s dangerous

Although the rise in flu cases is a concern, the respiratory virus landing the most kids in the hospital right now is RSV, doctors said. Statewide, RSV cases are already at peak levels typically seen in colder winter months, Moore said, and the trend shows no signs of slowing down.

Atrium Health said Levine Children’s Hospital has averaged five to 10 cases of RSV each week since mid-August, but cases have tripled within the past week, with 31 patients admitted. 

In most adults and older kids, RSV causes typical cold symptoms such as coughing, congestion, a runny nose and a fever.

However, RSV can be dangerous for infants, the elderly and anyone with a breathing or cardiac ailment because it can inflame the small airways in the lungs, creating a condition called bronchiolitis, said David Priest, senior vice president and chief of safety, quality and epidemiology at Novant Health.

“When your airways are small and you get infected by RSV, that inflammation can have a dramatic impact on your ability to breathe,” Priest said. “We have a number of children in the hospital right now with bronchiolitis and RSV infection.”

Doctors this year have also been seeing more toddlers with severe RSV, said Rhonda Patt, medical director of Atrium Health Levine Children’s Charlotte Pediatrics. That’s probably because they were infants during the pandemic, so they didn’t get a chance to develop any natural immunity to RSV because they were exposed to fewer other children in daycares and school settings, she said.

Most kids who are hospitalized with RSV are treated with intravenous fluids and oxygen support, Kamath said. There is also an antiviral treatment that is reserved for those who are immunocompromised. “Thankfully, most (children) shake it off in 24 to 48 hours and are able to go home looking like they used to,” he said.

What parents should know

If your child is three months old or younger, the American Academy of Pediatrics says it’s important to call your pediatrician at the first sign of illness. “With young babies, it may be hard to tell when they are very sick,” the academy says. “Colds can quickly become dangerous problems.”

In older children, the academy says you should call a doctor if you notice:

  • Any signs of breathing trouble, including blue lips or nails, nostrils that get larger with each breath or if the skin above or below their ribs sucks in with each breath
  • Nasal mucus that lasts longer than 10 days
  • A cough that lasts more than a week
  • Ear pain
  • A temperature over 102 degrees Fahrenheit
  • Excessive sleepiness or irritability

To protect your family from RSV and other respiratory illnesses, experts stressed the same precautions we all learned during the pandemic: keep your distance from others, wash your hands regularly (RSV in particular lives on surfaces, Priest said), and consider wearing a mask, especially if you are in a crowded indoor location.

Also, make sure your kids get their flu shots and COVID boosters, doctors said, because both influenza and COVID cases are expected to rise as the weather cools.  

“Unfortunately, I think these are the good times right now,” Moore said. “I think we are going to start seeing both more COVID and flu in upcoming weeks.”  

A six-hour wait

As for Sully, he tested positive for two different respiratory viruses, RSV and rhinovirus. It took six hours for him to be called in the ER, his mom said, even though the nurses who triaged him said he was a top priority because of his age. 

Sully was ultimately admitted to the hospital and spent five days there. He received oxygen support to help with his breathing, and he also had a feeding tube and an IV for fluids.  

“I’ve never cried so much in all my life,” Sweeney said.

Sully finally came home last Sunday, and despite a little cough, Sweeney said he is acting like himself again.

“For sure, those were the worst few days of my life, but I am so grateful he is ok,” Sweeney said. “Now I’m worried about reinfection and what the rest of the season is going to bring.” 

This story was produced as part of a partnership between North Carolina Health News and the Charlotte Ledger to produce health care reporting focused on the Charlotte metropolitan area.

Republish our articles for free, online or in print, under a Creative Commons license.

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