2022 Pediatric Respiratory Surge Event Situation Report #9

2022 Pediatric Respiratory Surge Event #9

Healthcare Ready is ENGAGED for this event. We are monitoring potential concerns for supply chain disruptions and impacts on healthcare services.

Highlights and Key Updates

  • This will be the last situation report for this event for 2022. Reports will resume on a biweekly basis starting January 5, 2023.
  • Pediatric units in hospitals remain strained across the US. While some states have seen improvements, pediatric bed utilization is high overall, with 17 states reporting over 80% pediatric beds in use.
  • RSV has peaked in some areas of the US, and influenza shows signs of plateauing at the national level. However, many jurisdictions continue to experience high hospitalization rates, and clinicians are concerned about additional surge following winter holiday travel and gatherings.
  • Cases of and hospitalizations due to COVID-19 continue to rise. 
    • If COVID-19 hospitalizations continues to trend upward, further strain on healthcare infrastructure and workforce may impact patient care. In previous seasonal surges of COVID-19, workforce surge capacity was offset due to lower numbers of pediatric cases (e.g., in 2020). However, with both pediatric and adult clinicians experiencing high case and hospitalization burdens, there is little to no margin for workforce to augment populations they do not typically care for.  
  • As of 12/21, there is no response to AAP and CHA’s 11/15 letter calling for government officials to declare a public health emergency for RSV. Federal officials point to the lack of local and state requests for an emergency declaration through departments of health and mayoral/gubernatorial offices.
  • Healthcare Ready developed a report explaining how emergency declarations can strengthen public health capabilities and surge capacities in this response. Healthcare Ready recommends that healthcare systems advocate for local declarations to access immediate resources at the state and regional levels.
  • On 12/15, the White House announced its COVID-19 Winter Preparedness Plan. The Plan focuses on expanding access to COVID-19 testing, vaccinations, and treatments. The plan notes that HHS Secretary Becerra sent a letter to all governors regarding actions to take to prepare for COVID-19 surge and reminding them of the federal support available for their responses.
  • On 12/20, CDC’s Health Alert Network (HAN) issued the alert, “Important Updates on COVID-19 Therapeutics for Treatment and Prevention.”  
  • On 12/22, CDC’s Health Alert Network (HAN) issued a Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections.
  • Amoxicillin and oseltamivir remain on ASHP and FDA shortage lists.
  • On 12/21 , HHS/ASPR announced that Tamiflu will be released from the Strategic National Stockpile and other sources to states and territories that request it.
  • Oseltamivir Oral Suspension and Capsules of various sizes from 10 different companies remain on the ASHP shortages list, but are not yet on the FDA list. According to ASHP: Ajanta and Alembic have oseltamivir available to contracted customers. Alvogen has oseltamivir suspension and capsules available. Genentech has Tamiflu presentations available and is reviewing orders. Strides has oseltamivir capsules available.
  • The two largest pharmacy chains, CVS and Walgreens have started implementing limitations on purchasing children’s pain relief and fever reducing over the counter medicines. These measures are meant to protect supply of these products, which are not yet in shortage but are experiencing localized disruptions due to demand. CVS purchases are restricted to two items online and in-store, and Walgreens is limiting buys to 6 items online (in-store purchases are not limited).
  • Healthcare Ready is regularly updating a map showing HHS data on pediatric hospital bed utilization. The map was last updated with data from 12/21. 
  • Healthcare partners are reporting that many facilities are compared to the number of licensed beds for a facility, instead of staffed and equipped beds. This may be artificially inflating bed availability in many places experiencing staffing and equipment shortages. Healthcare Ready is working to develop a new model for bed availability reporting but will report official data in the meantime. Our mapping tool notes this complication.

Assessment of Healthcare Logistics Impacts

Background

The confluence of respiratory illnesses is creating a surge in severe clinical presentations and hospitalizations that threaten healthcare delivery systems. Influenza and RSV activities are higher than usual for this time of year, due to relaxed pandemic-related preventative measures. 
 
Healthcare Ready is working to understand these impacts to best support communities with the greatest needs.

Pediatric Hospitalizations
  • Pediatric units in hospitals remain strained across the US. While some states have seen improvements, pediatric bed utilization is high overall, with 17 states reporting over 80% pediatric beds in use.
  • As of 12/21, 71.85% of pediatric beds are occupied (+2.11 percentage points from 12/13), with four states reporting bed utilization above 90%. Bed utilization estimates may be underestimated due to low participation from hospitals reporting into HHS TeleTracking. For 12/21 data, 69% of US hospitals were reporting. Local capacity may vary drastically within a given state as not all hospitals report data. As such, hospital capacity is likely more strained than reflected in the available data.
  • As of 12/21, states with the highest rates of in-patient pediatric bed utilization are: Idaho: 95.31% (-49.43 percentage points), Nevada: 92.45% (-7.55), Arizona: 92.65% (-1.32), Utah: 80.72% (-10.9), Rhode Island: 95.95% (+6.32), District of Colombia: 89.64% (+0.59), Texas: 86.80% (+1.26), Oregon: 82.82% (-5.47), Minnesota: 84.39% (-3.61),  Missouri: 88.65%, New Mexico: 87.83%, North Dakota: 81.93%, Connecticut: 81.26%, Virginia: 81.06, Washington state: 80.70%, and Oklahoma: 80.23%.
  • Healthcare Ready is regularly updating a map showing HHS data on pediatric hospital bed utilization (snapshot, below).
Confluence of Respiratory Illnesses
  • RSV has peaked in some areas of the US, and influenza shows signs of plateauing at the national level. However, many jurisdictions continue to experience high hospitalization rates, and clinicians are concerned about additional surge following winter holiday travel and gatheringsCases of and hospitalizations due to COVID-19 continue to rise.
  • If the upward trend of COVID-19 hospitalizations continues into the respiratory season, healthcare institutions might end up dealing with compounding crises and surge, putting further strain on healthcare infrastructure and workforce. In previous COVID-19 surges, there was some room for workforce surge – in the 2020 surges of adult patients, pediatric clinicians were available to bolster care because pediatric patients were not severely impacted. However, with both pediatric and adult clinicians experiencing high case and hospitalization burdens, there is little to no margin for workforce to augment populations they do not typically care for.  
  • On 12/15, the White House announced its COVID-19 Winter Preparedness Plan. The Plan focuses on expanding access to COVID-19 testing, vaccinations, and treatments. The plan notes that HHS Secretary Becerra sent a letter to all governors regarding actions to take to prepare for COVID-19 surge and reminding them of the federal support available for their responses.
  • CDC is encouraging use of masks and COVID-19 and influenza vaccinations to help prevent spread of COVID-19, flu, and RSV during the holiday season.
  • On 12/22, CDC issued a Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. The Health Advisory highlights the recent rise in iGAS infections in children, the increased seasonal risk of iGAS disease for all age groups, and the importance of early recognition, diagnosis, and appropriate treatment of these diseases in children and adults.
  • CDC created an advisory page for possible increase in iGAS infections in the US. Colorado and Minnesota have released advisories regarding the increase in cases. Streptococcus A is typically treated with penicillin or amoxicillin.
    • If Streptococcus A infections continue to spread globally, the penicillin class of antibiotics, which includes already disrupted amoxicillin formulations, may see greater disruptions in an already strained market. 
RSV
  • Data shows that rates of RSV cases and hospitalizations may have peaked in some areas of the US. However, lack of comprehensive localized (smaller than state-level) data leaves gaps in national picture of when and where cases are peaking. Disclaimer: The following analysis is based on the limited available data for RSV.
  • CDC National Respiratory and Enteric Virus Surveillance System (NREVSS) RSV laboratory test data show:
    • RSV cases in HHS Region 8 (Montana, Wyoming, Utah, Colorado, North Dakota, and South Dakota) have likely peaked regionally. Cases in some states in the Region may not have peaked: state level data shows a continuous upward trend in 3-week averages for RSV PCR test positivity in Montanathough this measure may be plateauing. State level data shows a downward trend in 3-week averages for RSV PCR test positivity in Wyomingthough total PCR tests in the state are relatively low (so it is possible some cases have not been captured). PCR test positivity for North Dakota and Colorado indicates cases in those states are trending downward. South Dakota’s PCR test positivity has shown an inconsistent (not continuous) upward trend; it is unclear if this indicates a peak in cases. Data for Utah is not available.  
    • Cases in Region 10 (Washington, Oregon, Idaho, Alaska) may be peaking in some states, while others continue to rise. PCR test positivity for Idaho shows the upward trend in 3-week averages for RSV PCR test positivity may be peaking or plateauing, though the 3-week average positivity for antigen tests have continued to rise. PCR test positivity in Alaska shows PCR test positivity may have peaked. Oregon data shows a downward trend in cases in 3-week averages, though detections remain high. Data from Washington state show a continuous downward trend in 3-week averages for RSV PCR test positivity.
    • Antigen tests for Region 9 (California, Nevada, Arizona, Hawaii) show RSV cases may be rising in the region again, though positivity is far from the peak that was seen in late October. Three-week averages show a decline in PCR test positivity for the region overall.
  • Guidance for assessing and prioritizing bronchiolitis patient needs is available in resources such as East Tennessee’s Children’s Hospital’s Bronchiolitis Care Map and Spectrum Health’s Clinical Pathway: Pediatric Bronchiolitis, Inpatient.
  • WRAP-EM subject matter experts released a 10-minute videoJust-in-time Bronchiolitis Pearls and Pitfalls,” which is intended to be an overview to bronchiolitis care for providers with limited pediatric experience.
  • ASPR TRACIE released guidance on use of high flow nasal cannulas (HFNC) in pediatric patients, including the clinical pathways, decision support tools, and information on use of HFNC in non-intensive care unit settings and during patient transport.
Influenza
  • For the week ending 12/10, CDC reports that “seasonal influenza remains high but appears to be declining in some areas.”
  • Influenza-like illnesses (ILI) levels are very high across the United States for the week ending in 12/10.  Forty-eight (+2) states, New York City, Puerto Rico and the District of Columbia are experiencing high to very high levels of ILI. Nine (- 3) of the jurisdictions are reporting ILI activity level 13, the highest possible. Those jurisdictions are: Colorado, Idaho, Kentucky, Nebraska, New Mexico, Oklahoma, Tennessee, Washington, and New York City. Connecticut, District of Columbia, New Jersey, and Virginia are no longer at level 13, but continue to have very high activity (level 12).
    • Very high ILI activity, levels 11-13, indicates that flu activity is 12-20 standard deviations present above the mean, indicating that the area’s infrastructure, workforce, and supply chain capacities might not be able to accommodate local needs without additional assistance.
  • Influenza-associated pediatric deaths rose to 30 (+9) for 2022-2023 flu season as of the week ending 12/10.
  • HHS Region 10 (Alaska, Idaho, Oregon, Washington State) has the highest rate of pediatric mortality (1; rate is calculated as number of deaths reported per 100,000 inhabitants age 17 or younger) followed by Region 4 (0.7).
  • The number of influenza-related hospital admissions reported to HHS Protect system decreased during week 49 as compared to the previous week, but remain high compared to recent seasons.
  • CDC estimates that this season, there have been at least 15 million influenza infections, 150,000 hospitalizations and 9,300 influenza-related deaths. For comparison, CDC estimates that there were 9 million influenza infections, 4 million medical visits, 100,000 hospitalizations, and 5,000 during the entire 2021-2022 season.
  • The test positivity rate increased slightly to 25.4% (+0.6 percentage points) compared to the week ending 12/03 (24.8%).  
Source: CDC Outpatient Respiratory Illness Activity Map. Accessed: December 20, 2022
COVID-19  
  • National-level data shows a slight decrease (compared to the prior week) in new hospital admissions of pediatric patients with confirmed COVID-19New admissions of elderly patients increased since the week ending in 12/10. New admissions of patients with confirmed COVID-19 have shown a continuous upward trend overall that began in late October. As of 12/18, compared to the average admissions for the week ending 12/11:
    • People ages 0-17: -6.3% new admissions per 100,000
    • People ages 70+:  -5.8% new admissions per 100,000
  • On 12/09, CDC expanded the eligibility for the updated COVID-19 bivalent vaccines to include children ages 6 months through 5 years.
  • The COVID-19 public health emergency (PHE) provides federal, state, and local flexibilities in regulation and funding support for the response to RSV and flu. If the COVID-19 PHE is not renewed before its expiration mid-January 2023, between 5.3 and 14.2 million Medicaid enrollees could lose their coverage between January and April 2023.
  • It is expected that the PHE will be renewed at least one more time, which would move the expiration date to April 2023. Despite this, on 12/19 25 governors sent a letter to President Biden requesting he end the Federal PHE. If the Federal PHE is rescinded, measures relied upon by hospitals to manage ongoing surge, including 1135 waivers, staff redeployment flexibilities, and telemedicine flexibilities, will no longer be available. This would further limit surge capacity of hospitals.  
  • Federal funding for COVID-19 vaccines might run out as early as in January 2023, at which point COVID-19 vaccines and therapeutics will become available only via the commercial market. 
    • According to an analysis from the Kaiser Family Foundation, “private insurers will be required to take on more of the cost of vaccines (including paying for the doses themselves once the federal supply runs out), which could have a small upward effect on premiums.”
    • Implications for how these changes may affect vaccine availability and out-of-pocket costs to patients will become clearer as the commercial cost of vaccines and mechanisms for distribution and purchasing are defined.
Health Equity Concerns
  • Some reporting suggests pediatric patient transport, which is already constrained due to staffing, availability of hospital beds that are staffed to receive a patient, and specific supplies needed to transport a child, is especially challenging for rural areas. Ability for rural areas to move patients, especially across state lines, may be limited.
  • Children with underlying conditions, especially obesity and diabetes, are more likely to experience severe COVID-19 and hospitalization. According to data from CDC’s COVID-19 Associated Hospitalization Surveillance Network (COVID-NET), during the 2021-2022 Omicron surge (December 2021 – February 2022): 70% of hospitalized children had an underlying medical condition, 19% were admitted to an intensive care unit, and children with diabetes and obesity were more likely to experience severe COVID-19.
  • For the limited areas tracked by CDC’s RSV-NET* for the week ending 12/17, hospitalization rates for all races and ethnicities have fallen compared to the previous week.
Source: CDC RSV-NET Interactive Dashboard. Accessed: December 22, 2022.

Government Response

Federal Posture
  • On 12/22, CDC’s Health Alert Network (HAN) issued a Health Advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. CDC has also created an advisory page for possible increase in iGAS infections in the US where it outlines what actions parents, healthcare providers, and laboratorians should do if they suspect a child might be infected with Streptococcus A.
  • On 12/20, CDC’s HAN issued the alert, “Important Updates on COVID-19 Therapeutics for Treatment and Prevention.”
    • The alert supplements previous advisories that emphasize that the majority of Omicron sublineages circulating in the US have reduced susceptibility to the monoclonal antibody bebtelovimab and the monoclonal antibody combination, cilgavimab and tixagevimab (EvusheldTM). Due to this resistance, as of 11/30, use of bebtelovimab is not FDA authorized for patients with COVID-19.
    • Ritonavir-boosted nirmatrelvir (Paxlovid™)remdesivir (Veklury®), and molnupiravir (Lagevrio™), retain activity against currently circulating Omicron sublineages and are widely available for eligible patients.
  • On 12/15, the White House announced its COVID-19 Winter Preparedness Plan. The Plan focuses on expanding access to COVID-19 testing, vaccinations, and treatments. The plan notes that HHS Secretary Becerra sent a letter to all governors regarding actions to take to prepare for COVID-19 surge and reminding them of the federal support available for their responses.
  • On 12/14, CDC HAN distributed Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir, where it outlines:
    • General recommendations for clinicians and public health practitioners; and,
    • Guidance for prioritization when antiviral supplies are limited (per medical setting, age, and condition)
  • On 12/2, Secretary of the Department of Health and Human Services Xavier Becerra sent a letter to state governors providing guidance on how to deal with the pediatric hospitalization crisis. The letter reiterates the resources and tools that are available, including flexibilities under the COVID-19 PHE declaration, as well as funding available from the Centers for Disease Control (CDC).
  • There is currently no declared federal public health emergency (PHE) for pediatric surge.
    • An emergency declaration would grant waivers for certain Medicare and Medicaid programs and the Children’s Health Insurance Program (CHIP).
    • PHE waivers for  Section 1135 of the Social Security Act waiver would allow for easier movement or transfer of patients, use of new spaces for care, creation of offsite triage to manage capacity challenges, adaptation to workforce shortages, and licensure reciprocity to enable cross-state care, including telehealth.
  • CDC issued an official Health Advisory on 11/14 about rising rates of RSV and the co-circulation with COVID-19 and influenza and its potential impact on healthcare systems.
  • HHS ASPR and TRACIE Pediatric Surge Resources page.
State and Local Posture

Healthcare Ready developed a report explaining how emergency declarations can strengthen public health capabilities and surge capacities in this response. Healthcare Ready recommends that healthcare systems advocate for local declarations to access immediate resources at the state and regional levels.

The following table summarizes states with active emergency declarations or states of emergency for COVID-19 and/or respiratory surge. Nine states are under a state-level emergency declaration for COVID-19. Two states (Oregon and Colorado) are under a state of emergency specific to respiratory surge.

Potential Threats for Pediatric Medical Surge

Several challenges are unique to managing pediatric medical surges, particularly for the healthcare workforce and supply chain. For one, pediatric hospitals require more intensive nursing resources to treat and monitor patients, especially in intensive care and neonatal intensive care units.
 
Additionally, pediatric supply chains can also be more vulnerable to supply chain disruptions, as some critical products have only one supplier or manufacturer capable of producing the necessary pediatric-specific equipment and supplies.

Product Availability
  • The repeal of China’s COVID Zero policies have led to a surge in COVID cases. Pharmaceutical companies around the world rely on active pharmaceutical ingredients (APIs) and key starting materials from abroad, including China. Without reliable reporting from China’s economic partners, analysts are keeping a close eye for any warning signs of supply chain disruptions in every sector.
  • Amoxicillin
    • Amoxicillin remains in short supply.
    • The majority of amoxicillin production facilities are located overseas. Domestic amoxicillin capacity is limited by staffing and active pharmaceutical ingredients (API) constraints, as well as reduction of capacity due to low demand in recent years.
    • The lack of guaranteed demand prior to the respiratory season is driving a lack of surge capacity. Manufacturers of amoxicillin and other antibiotics typically determine production amounts prior to respiratory season based on the amount ordered. Manufacturers typically do not manufacture additional product beyond what is ordered because profit margins for the product are small; it would be a major risk to overproduce and not sell additional product. Contracts that guarantee demand (between manufacturers and government, distributors, and/or providers) may help mitigate shortages for future respiratory seasons.
    • As of 12/22, multiple forms of amoxicillin remain on the FDA and ASHP drug shortage lists. This includes tablets, capsules, and powder for suspension. Providers and patients continue to experience impacts.
    • The American Academy of Pediatrics reported on alternative therapies during the shortage.
  • Tamiflu (oseltamivir)
  • The two largest pharmacy chains, CVS and Walgreens have started implementing limitations on purchasing children’s pain relief and fever reducing over the counter medicines. CVS purchases are restricted to two items online and in-store, and Walgreens is limiting buys to 6 items online (in-store purchases are not limited).
  • Many over-the-counter pediatric pain relievers (ibuprofen and acetaminophen) are experiencing spot shortages locally. With the exception of ibuprofen oral suspension (prescription only), which is on the ASHP Shortages list, these products are not yet on the ASHP or FDA Drug Shortage lists.
  • The shortages of pediatric pain relievers as well as influenza and other respiratory illness medications will have compounding impacts on the surge in hospitalizations. If parents and caregivers cannot find medication for their sick children, their condition may worsen, and the parents will have no choice but to bring their children to the pediatric hospital or emergency room where we continue to see long wait times for access to healthcare. It is critical to continue mitigating supply chain disruptions around the pediatric drug shortage before hospitalization rates increase further.
  • ASHP’s current drug shortages list includes the following drugs that could negatively impact treatment of RSV and other respiratory illnesses:
    • Reverified 12/22: Oseltamivir Oral Suspension and Capsules of various sizes from 10 different companies have been added. Ajanta and Alembic have oseltamivir available to contracted customers. Alvogen has oseltamivir suspension and capsules available. Genentech has Tamiflu presentations available and is reviewing orders. Strides has oseltamivir capsules available. The sizes/formulations that are in shortage will either release in late December 2022, are on allocation right now, or the company cannot estimate a release date.
    • Reverified 12/22): 0.9% Sodium Chloride Small Volume Bags (< 150 mL) of various sizes from six different companies have been added. There are a multitude of reasons for the shortage including increased demand, manufacturing delays, and labor shortages. A number of the companies have supplies on allocation as they work through this shortage while Fresenius Kabi expects a release date of mid-to-late December.
    • Reverified 12/22: 0.9% Sodium Chloride Large Volume Bags of various sizes from five different companies have been added. The majority of companies stated that the reason for the shortage was due to an increase in demand. Additionally, a majority of the companies have product on allocation to their customers while Fresenius Kabi estimates a release date of mid-to-late December for the 250, 500, and 1000 mL bags.
    • Reverified 12/22: Ibuprofen Oral Suspension (Prescription Products Only) from Teva has been added. While no reason for the shortage has been provided, we can assume it is due to or exacerbated by the surge of respiratory illnesses impacting the nation. There has been no estimated resupply date.
    • Reverified 12/22: 0.9% sodium chloride vials of various sizes from Fresenius Kabi and Pfizer have been added. The shortage is likely caused by increased demand, related to the application of sodium chloride for respiratory therapy. Pfizer has 0.9% sodium chloride 10 mL vials on backorder and the company estimates a release date of May 2023. Fresenius Kabi has 0.9% sodium chloride vials available.
    • Reverified 12/22: 23.4% Sodium chloride injection of various formulations from Fresenius Kabi and Pfizer have been added. Both Fresenius Kabi and Pfizer have said the shortage is due to an increase in demand. Expected resupply dates are from mid-December 2022 to January 2023.
    • Reverified 12/22: Ceftazidime Injection (and its generic name Tazicef) from Pfizer, Sagent, and BBraun have been added. The shortage is due to increased demand, likely due to the fact that ceftazidime is used to treat a wide variety of bacterial infections and providers could be prescribing this drug as a remedy to respiratory symptoms.
    • Reverified 12/22: Rocuronium injection, used during tracheal intubation, is in shortage from several manufacturers due to increased demand and manufacturing delays. Estimated resupply dates vary based on manufacturer. 
  • While not listed on the ASHP and FDA Drug Shortage lists, over-the-counter pediatric pain relievers (ibuprofen and acetaminophen) are experiencing spot shortages.
  • FDA’s drug shortage database lists the following updates regarding drugs that may be related to treating respiratory illness:
    • Reverified 12/22: Amoxicillin oral powder for suspension is available for current customers from Hikma pharmaceuticals. As of 12/6 most of the amoxicillin oral powder product for suspension from Sandoz is unavailable while some has limited availability. Additionally, as of 12/6, products from Aurobindo and Teva are on allocation.
    • Reverified 12/22: albuterol sulfate, a bronchodilator for oral inhalation, manufactured by Akorn Pharmaceuticals, remains unavailable and is estimated to be back in stock by Q2 2023. A 5 mL version from Nephron Pharmaceuticals is available.
  • FDA’s medical device shortage database lists the following updates regarding medical devices that may be related to treating respiratory illness:
  • Definitions for product shortage vary by organization. Healthcare Ready sources data from multiple organizations that maintain drug shortage lists, including:
    • American Society of Health-System Pharmacists (ASHP), which defines a drug shortage as “a supply issue that affects how the pharmacy prepares or dispenses a drug product or influences patient care when prescribers must use an alternative agent.”
    • US Food and Drug Administration (FDA), which defines a drug shortage as “a situation where the total supply of all versions of the approved product available at the user level will not meet the current demand, and a registered alternative manufacturer will not meet the current and/or projected demands for the potentially medically necessary use(s) at the user level.”
  • On 11/22, the FDA issued an emergency use authorization (EUA) for the Lucira COVID-19 and influenza multiplex test for use in a point-of-care (POC) setting. This will expand the testing kit pool as well as reduce the strain on the testing kit supply chain as two tests are combined into one.
Treatments for RSV

A monoclonal antibody therapy called palivizumab is available as a precautionary measure to prevent severe RSV illness in certain infants and children at high risk for severe disease during the normal respiratory season. It cannot cure or treat children who are already suffering from severe cases of RSV; it is a preventative treatment.

  • On 11/17, AAP updated its guidance: Given the known efficacy of palivizumab along with the unpredictable surge capability of RSV, AAP recommends programmatic consideration of providing more than five consecutive doses of palivizumab depending on the duration of the current RSV surge in a particular region of the country.
  • Palivizumab is sold under the brand name Synagis, and is marketed by Sobi in the United States. Sobi purchased US rights to Synagis from AstraZeneca in 2018. Before COVID-19, physicians prescribed Palivizumab more frequently as a preventative measure, yet, this treatment strategy slowed during the pandemic.
  • AAP says that it recommends Palivizumab in eligible infants in regions that are experiencing high rates of RSV and that it will release updated guidance as they monitor the seasonal trends.
Workforce Shortages

Workforce shortages continue to impact access to care in hospitals around the country. Resident physiciansdoctorshospitals staff are advocating for increased federal support.
 
Ongoing workforce shortages may threaten the ability of facilities to establish a predictable quality of care for patients. Because pediatrics is a specialty practice, there may be additional strain on the workforce with pediatric care experience. Reports indicate that pediatricians are requesting increased federal support as they deal with RSV, COVID-19, and influenza treatment in unison. Physicians state that they can only successfully handle this “tripledemic” with the assistance of a federal emergency declaration and dissemination of support. The Administration for Strategic Preparedness and Response (ASPR), Technical Resources, Assistance Center, and Information Exchange (TRACIE) team has a staffing resources section on their pediatric surge response resources page, which can be found here.
 
Hospitals and other healthcare facilities may need to increase surveillance for respiratory illnesses among staff to reduce the spread and the potential for staff being out sick. Practitioners’ mental health should also be considered and protected. Additional training and support for practitioners that are not used to caring for acute pediatric cases for prolonged periods should be provided whenever possible.

About Healthcare Ready

Healthcare Ready is a 501(c)(3) nonprofit organization that works to ensure patient access to healthcare in times of disaster, emergency, and disease outbreaks. We leverage unique relationships with government, nonprofit and medical supply chains to build and enhance the resiliency of communities before, during and after disasters. Learn more about Healthcare Ready

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