Doctors, nurses and other frontline health care providers are used to being stretched thin, seeing record numbers of patients while staffing levels are as tight as ever.
But as weary Coloradans stagger into a third pandemic winter, with a triple threat of RSV, flu and COVID-19 brewing, health professionals are seeing something new.
“You have a huge influx of children,” said Dr. Ricky Dhaliwal, a Front Range emergency doctor who closely tracks statewide trends as a past president of the American College of Emergency Physicians. “We're seeing more children than I think we've seen probably ever in regards to just respiratory illness.”
“Things are definitely getting worse,” said Dhaliwal.
“Every week we see more cases than we did the week before, and RSV typically peaks around mid-winter. Nobody knows that that's going to be the case here in Colorado,” said Dr. Reginald Washington, the chief medical officer of Rocky Mountain Hospital for Children and Presbyterian St. Luke's.
He described his hospitals as very busy, with every available bed in use.
“Nationally, all across the United States, it's really a pandemic and it continues to increase and has yet to plateau. We also are seeing an increased number of flu cases” he said.
Washington said he was concerned because Coloradans have largely ditched precautionary measures, like mask-wearing, avoiding crowds and limiting large gatherings.
“So I think we're setting ourselves up for a potential increase in all those viruses,” he said.
He said the hospital is opening additional units to cope.
“We're expanding our capabilities as necessary with the staff that we can find,” adding that staffing levels are tight.
According to the state’s coronavirus website, more than 90 percent of all acute care beds and nearly 90 percent of all intensive care beds statewide are in use.
Sounding the alarm
In recent weeks, doctors, hospital administrators and public health officials have been sounding increasingly urgent alarms.
“Since last week, we've not seen really any significant change in our RSV volume and the number of kids who are infected with that leading to bronchiolitis and requiring admission to the hospital,” said Dr. Kevin Carney, associate chief medical officer with Children’s Hospital Colorado.
But the hospital is seeing a rise in respiratory cases caused by other bugs.
“We're seeing many more children who have flu coming to our clinics and to the ERs and our number of kids who are COVID-positive in the hospital has also been increasing,” Carney said.
RSV is still the headliner, causing the capacity crunch, he said, but the other viruses appear to be picking up steam.
“Flu is very quickly gonna really compound the complexity of what we're managing here,” Carney said.
Children's Hospital Colorado has four facilities — on the Anschutz medical campus in Aurora, plus in Broomfield, Highlands Ranch and Colorado Springs.
“All of our ERs are basically seeing volumes 30, 40 to sometimes even 50 percent above even the highest numbers that we've seen in previous seasons and that has not changed,” he said.
But Carney said the system is not “running out of beds.” That is because, as children arrive and get admitted, there’s a constant flow of some other children getting discharged.
“We are discharging children and we keep trying to, as much as we can, keep that flow going,” he said. “So I don't want to message that ‘we've run outta beds, there's no place else to go,’ it's just that we are really busy and it's pretty much taking a 24-7 effort on all of our team parts to keep taking care of all these kids.”
As of last week, the state health department reported the convergence of the three virus waves in stark and jarring numbers: Colorado has more than 550 RSV hospitalizations this fall, more than 300 patients in the hospitals with confirmed COVID-19 cases and nearly 100 flu hospitalizations this season.
New numbers are expected Wednesday, when the agency releases its latest data.
Get vaccinated, and stay home when you're sick
Now, the busy holiday season is here, with plenty of travel, gatherings and copious opportunities to spread viruses around.
More than ever, health experts say, is the time to be ever vigilant about not passing around a contagious illness, like another, less appetizing, side dish at the Thanksgiving table.
“We know that there are a number of things that we can do to prevent transmission of respiratory viruses,” said state epidemiologist Dr. Rachel Herlihy during a press briefing last week. “Obviously, the most important is going to be vaccination.”
“It's time now,” said Dr. Michelle Barron, an infectious disease expert at UCHealth. “And if only to protect your holiday plans, it's a good way to do it.”
Both physicians urged people to get both the bivalent COVID-19 vaccine, which became available this fall and targets both the original strain and the super-transmissible omicron subvariant, and the flu shot. She said both can be received simultaneously.
“If you’re sick, stay home,” has been prime public health advice since the start of the pandemic, and that remains true, health experts say.
The desire to hang out with friends and family is strong for all of us, but so are the respiratory bugs circulating.
“If you or your family are sick, please really think twice before getting together with others,” said Carney, “because what may be a mild infection to you or your kids might be more severe to somebody else.”
One other piece of advice, health officials said. Despite the influx of patients at hospitals and their emergency departments, don’t delay care in the event of an emergency care.
Through the pandemic, that has happened, said Dr. Jared Scott, associate medical director at Swedish Hospital. “Important conditions — including heart attacks and strokes - went untreated,” he said. “While the ED may get overwhelmed at times, especially pediatric hospitals during the current RSV surge, we remain ready to help.”
Stressing a weary system
He said the triple threat of respiratory viruses is straining not just the children’s health care system, but the entire system.
“Our adult hospital colleagues as well are seeing a huge uptick in flu cases,” Carney said.
Don’t get lax with hand hygiene and indoor air precautions, ED doctor Dhaliwal said.
“I think the biggest thing you can do is ensure that you're following proper hand hygiene, teaching your kids to cover their mouths when they cough,” he said.
And Dhaliwal said despite it being the busy season, don’t delay care if you think your child or other loved one needs emergency care.
“The emergency department will always be there for you. You may have to be a little bit more patient as we continue to try to do our best to care for everyone in the best way we can,” he said. “We have a system and it's working. It's definitely getting stretched again but as it's always been, we're trying to be as resilient as possible.”
Masks back on inside hospitals
With the upswing, Rocky Mountain Hospital for Children is making a change in one key public health precaution.
“We now will require masks again for anybody who enters our hospital,” said Washington. “And that's primarily because the numbers are starting to go in the wrong direction and we have an obligation to protect our staff and our patients.”
The requirement had been lifted just three weeks ago, after being in place during the COVID-19 pandemic. He said the hospital’s infection prevention team had been monitoring CDC guidance closely and knew the window of time without masks required was likely to be short.
He said the pandemic has shown the “enormous impact” of masks in limiting the spread of respiratory viruses.
“So I think that's the other message here too, is we as adults have a responsibility and an opportunity to help mitigate this as well,” Washington said.
