Thu. Jun 8th, 2023

We know how to treat COVID, flu, and RSV, so our pediatric healthcare system isn’t at risk because of some unbeatable viral plague. It’s at risk because the system itself has failed our kids.
“Have you heard about the crazy new virus sending kids to the hospital?”
As pediatricians — one of us the mother of a young child — we each experienced a wave of shock the first time we heard this question. After living through COVID-19, and still experiencing the myriad harmful downstream effects of the pandemic on kids, we both felt overwhelmed at the prospect of a new viral Big Bad. Hadn’t children (and, by extension, the health-care workers who care for them) been through enough?
Discovering that this “new” viral surge was in fact a reference to the “tripledemic” — a bump in pediatric infections with RSV, influenza, COVID — was initially a relief. It was comforting to know that there was no new mysterious microbe, and it was reassuring to finally see coverage of how serious common cold viruses can be for children. The stories of the surge of sick kids were validating, and reminded us of the countless children we have seen in our hospital practice over the years during this season: the 5-day-old with RSV intubated just hours after hospital admission, the 10-year-old who didn’t get a flu shot then ended up in the intensive care unit with the flu and a life-threatening pneumonia, the 3-year-old hospitalized for prolonged fevers and heart inflammation from COVID.
» READ MORE: RSV has parents ‘freaking out.’ Can you blame them?
Yet our relief was short-lived. As news coverage about the “tripledemic” has become more frequent and more alarmist, our frustration has grown alongside it.
Many articles continue to depict a crisis of novel, untreatable viruses that simply can’t be stopped. But pediatricians know better.
Yes, we are seeing viral infections earlier and in larger numbers than in years prior. But RSV, influenza, and now COVID (as well as the hundreds of other pediatric cough and cold viruses that bring kids to the hospital) are our bread and butter. Call it what you will, but a season of seemingly insurmountable pediatric pathogens is nothing new, and we are actually quite good at treating these illnesses.
Blaming this crisis on the viruses themselves isn’t just inaccurate — it’s dangerous.
As they stand, current headlines paint a picture of despair, and we see firsthand how the current coverage leaves parents feeling terrified and hopeless. But here’s the truth — though tragically under-reported: Pediatricians and health-care providers have the ability to stop this crisis and prevent the next one.
We have the necessary knowledge to provide the medical care these children and families need and deserve. Training is not the issue, compassion is not the issue, and most of the time even physical hospital beds are not the issue. Our pediatric health-care system isn’t at risk because of some unbeatable viral plague. It’s at risk because the system itself has failed our kids.
In this way, the “tripledemic” isn’t the disease. It’s a symptom of a much bigger, systematic problem.
The “tripledemic” isn’t the disease. It’s a symptom.
Pediatricians have seen this coming for years. Our for-profit health-care system and hospitals have made deliberate choices that have led to predictable outcomes. Between 2008 and 2018, the number of inpatient pediatric care units shrank by almost 20%. This trend worsened during the pandemic, when hospitals converted pediatric beds to adult ICU beds; since adult beds make more money, hospital systems are now reluctant to give them up.
Medicaid, which serves as the safety-net coverage for children, pays less than Medicare for physician services, which may help explain why pediatricians are paid less than adult medicine specialists in all fields. We have seen staffing decreases, been asked to work more with less, watched funds get distributed to higher-reimbursed services, and witnessed burnout among frontline workers.
Our patients exist in a world where obtaining access to basic health-care resources is a daily struggle. Any surge in demand for pediatric care is destined to break an already stressed system (made weaker by the ravages of a global pandemic).
This country’s failure to protect children extends beyond the walls of the hospital or doctor’s office. An enormous amount of the severe illness we see from these viruses could be easily prevented with adequate public health infrastructure. Yet basic health measures that would make a real difference in children’s lives have been painfully politicized.
Wearing masks – even just during an RSV surge, even just in crowds, even just when visiting a vulnerable baby — has gone from commonsense advice to partisan controversy. And kids aren’t getting the vaccines they need, a trend that began long before COVID and has been fueled by an anti-vaccine misinformation machine. Two of the viruses making up this “tripledemic” — flu and COVID — are preventable with vaccines. Even when not fully effective in stopping viral infection, these vaccines have been shown to significantly reduce hospitalizations and severe illness in children, including death — more evidence that prevention really is the best medicine.
Prevention starts with empowering and supporting caregivers. In the first eight years after the Affordable Care Act was implemented in 2010, the number of well-child visits with out-of-pocket costs for families dropped by more than half. These visits, in which kids get their vaccines and families receive guidance on how to stay healthy, went from costing families to being covered by insurance. We need to continue to support families and caregivers who care for these children and promote their wellness 365 days of the year. Our society needs to invest in parental support (such as paid leave) to enable sick kids to stay home, where they can recover more quickly and be less likely to transmit viruses to peers.
Portraits of an uncontrollable virus promote complacency and push a narrative that absolves our society from the responsibility of actually investing in children. The solutions to this “tripledemic” are clear, and they have nothing to do with radical scientific advancements. Instead, they hinge upon coherent policy decisions that prioritize public health, a society that invests in pediatric medicine and those who provide it, and a country that gives bare-minimum protections to working families.
When you push past the clickbait and alarmism, the problem becomes frustratingly obvious. There is a flood of sick kids pediatricians know how to help but lack the tools to do so.
Amelia B. Warshaw is a second-year pediatric resident in the Columbia-NYP pediatrics division at the Morgan Stanley Children’s Hospital of New York. @meelzy8. Rebekah Diamond is an assistant professor of pediatrics at Columbia University and a hospital pediatrician at New York-Presbyterian, and author of Parent Like a Pediatrician. @parentlikeapediatrician.


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