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Respiratory illnesses surge in Idaho

Intermountain Healthcare
Intermountain Healthcare

Hospitals in Idaho are seeing a large influx of people suffering from respiratory illnesses, including RSV, which most often affects children.

Health officials are responding to the increased need for help. St. Luke's has created a Suction Clinic in Boise for children and the health system is working on similar clinics in Meridian and the Magic Valley.

Leaders at St. Luke's are now meeting twice a day to find out how many beds are available in their hospitals, along with trying to keep up with the need for medical staff and supplies.

The Idaho Department of Health and Welfare held a news conference on Thursday to discuss the surge in cases of flu, RSV, and COVID-19 in Idaho, which has created a "triple-demic."

Dr. Kenny Bramwell is St. Luke's Children’s System Medical Director and joins Idaho Matters to give us an update.

Read the full transcript below:

SAMANTHA WRIGHT: From the studios of Boise State Public Radio News, I'm Samantha Wright, filling in for Gemma Gaudette. This is Idaho Matters. Hospitals in Idaho are seeing a large influx of people suffering from respiratory illnesses, including RSV, which most often affects children. Health officials are responding to the increased need for help. St Luke's has created a suction clinic clinic in Boise for children, and the health system is working on similar clinics in Meridian and the Magic Valley. Leaders at St Luke's are now meeting twice a day to find out how many beds are available in their hospitals, along with trying to keep up with the need for medical staff and supplies. The Idaho Department of Health and Welfare is holding a news conference later today to talk about the surge in cases of flu, RSV and COVID in Idaho, which has created a triple demic. Dr. Kinney Bramwell is St Luke's Children's System medical director, and he joins us again to give us an update on all of this. Welcome back to the show, Dr. Bramwell.

DR. KENNY BRAMWELL: Thank you, Sam. Happy to be here.

WRIGHT: All right, so let's start off with what's the situation right now at St Luke's with this surge? What are you seeing at your children's hospital?

BRAMWELL: You know, what I would say is we're having a very severe need for patients needing to be admitted to the hospital because of the respiratory illnesses that they have. This is a little earlier than we have on normal years. The biggest problem is, is both the fact that it came probably eight weeks earlier than usual and the fact that we haven't needed this many patients to be admitted in prior years. So it's a it's a challenge to be sure.

WRIGHT: Do we know why it's coming so early?

BRAMWELL: Well, if you if you take a 20 or 30 year view of all of this prior to COVID, we would have very predictable seasonal spikes in a handful of different viruses. Rsv has always been a major player, if not the major player for children's hospitals. And I'll come back to that in a bit. We see influenza every respiratory season. Covid is now another member of the family of of very bothersome viruses for certain populations. The thing that happened during COVID, it turns out that a lot of the stuff that we were doing distancing, masking, staying home when we were sick stopped. The overwhelming majority of viruses, not just some we had in prior years, always seen a very severe, very severe spike of RSV in the December through April or January through April of every prior year. During COVID, we didn't see a single RSV case for 18 months. Wow. And then in July of 21, we saw a big spike, largely because everybody sort of came out of hiding and masking, stopped to large degrees and people gathered. And then the small infants and toddlers that hadn't seen RSV got it the summer before last. So I think we're getting closer to having our normal seasonality of RSV. This year, it came in October instead of December or January, which which surprised us a bit.

WRIGHT: Well, let's talk about beds. Do you have enough beds for your young patients?

BRAMWELL: That's a great question. As of today, we're okay as of this morning's meeting. You mentioned that that we're doing that twice a day. It's a it's a morning and an afternoon incident command meeting similar to a lot of the incident command work that we were doing doing during COVID. This is maybe a little more frequent. I think our incident command structure was largely once a day or many times was once a day during the worst times of that pandemic. So we are we are doing that twice a day now. And we have people from both the the Boise and the Meridian, sorry, Boise and Magic Valley campuses talking about what things are like at the ground in their hospital, how how they are doing as far as beds, how they're doing as far as staffing, how we are doing in those different locations, as well as our other ERs and how we are doing in the region with with other kids sort of waiting, hoping to be admitted from whichever E.R. they're at initially.

WRIGHT: Well, what happens if you if you run out of bed somewhere? I mean, is it a is it a shuffle game.

BRAMWELL: To a degree? It's it's an ongoing challenge. We have done a handful of things in this recent surge that we've done before, and we've also done a handful of things that we've never done before. And I'll try and share those with you. We have had plans in place for for many years about what to do when we have the seasonal spike in these respiratory illnesses. So some of those include admitting the youngest infants to the neonatal intensive care unit in a sort of special or separate part of the NICU to prevent infection to the other kids that are there. We can admit older teenagers say we're using above 14 years and 40 kilos as the cutoffs, and then those teenagers can be admitted to adult floors in our Boise campus. We have. Tried to open up additional beds within the hospital for these ongoing needs. We are trying to keep some children at our critical access hospitals like McCall, Elmore and Wood River. We've opened up the section clinic, which I suspect we can come back to. We have brought in additional advanced practice providers so nurse practitioners and physician assistants, as well as additional docs to deal with the increased load. The part that's different that we haven't done in the past largely have to do with those last two comments that I made opening up the section clinic, which we've never done. I don't believe anyone's done in the state before and sort of bringing in additional manpower from our own employees to come and help the pediatric hospitalist with this large surge of patients.

WRIGHT: Wow. Talk about these suction clinics. What? What is that? How does it work?

BRAMWELL: Okay, so it's probably relevant to talk a little bit about RSV and what it does. Rsv stands for respiratory syncytial virus. It affects it affects all of us. We all get it. And for most of us, it's like a cold. You have a runny nose, maybe you have a sore throat, you have a little cough. It's not that big of a deal. But if you're very small, it can be really difficult. The three main things that RSV does to very small infants and toddlers is it swells their nasal passages. There's a lot of debris in their. And it almost swells. It shut. And these small infants and toddlers sometimes have trouble eating and drinking because their noses are completely swollen shut. You know, you can't suckle a breast or a bottle if you can't breathe through your nose. So So that's problem one is their nose. Their nasal passages swell shut. Problem, too, is they get weak and tired and dehydrated because they can't eat. And problem three, the same sort of inflammation and sloughing that happens in the nasal passages also happens inside the lungs. So occasionally, some of the sicker infants and toddlers will have low oxygen levels and they will need supplemental oxygen for a few days. So if we back up to what is your initial question, what is the suction clinic? What the suction clinic does is after a patient is seen, let's say, in one of our emergency departments, because that's why the most common occurrence they get seen there.

We determine that the child has RSV or has bronchiolitis, which is the illness caused by RSV. If the child doesn't need to be admitted to the hospital, we can then refer that infant to our suction clinic where they come later that day if they need to, or the next day they can come any time over the next five days and get their nasal passages suctioned. And what that does is it allows families to keep their infant at home and take care of them at home. And it's very convenient for families. I mean, it's hard to have your six week old admitted to the hospital. And the other thing that it does is it allows these patients to not need to be admitted to the hospital or to be a repeat er patient. If we back up a year ago, all these kids that are being seen in the section clinic would have needed to come back to the ER or excuse me sometimes to be admitted to the hospital to get this ongoing suctioning. So what the suction clinic does is it gives all of these families a way to continue to be at home if that's medically safe.

WRIGHT: Wow. Okay. And you're putting together some other suction clinics around the state.

BRAMWELL: Yeah, well, since we. Since we hadn't ever done this before, we we had to sort of test it and see how it worked and see what the problems were and see what the challenges were and see where we sort of tripped and fell and could have done it better. So what we did initially is we we had a requirement that in order to be referred to these clinics, you had to be seen at one of our facilities by either an ER doc, a pick U, a pediatric ICU doc, a pediatric hospitalist, or one of our general pediatricians in the Treasure Valley. It wasn't meant to be elitist as much as it was to sort of see how things went with a small portion of referral providers. And we did that for the first three weeks. And then this week, Monday, 1212, we opened it up to to anyone who is able to do orders and referrals in our electronic medical record. So we opened it up really broadly to all of those referring docs and advanced practice providers, and we've opened up additional locations. We opened up Magic Valley on Monday of this week. We opened up Nampa yesterday and I believe today we are opening up facilities or suction clinics both at Fruitland and in Meridian, and I think we'll have more next week.

WRIGHT: Wow. We're speaking with Dr. Kimi Kenny Branwell. He's St Luke's Children's System medical director, about the triple demic of flu, COVID and RSV that's hitting Idaho. So I'm guessing since you're opening up so many of these suction clinics that they're working.

BRAMWELL: Yeah. So far and I've got newer data from this morning, but as of yesterday we've had 218 kids referred to these clinics and just over 100 of them have presented in the next handful of days. And there have been a total of 55 patients who've been seen about 100 times. Not not, not each, but total. There have been about 10% of those patients who get referred to the suction clinic who once they are seen and suctioned the respiratory therapist caring for them says you are sicker than you were being discharged or being referred here. So we're going to take you to the emergency department to be evaluated. So about about 10% of the patients who have been seen have needed to be taken from the suction clinic down the hallway to the emergency department, and about 5% of those patients. So so half of the ones who go to the ER then then end up needing to be admitted. It's, it is unfortunate that that. Some of these kids sort of progress in their illness. But the benefit is that a year ago, all 100 plus of them would have been E.R. patients. So this is been really helpful for keeping the vast majority of these infants out of the air and out of the hospital, particularly now that the ERs are swamped as well.

WRIGHT: Well, yeah, you're you're you're keeping beds open for the the sicker kids. And you're I mean, it's just better overall if you don't have to go into the hospital, whether it's stress or or you know, with parents or money. I mean, it's it's I would think that would be a win win.

BRAMWELL: Yeah, it's been it's been a really nice upgrade that we've been able to open this up in the last few weeks.

WRIGHT: You mentioned you've never done the suction clinics before. Speaking as as a doctor who's been practicing for a while, how unusual is this? I mean, is this is this an indication of of how bad things are? Or are you just getting better at figuring out ways to to get around some of these problems?

BRAMWELL: To be totally honest with you, Sam, the first time I ever heard of this was almost three years ago with my grandson, who was living in Salt Lake City at the time. And my daughter called me and told me that her son had RSV and they were going to the suction clinic. And I said, What is that? And he basically went to a hospital a few times the first two days, and then once a day, the few days after that, and stayed completely out of the hospital. And I remember thinking at the time, what a what a fabulous thing for families and what a fabulous thing for for my own grandson. And boy, she would be great if we could do that. So we we put it we put it on the list of things to do soon. And then we got sort of distracted by COVID and we were not seeing gigantic numbers of RSV. But I will tell you that, you know, eight weeks ago or ten weeks ago when we when we saw this coming because of what had happened in other parts of the country and in the southern hemisphere, we said let's let's make a run at this. Let's see if we can open this up and and really, in essence, get this started in the next month. And I am I am just thrilled that that we got going and we got permission and blessing from all of the different entities that needed to review this sort of thing. So I would say St Luke's pulled out all the stops to get this, to get this up and running to help the community.

WRIGHT: Wow. That's that's just amazing. I guess I'm going to wrap up with what what should parents be looking for when it comes to RSV and their kids being sick? What should they look for in terms of, you know, just being sick and then an emergency situation where maybe they they need to go and get help?

BRAMWELL: Yeah, those are great questions. Know the best thing that you can do in the prevention category is if you know that someone is sick, try not to be too close to them. If you know that someone has a cough and you have a four week old, do your best to keep the people who are coughing away from your four week old if you can. Sometimes that's a sibling and they're licking each other. The the thing to do once you get sick is to sort of keep an eye on how the infant or toddler is doing, if they're having trouble breathing or if you watch them breathe sort of without a shirt on and you can see their ribs moving or you can see the muscles between their ribs, or if they do what we call abdominal breathing, where their belly is going out, when their lungs are going in, or if they head bob where they're just lifting their head as another way to help them breathe. All of those things are worrisome. And I and I would I would seek medical care. Another another thing to think about is how active is the child if they're if they're able to eat and drink, that's fantastic. And that's reassuring. And that's that's really good news. But if you find that previously, let's say the infant was able to take an ounce and a half or two ounces and now they do half an ounce and they pull off and they just cry. I would I would seek some medical attention for for that infant because this this is somewhat nefarious. How it sneaks up on you and how children just have sort of progressive difficulty breathing because of the nasal swelling.

WRIGHT: Wow, This is great advice and good news about the the suction clinics. We've been speaking with Dr. Kenny Bramwell, the St Luke's Children's System medical director, about RSV that's hitting Idaho. I want to thank you so much for coming on and telling us more.

BRAMWELL: Thank you, Sam.

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As Senior Producer of our live daily talk show Idaho Matters, I’m able to indulge my love of storytelling and share all kinds of information (I was probably a Town Crier in a past life!). My career has allowed me to learn something new everyday and to share that knowledge with all my friends on the radio.