HJNO Nov/Dec 2021

Q&A 26 NOV / DEC 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS was exacerbated by the fact that at the peak of the surge, we had as many as about 70 staff members out at any given time with COVID-19. We had to be diligent and cre- ative to ensure adequate staff coverage. By doing so, we were able to completely avoid going on diversion or transferring patients to other facilities. Did hospital staff anticipate this surge in pediatric cases? Having been through prior surges of COVID-19, we knew that another surge was a possibility. What surprised us was both the magnitude and velocity of this particular surge. The COVID-19 test positivity rate in our emergency department and outpatient clinics increased from 1% to about 20% in just one month, and the number of chil- dren hospitalized at CHNOLA for COVID-19 increased from just one to 18 over a 10-day period in July. Delta clearly is far more con- tagious than earlier forms of the virus. What impact did Hurricane Ida have on your facility and patients? Hurricane Ida added insult to injury. A category 4 hurricane was just about the last thing our exhausted professionals needed after summer surges of both COVID-19 and RSV, but they worked with their typical dedi- cation to patient care, and we came through the storm unscathed. The facility itself suf- fered only minor water damage, and with the exception of temporary interruption of outpatient services and elective procedures, patient care was not impacted. What were the biggest challenges during this Delta wave? The availability of professional staff, particularly nurses, became our rate-lim- iting factor. We know that many healthcare facilities across Louisiana and the nation are having the same experience. Like others, we are using every strategy at our disposal to recruit and retain professionals. What experiences and details were unexpected? As I mentioned, I think the magnitude and velocity of this Delta surge was surprising. Many of us had come to believe that chil- dren would escape the worst of COVID-19, but Delta has changed that perception. In addition, I was particularly struck by the fact that so many of the children hospi- talized during this most recent surge were so young. Going forward, children clearly are going to be a major element of our response to COVID-19. Delta has increased the urgency to study and approve COVID- 19 vaccines for young children. Has the hospital seen an unexpected surge of Respiratory Syncytial Virus (RSV) cases recently? If so, why do you think that happened? Do you think it may be due to the previous year’s social isolation preventing kids building up immunity? As I mentioned, we did have an unusual summertime epidemic of RSV infection, as well. The speculation is that this resulted from the very attenuated RSV outbreak we had last winter, meaning that there was a larger-than-usual pool of susceptible and vulnerable young children who could become infected with the virus as social isolation was loosened. To be honest, this is uncharted territory. It is difficult to pre- dict what any of this means for the upcom- ing winter season, RSV, influenza and other seasonal viruses. What was different about treating children with COVID-19 as opposed to adults? The medical care of children and adults with COVID-19 is similar. The main differ- ences are in the social aspects of care. It is impossible to isolate a child from his or her parents. Many adult family members are at risk for COVID-19, so hospital policies have to carefully balance the needs of the child to “Delta was a gamechanger for children, affecting patients who were younger and healthier than ever before ... Pediatric hospitalizations tripled among children 5-11 years of age and increased tenfold among children 0-4 years of age after the emergence of the Delta variant.”