View source for Medicine:2022–2023 pediatric care crisis

{{Short description|Ongoing viral disease outbreak}}
{{Infobox outbreak
| name            = 2022–2023 pediatric care crisis <!-- do not capitalize -->
| width           = 
| image           = RSV, Influenza, and SARS-CoV-2 (52620877022).jpg
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| caption         = RSV, Influenza, and COVID-19 are among the primary contributors to the crisis
}}
In the waning months of 2022, the first [[Earth:Northern Hemisphere|northern hemisphere]] autumn with the nearly full relaxation of public health precautions related to the COVID-19 pandemic, hospitals in the United States and Canada<ref>{{Cite news |last=Shingler |first=Benjamin |title=What to know about RSV, a virus surging among young children in Canada |work=CBC News |url=https://www.cbc.ca/news/health/rsv-canada-children-virus-1.6628778}}</ref> began to see overwhelming numbers of [[Medicine:Pediatrics|pediatric care]] patients, primarily driven by a massive upswing in [[Biology:Respiratory syncytial virus|respiratory syncytial virus (RSV)]] cases, but also [[Medicine:Influenza|flu]], rhinovirus, [[Biology:Enterovirus|enterovirus]], and [[Biology:SARS-CoV-2|SARS-CoV-2]].<ref name="Atlantic">{{cite news |last1=Wu |first1=Katherine |title=The Worst Pediatric-Care Crisis in Decades |url=https://www.theatlantic.com/health/archive/2022/10/rise-of-rsv-flu-covid-infections-kids/671947/ |access-date=1 November 2022 |publisher=The Atlantic |date=31 October 2022 |archive-url=https://web.archive.org/web/20221031233050/https://www.theatlantic.com/health/archive/2022/10/rise-of-rsv-flu-covid-infections-kids/671947/ |archive-date=31 October 2022}}</ref>   

With high levels of hand-washing, mask-wearing, and [[Medicine:Social distancing|social isolation]] during the early years of the pandemic, children born during this period had particularly low levels of exposure to RSV, with public health professionals reporting extremely low levels of RSV transmission in 2020 and 2021. In contrast, 2022 evidenced a dramatic reversal.<ref>{{cite news |last1=Roth |first1=Clare |title=Doctors say respiratory infection RSV may surge this winter |url=https://www.dw.com/en/facts-on-rsv/a-63562530 |access-date=1 November 2022 |publisher=Deutsche Welle |date=27 October 2022 |ref=DW |archive-url=https://web.archive.org/web/20221031040111/https://www.dw.com/en/facts-on-rsv/a-63562530 |archive-date=31 October 2022}}</ref>

Starting in September 2022, many emergency departments and intensive-care units in the United States have been either at-capacity or over-capacity, with a variety of hospitals resorting to extreme measures which have included the use of a makeshift tent outside Johns Hopkins Children's Center in Maryland and the proposed deployment of the National Guard in Connecticut.<ref name= "Atlantic" />

Outside of North America, in the {{wipe|United Kingdom}}, pediatric infections also began to spike beyond pre-pandemic levels, albeit with different illnesses, such as Group A streptococcal infection and resultant [[Medicine:Scarlet fever|scarlet fever]].<ref name="United Kingdom">{{cite news |last1=Mackintosh |first1=Thomas |last2=Durbin |first2=Adam |title=Father of girl, 4, fighting for life with Strep A infection is 'praying for a miracle' |url=https://www.bbc.com/news/health-63844880 |access-date=4 December 2022 |publisher=BBC News |date=3 December 2022 |archive-url=https://web.archive.org/web/20221203125723/https://www.bbc.com/news/health-63844880 |archive-date=3 December 2022}}</ref> As of mid-December in 2022, 19 children in the UK had died due to [[Biology:Streptococcus pyogenes|Strep A]] and the wave of infections had begun to spread into North America and Mainland Europe.<ref name="Strep A death">{{cite news |title=Strep A kills three more children as UK activates alternative medicines plan: At least 19 children have died and scarlet fever cases are more than treble what they were in previous high season |url=https://www.theguardian.com/society/2022/dec/15/strep-a-kills-three-more-children-as-uk-activates-new-medicines-plan|access-date=17 December 2022 |work=The Guardian |date=15 December 2022 |archive-url=https://web.archive.org/web/20221217040228/https://www.theguardian.com/society/2022/dec/15/strep-a-kills-three-more-children-as-uk-activates-new-medicines-plan |archive-date=17 December 2022}}</ref><ref name="Strep Expansion" /> 

In late 2023, a similar pattern of pediatric illness appeared to emerge with [[Biology:Mycoplasma pneumoniae|Mycoplasma pneumoniae]] in {{wipe|China}} during the first full autumn and winter season following relaxation of its stringent Zero-COVID policies.<ref>{{cite news |last1=Sparrow |first1=Annie |title=Chinese Hospitals Are Housing Another Deadly Outbreak |url=https://foreignpolicy.com/2023/11/28/chinese-hospitals-pandemic-outbreak-pneumonia/ |access-date=30 November 2023 |publisher=Foreign Policy |date=28 November 2023 |archive-url=https://web.archive.org/web/20231129111636/https://foreignpolicy.com/2023/11/28/chinese-hospitals-pandemic-outbreak-pneumonia/ |archive-date=29 November 2023}}</ref> Increased rates of pediatric [[Medicine:Mycoplasma pneumonia|Mycoplasma pneumonia]] were simultaneously observed in other parts of the world, with {{wipe|Denmark}} declaring that infections had reached epidemic levels.<ref>{{cite news |last1=Schnirring |first1=Lisa |title=Denmark reports Mycoplasma pneumonia epidemic {{!}} CIDRAP |url=https://www.cidrap.umn.edu/pneumonia/denmark-reports-mycoplasma-pneumonia-epidemic |access-date=30 November 2023 |publisher=Center for Infectious Disease Research and Policy at the University of Minnesota |date=29 November 2023 |archive-url=https://web.archive.org/web/20231130053021/https://www.cidrap.umn.edu/pneumonia/denmark-reports-mycoplasma-pneumonia-epidemic |archive-date=30 November 2023 |language=en}}</ref> 

== Timeline ==
The crisis had no clear start date, as multiple disease outbreaks occurred over the course of 2022, with cascading effects on healthcare systems already burdened by the ongoing pandemic. Notably, staffing shortages led commentators in the US to say that the system was "crumbling" in August.<ref>{{Cite web |last=J.D |first=Sai Balasubramanian, M. D. |title=The Healthcare Industry Is Crumbling Due To Staffing Shortages |url=https://www.forbes.com/sites/saibala/2022/08/26/the-healthcare-industry-is-crumbling-due-to-staffing-shortages/ |access-date=2022-11-02 |website=Forbes |language=en}}</ref> While authorities at one health region in Ontario spoke of "serious" and "unprecedented" challenges in September.<ref>{{Cite web |title=Health-care worker shortage presenting serious challenge to Niagara hospital system - Niagara Health News, Updates & Publications {{!}} Niagara Health System {{!}} Système De Santé De Niagara |url=https://www.niagarahealth.on.ca/site/news/2022/09/22/health-care-worker-shortage-presenting-serious-challenge-to-niagara-hospital-system |access-date=2022-11-02 |website=www.niagarahealth.on.ca |language=en}}</ref>  In Canada, warning signs appeared as early as July with a spike in enterovirus ("hand foot and mouth disease") cases<ref>{{Cite web |title=Hand-foot-and-mouth disease outbreaks higher than in years past: AHS - Edmonton {{!}} Globalnews.ca |url=https://globalnews.ca/news/9004111/hand-foot-mouth-disease-outbreaks-alberta/ |access-date=2022-11-02 |website=Global News |language=en-US}}</ref> which continued into August.<ref>{{Cite news |last=Sweet |first=Jennifer |title=Doctors see hand, foot and mouth disease make comeback in N.B. |work=CBC News |url=https://www.cbc.ca/news/canada/new-brunswick/common-childhood-illnesses-comeback-saint-john-pediatrician-1.6559726}}</ref>

The pediatric care crisis in the United States began to be visible in statistics with high late-summer, August 2022 hospitalization numbers of children infected with rhinovirus and enterovirus, which are both acute respiratory illnesses and often indistinguishable without molecular sequencing or via a specific [[Biology:Reverse transcription polymerase chain reaction|rRT-PCR]] assay. By early September, the Centers of Disease Control issued an official Health Advisory about severe respiratory illnesses from Rhinoviruses and/or Enteroviruses D-68. <ref>{{cite news |title=Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68 – Multistate, 2022 |url=https://emergency.cdc.gov/han/2022/han00474.asp |access-date=1 November 2022 |agency=Centers for Disease Control and Prevention |publisher=CDC Health Alert Network |date=9 September 2022 |archive-url=https://web.archive.org/web/20221031213641/https://emergency.cdc.gov/han/2022/han00474.asp |archive-date=31 October 2022}}</ref>

RSV then began to see its exponential rise to the top of pediatric infections in September and October 2022, with mid and late-autumn SARS-CoV-2 and seasonal flu infections increasing the pediatric care burden later into the year.By mid-autumn, flu cases had already shuttered schools and reactivated [[Social:Distance education|remote learning]] in parts of the American South and mid-Atlantic.<ref name= "Atlantic" />

On October 26, the Government of Canada issued an advisory that Canada was experiencing [[Finance:Shortages related to the COVID-19 pandemic|a shortage of children's acetaminophen and ibuprofen]] due to the spike in infections.<ref>{{Cite web |date=2022-10-26 |title=Infant and children's acetaminophen and ibuprofen shortage |url=https://www.canada.ca/en/health-canada/services/drugs-medical-devices/safe-use-medication-for-children/infant-childrens-acetaminophen-ibuprofen-shortage.html |access-date=2022-11-02 |website=www.canada.ca}}</ref>  By late October, staff infections with respiratory illnesses had compounded the previous staffing shortages in Ontario causing many emergency rooms and other departments at multiple hospitals to close.<ref>{{Cite web |title=Ontario hospitals continue to deal with significant staffing shortages {{!}} Globalnews.ca |url=https://globalnews.ca/news/9216828/ontario-hospitals-significant-staffing-shortages-october-2022/ |access-date=2022-11-02 |website=Global News |language=en-US}}</ref>  In the USA staffing shortages and the spike in infections saw 80% of pediatric beds full nationally, with the worst numbers being in Rhode Island where beds were 99% full, causing some hospitals to set up field tents.<ref>{{Cite web |last=Christensen |first=Jen |date=2022-10-28 |title=Staff shortages make patient surges harder for children's hospitals -- and the situation won't get better soon |url=https://www.cnn.com/2022/10/28/health/staff-shortages-childrens-hospitals/index.html |access-date=2022-11-02 |website=CNN |language=en}}</ref>

On November 7, researchers determined that the United States was concurrently facing epidemics of flu, RSV, and COVID-19 in children.<ref name="Tanne 2022 p=o2681">{{cite journal | last=Tanne | first=Janice Hopkins | title=US faces triple epidemic of flu, RSV, and covid | journal=BMJ | date=2022-11-07 | volume=379 | issn=1756-1833 | doi=10.1136/bmj.o2681 | page=o2681| pmid=36343961 | s2cid=253371039 | doi-access=free }}</ref>
As of early November, 75% of beds in US children's hospitals were full and the crisis had spread to eastern Canada, with a children's hospital in Ottawa reporting over 130% capacity for both intensive care and inpatient beds. On November 1, 2022, California's Orange County declared a pediatric health emergency after seeing record-breaking numbers of children enter emergency rooms in the county's hospitals.<ref name="Fortune">{{cite news |last1=Prater |first1=Erin |title=Viral infections like RSV, the flu, and COVID have one Southern California county declaring a pediatric health emergency. It's far from alone |url=https://fortune.com/well/2022/11/01/tripledemic-rsv-flu-covid-flu-like-illness-pediatric-health-emergency-orange-county-southern-california-us-united-states-canada-winter-fall-surge-schools-viral-illness-public-health/ |access-date=2 November 2022 |work=Fortune |date=1 November 2022 |archive-url=https://web.archive.org/web/20221102023911/https://fortune.com/well/2022/11/01/tripledemic-rsv-flu-covid-flu-like-illness-pediatric-health-emergency-orange-county-southern-california-us-united-states-canada-winter-fall-surge-schools-viral-illness-public-health/ |archive-date=2 November 2022}}</ref>  At the same time over fourteen thousand students were out of school due to illness in the Edmonton region of Alberta.<ref>{{Cite web |title=14K+ Edmonton students off sick as respiratory illnesses spike in region {{!}} Globalnews.ca |url=https://globalnews.ca/news/9254632/alberta-respiratory-illnesses-edmonton-school-outbreaks/ |access-date=2022-11-07 |website=Global News |language=en-US}}</ref> By November 5, Emily Gruenwold, president and CEO of Children's Healthcare Canada said that "across the country, almost without exception, our children's hospitals are all running at 100 percent occupancy or more" in part because the shortage of over-the-counter painkillers that could suppress fevers lead more parents to bring their sick children to hospitals.<ref>{{Cite web |date=2022-11-05 |title='We are so overwhelmed': Children's hospitals across Canada stretched as RSV cases, flu-like illnesses spike |url=https://www.ctvnews.ca/health/we-are-so-overwhelmed-children-s-hospitals-across-canada-stretched-as-rsv-cases-flu-like-illnesses-spike-1.6139599 |access-date=2022-11-07 |website=CTVNews |language=en}}</ref>

[[File:Covid Flu and RSV testing.jpg|thumb|left|Testing booth for COVID-19, both major influenza strains, and RSV in New York City.]]
On November 14, the Children's Hospital Association and the American Academy of Pediatrics wrote a joint letter to President Biden and Health Secretary Xavier Becerra, asking that the administration declare an emergency that would unlock funding and regulatory flexibilities akin to the ongoing COVID-19 emergency. This request came as RSV hospitalizations reached seven times pre-pandemic levels among infants 6 months and younger and flu hospitalizations were the highest in a decade.<ref>{{cite news |last1=Kimball |first1=Spencer |title=Children's hospitals call on Biden to declare emergency in response to 'unprecedented' RSV surge |url=https://www.cnbc.com/2022/11/18/biden-asked-to-declare-emergency-over-rsv-flu-kids-hospitalizations.html |access-date=21 November 2022 |publisher=CNBC |date=18 November 2022 |archive-url=https://web.archive.org/web/20221121015732/https://www.cnbc.com/2022/11/18/biden-asked-to-declare-emergency-over-rsv-flu-kids-hospitalizations.html |archive-date=21 November 2022}}</ref> One US state, Oregon, had already declared a public health emergency related to the pediatric care crisis several days prior to the national appeal.<ref>{{cite news |last1=Rideout |first1=Nicole |title=Oregon governor declares RSV in children a public health emergency |url=https://news.ohsu.edu/2022/11/15/oregon-governor-declares-rsv-in-children-a-public-health-emergency |access-date=21 November 2022 |publisher=OHSU News |date=15 November 2022 |archive-url=https://web.archive.org/web/20221119041934/https://news.ohsu.edu/2022/11/15/oregon-governor-declares-rsv-in-children-a-public-health-emergency |archive-date=19 November 2022}}</ref> The US Department of Health and Human Services decided against a national emergency declaration at the time, deciding to instead support struggling communities on a case-by-case basis.<ref>{{cite news |last1=Weixel |first1=Nathaniel |title=White House resists declaring emergency as flu, viruses surge in children |url=https://thehill.com/policy/healthcare/3748779-white-house-resists-declaring-emergency-as-flu-viruses-surge-in-children/ |access-date=26 November 2022 |work=The Hill |date=25 November 2022 |archive-url=https://web.archive.org/web/20221125111748/https://thehill.com/policy/healthcare/3748779-white-house-resists-declaring-emergency-as-flu-viruses-surge-in-children/ |archive-date=25 November 2022}}</ref>

Also on November 14, the [[Organization:Public Health Agency of Canada|Public Health Agency of Canada]]'s FluWatch surveillance program took action on one major component of the pediatric crisis, declaring the flu an epidemic and noting a spike in pediatric flu hospitalizations above expected levels.<ref name="FluWatch2022-11-14">{{cite web | url = https://www.canada.ca/en/public-health/services/publications/diseases-conditions/fluwatch/2022-2023/week-44-october-30-november-5-2022.html | title = FluWatch report: October 30 to November 5, 2022 (week 44) | publisher = Public Health Agency of Canada | date = 2022-11-14 | access-date = 2022-11-14}}</ref>
Days later, on November 17, the Canadian Medical Protective Association (a legal defense fund for doctors) issued advice to its members about practising out of scope due to the "unprecedented overcrowding occurring in pediatric hospitals across the country".<ref>{{Cite web |title=CMPA - Pediatric care crisis – Practising outside of scope |url=https://www.cmpa-acpm.ca/en/news/2022/pediatric-care-crisis-practising-outside-of-scope |access-date=2022-12-09 |website=CMPA |language=en-US |archive-date=2022-12-09 |archive-url=https://web.archive.org/web/20221209155505/https://www.cmpa-acpm.ca/en/news/2022/pediatric-care-crisis-practising-outside-of-scope |url-status=dead }}</ref> On November 23, a group called "Moms, Grandmoms, and Caregivers for Kids" issued an open letter to the Canadian federal and provincial governments about the crisis because, they said, "There is a palpable sense of hopelessness amongst parents and those that serve kids on the frontlines. Doctors say the crisis will get worse before it gets better, yet we see no tangible signs of action." The signatories to the letter included Lisa Raitt, Penny Collenette, Kathleen Wynne, and Marg McCuaig-Boyd.<ref>{{Cite web |last=Kids |first=Moms, Grandmoms, and Caregivers for |title=Open Letter to Prime Minister Justin Trudeau and the Premiers: Our kids are in crisis - It's time to work together and prioritize children |url=https://www.newswire.ca/news-releases/open-letter-to-prime-minister-justin-trudeau-and-the-premiers-our-kids-are-in-crisis-it-s-time-to-work-together-and-prioritize-children-812388653.html |access-date=2022-12-09 |website=www.newswire.ca |language=en}}</ref> By the end of November, Canadian pediatric hospitalizations for seasonal influenza alone were 20 times the usual rate of admissions for that time of year.<ref>{{cite news |last1=Jones |first1=Nicola |title=Flu causes huge spike in child hospitalizations in Canada |url=https://www.nature.com/articles/d41586-022-04408-7 |access-date=12 December 2022 |publisher=Nature |date=12 December 2022 |archive-url=https://web.archive.org/web/20221212194255/https://www.nature.com/articles/d41586-022-04408-7 |archive-date=12 December 2022}}</ref>
On December 9, the premiers of Canada's provinces and territories held a joint news conference to address the crisis in children's hospitals.<ref>{{Cite web |title=Canadian premiers set to speak as viral surge overwhelms children's hospitals {{!}} Globalnews.ca |url=https://globalnews.ca/news/9337244/canada-premiers-news-conference-dec-9/ |access-date=2022-12-09 |website=Global News |language=en-US}}</ref>

By mid-December, some US children's hospitals were receiving transfer requests from communities far outside of their typical geographic coverage areas. Helen DeVos Children's Hospital of Grand Rapids, Michigan fielded requests from communities in the state's Upper Peninsula, upwards of 300 miles away, and the state of Illinois. Both areas share land borders with Wisconsin rather than lower Michigan, but Wisconsin's hospitals were full. Devos also had to turn away patients and could only accept children who were severely ill.<ref>{{cite news |last1=Wells |first1=Kate |title=Children's hospitals are struggling to cope with a surge of respiratory illness |url=https://www.npr.org/sections/health-shots/2022/12/15/1141679788/childrens-hospitals-are-struggling-to-cope-with-a-surge-of-respiratory-illness |access-date=15 December 2022 |publisher=NPR |date=15 December 2022 |archive-url=https://web.archive.org/web/20221215135514/https://www.npr.org/sections/health-shots/2022/12/15/1141679788/childrens-hospitals-are-struggling-to-cope-with-a-surge-of-respiratory-illness |archive-date=15 December 2022}}</ref>

The UK's spike in severe pediatric Strep A infections also began to spill over into the United States in December 2022, with Colorado, {{wipe|Texas}}, and Arizona reporting atypically high numbers of cases in children's hospitals, including two deaths in Colorado, while the [[Organization:World Health Organization|World Health Organization]] noted that the Netherlands, Ireland, Sweden, and {{wipe|France}} had also begun experiencing unusually high levels of Strep A infections.<ref name="Strep Expansion">{{cite news |last1=Wetsman |first1=Nicole |last2=McLean |first2=Nicole |title=US children's hospitals are tracking increases in severe strep infections |url=https://abcnews.go.com/Health/us-childrens-hospitals-tracking-increases-severe-strep-infections/story?id=95388618 |access-date=17 December 2022 |publisher=ABC News |date=16 December 2022 |archive-url=https://web.archive.org/web/20221217100006/https://abcnews.go.com/Health/us-childrens-hospitals-tracking-increases-severe-strep-infections/story?id=95388618 |archive-date=17 December 2022}}</ref> On 22 December, the US CDC issued a health advisory due to increasing levels of Strep A infections in the United States.<ref>{{cite news |last1=Jacquez |first1=Joe |title=CDC issues warning about rise of invasive strep A infections in children |url=https://thehill.com/homenews/3785953-cdc-issues-warning-about-rise-of-invasive-strep-a-infections-in-children/ |access-date=23 December 2022 |work=The Hill |date=22 December 2022 |archive-url=https://web.archive.org/web/20221223040706/https://thehill.com/homenews/3785953-cdc-issues-warning-about-rise-of-invasive-strep-a-infections-in-children/ |archive-date=23 December 2022}}</ref>

A study released on 7 February 2023 found that 40 percent of US households had experienced infection by one of the three primary drivers of the pediatric crisis in North America during the 2022–2023 winter season.<ref>{{cite news |last1=Weixel |first1=Nathaniel |title='Tripledemic' infected nearly 40 percent of households, survey finds |url=https://thehill.com/policy/healthcare/3846161-tripledemic-infected-nearly-40-percent-of-households-survey-finds/ |access-date=8 February 2023 |work=The Hill |date=7 February 2023 |archive-url=https://web.archive.org/web/20230207101609/https://thehill.com/policy/healthcare/3846161-tripledemic-infected-nearly-40-percent-of-households-survey-finds/ |archive-date=7 February 2023}}</ref>

== Coinfections ==
While coinfections have always been a possibility in pediatric medicine, SARS-CoV-2 has made coinfection with multiple viruses much more common, with doctors reporting back-to-back hospitalizations and children presenting with upwards of four distinct respiratory viruses in the span of a single month.<ref name= "Atlantic" /> According to a CDC report released in December 2022, children who experience a coinfection of SARS-CoV-2 and influenza are more likely to encounter adverse outcomes and require invasive or noninvasive respiratory support than children infected with influenza only.<ref name="CDC coinfection">{{cite journal |last1=Adams |first1=Katherine |last2=Tastad |first2=Katie |last3=Huang |first3=Stacy |display-authors=0 |title=Prevalence of SARS-CoV-2 and Influenza Coinfection and Clinical Characteristics Among Children and Adolescents Aged <18 Years Who Were Hospitalized or Died with Influenza — United States, 2021–22 Influenza Season |journal=MMWR. Morbidity and Mortality Weekly Report  |date=16 December 2022 |volume=71 |issue=50 |pages=1589–1596 |doi=10.15585/mmwr.mm7150a4 |pmid=36520656 |pmc=9762905 |url=https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a4.htm |access-date=19 January 2023}}</ref>

== Contributing factors ==
In the two decades preceding the crisis, US hospitals experienced a significant decline in the number of pediatric beds due to lower billable procedures in pediatric admissions in comparison to adults. Pediatric beds have also been occupied by greater numbers of young people experiencing mental health emergencies during the COVID-19 pandemic, who have been admitted to ICUs following suicide attempts.<ref name="Al Jazeera">{{cite news |last1=Beaumont |first1=Hilary |title=US children's hospitals overwhelmed by RSV cases |url=https://www.aljazeera.com/news/2022/11/30/us-childrens-hospitals-overwhelmed-by-rsv-cases |access-date=30 November 2022 |publisher=Al Jazeera |date=30 November 2022 |archive-url=https://web.archive.org/web/20221130191901/https://www.aljazeera.com/news/2022/11/30/us-childrens-hospitals-overwhelmed-by-rsv-cases |archive-date=30 November 2022}}</ref>

In typical years, without a surge of cases and multiple coinfections, RSV is the most common cause of pediatric hospitalization in developed countries, and [[Medicine:Bronchiolitis|Bronchiolitis]] caused by RSV is more severe and leads to higher hospitalization rates as compared with non-RSV bronchiolitis.<ref>{{cite journal |last1=Welliver |first1=Robert |title=Review of epidemiology and clinical risk factors for severe respiratory syncytial virus (RSV) infection |journal=The Journal of Pediatrics |date=November 2003 |volume=143 |issue=5 |pages=112–117 |doi=10.1067/S0022-3476(03)00508-0 |pmid=14615709 |url=https://www.sciencedirect.com/science/article/abs/pii/S0022347603005080 |access-date=2 December 2022}}</ref><ref>{{cite journal |last1=García |first1=Carla |last2=Bhore |first2=Rafia |last3=Soriano-Fallas |first3=Alejandra |last4=Trost |first4=Margaret |last5=Chason |first5=Rebecca |last6=Ramilo |first6=Octavio |last7=Mejias |first7=Asuncion |title=Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis |journal=Pediatrics |date=1 December 2010 |volume=126 |issue=6 |pages=e1453–e1460 |doi=10.1542/peds.2010-0507 |pmid=21098154 |pmc=3761792 |url=https://publications.aap.org/pediatrics/article-abstract/126/6/e1453/65032/Risk-Factors-in-Children-Hospitalized-With-RSV |access-date=2 December 2022}}</ref>

A widespread shortage of liquid [[Chemistry:Amoxicillin|amoxicillin]] has also complicated pediatric care for primary bacterial infections, such as Strep A, as well as potentially dangerous secondary bacterial infections arising from a primary viral infection.<ref name="Immunity Gap">{{cite magazine |last1=Pearson |first1=Rachel |title=The Post-COVID "Immunity Gap" Continues to Pummel Pediatric Wards |url=https://www.newyorker.com/science/annals-of-medicine/the-post-covid-immunity-gap-continues-to-pummel-pediatric-wards |access-date=28 December 2022 |magazine=The New Yorker |date=27 December 2022 |archive-url=https://web.archive.org/web/20221228031114/https://www.newyorker.com/science/annals-of-medicine/the-post-covid-immunity-gap-continues-to-pummel-pediatric-wards |archive-date=28 December 2022}}</ref> 

== Government responses ==
In the US, Surgeon General Vivek Murthy noted that the federal government was responding to the crisis in a variety of ways. First, it was offering direct support to struggling hospitals by providing personnel, ventilators, and equipment. The federal government also actively assisted in interstate coordination of available beds across given regions.<ref name="ABC News">{{cite news |title=Surgeon General Vivek Murthy advises on flu, RSV and COVID-19 |url=https://abcnews.go.com/US/surgeon-general-vivek-murthy-advises-flu-rsv-covid/story?id=94279024 |access-date=2 December 2022 |publisher=ABC News |date=1 December 2022 |archive-url=https://web.archive.org/web/20221202205640/https://abcnews.go.com/US/surgeon-general-vivek-murthy-advises-flu-rsv-covid/story?id=94279024 |archive-date=2 December 2022}}</ref> Although the US would not declare a public health emergency specific to the pediatric crisis, HHS Secretary Xavier Becerra wrote, in a 2 December letter to US governors, that the existing emergency declaration for COVID-19 could be broadly applied to the surge in other respiratory viruses related to the relaxation of pandemic public health measures.<ref name="non-declaration">{{cite news |last1=McPhillips |first1=Deidre |title=As respiratory viruses strain US health care systems, Biden administration tells states how it's ready to help |url=https://www.cnn.com/2022/12/02/health/flu-respiratory-viruses-hospitalization-increase/index.html |access-date=4 December 2022 |publisher=CNN |date=2 December 2022 |archive-url=https://web.archive.org/web/20221204023815/https://www.cnn.com/2022/12/02/health/flu-respiratory-viruses-hospitalization-increase/index.html |archive-date=4 December 2022}}</ref>

== Broader crisis ==

In December 2022, the terms "'''tripledemic'''"<ref>{{Cite news |title=CDC updates the status of the 'tripledemic' |language=en |work=NPR.org |url=https://www.npr.org/2022/12/05/1140806412/cdc-updates-the-status-of-the-tripledemic |access-date=2022-12-09}}</ref><ref>{{Cite news |last1=Barbaro |first1=Michael |last2=Harper |first2=Sydney |last3=Quester |first3=Rachel |last4=Chaturvedi |first4=Asthaa |last5=Lin |first5=MJ Davis |last6=Diao |first6=Lexie |last7=Georges |first7=Marc |last8=Powell |first8=Dan |last9=Lozano |first9=Marion |date=2022-11-22 |title=The 'Tripledemic,' Explained |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/11/22/podcasts/the-daily/flu-season-rsv-covid-tripledemic.html |access-date=2022-12-09 |issn=0362-4331}}</ref> and "'''tridemic'''"<ref>{{Cite web |title=After Covid Pandemic, Canada Now Faces "Tridemic": Report |url=https://www.ndtv.com/world-news/after-covid-pandemic-canada-now-faces-tridemic-report-3577947 |access-date=2022-12-09 |website=NDTV.com}}</ref><ref>{{Cite web |date=2022-11-22 |title='Tridemic' threatening to overwhelm health care systems as flu, RSV, COVID cases rise |url=https://www.pbs.org/newshour/show/tridemic-threatening-to-overwhelm-healthcare-systems-as-flu-rsv-covid-cases-rise |access-date=2022-12-09 |website=PBS NewsHour |language=en-us}}</ref> were used to describe simultaneous outbreaks of RSV, influenza, and COVID-19 in both Canada and the United States. Accordingly, with cases of RSV at 300% more than would be expected in a normal season and rising numbers of adult infections together with increased COVID-19 hospitalizations, some public health professionals have expressed alarm at the potential for spillover into a widespread medical crisis, not confined solely to pediatric care.<ref name="WFIE">{{cite news |last1=Ponder |first1=A’Leeyah |title=RSV cases surging in adults |url=https://www.14news.com/2022/10/31/rsv-cases-surging-adults/ |access-date=1 November 2022 |publisher=WFIE 14 News |date=31 October 2022 |archive-url=https://web.archive.org/web/20221101013508/https://www.14news.com/2022/10/31/rsv-cases-surging-adults/ |archive-date=1 November 2022}}</ref><ref name="MPR">{{cite news |last1=Gawthrop |first1=Elisabeth |last2=Clary |first2=Benjamin |title=Uptick in COVID-19 hospitalizations and a surge in RSV cases in Minnesota |url=https://www.mprnews.org/story/2022/10/28/uptick-in-covid19-hospitalizations-and-a-surge-in-rsv-cases-in-minnesota |access-date=1 November 2022 |publisher=MPR News |date=28 October 2022 |archive-url=https://web.archive.org/web/20221031174330/https://www.mprnews.org/story/2022/10/28/uptick-in-covid19-hospitalizations-and-a-surge-in-rsv-cases-in-minnesota |archive-date=31 October 2022}}</ref>{{needs update|date=June 2023}}

==See also==

*[[Biology:Twindemic|Twindemic]]

== References ==
{{reflist}}{{COVID-19 pandemic in Canada}}{{COVID-19 pandemic in the United States}}

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[[Category:Epidemiology]]
[[Category:Pediatrics]]
{{DEFAULTSORT:2022-2023 pediatric care crisis}}

{{Sourceattribution|2022–2023 pediatric care crisis}}