California child dies of flu and RSV

Flu season has come to life in California, reaching levels not seen in years and threatening to further strain a healthcare system already grappling with an onslaught of RSV cases and a still-rough spread of the coronavirus.

California Department of Health officials underscored the worrisome conditions and on Monday reported the first death of a child under the age of 5 in the season from influenza and respiratory syncytial virus (RSV).

“This tragic event is a stark reminder that respiratory viruses can be deadly, particularly in very young children and infants,” said Dr. Tomás Aragón, the California health director and health officer, on the child’s death.

Influenza activity was considered high in California in the week ending November 5, the most recent time span for which data is available, according to the US Centers for Disease Control and Prevention. This is the second-hardest category on the agency’s five-point scale.

Two weeks ago, the nationwide activity of flu-like illnesses was considered low.

The CDC’s assessment is based on monitoring for respiratory illnesses, such as a fever and cough or sore throat, not just laboratory-confirmed cases of the flu.

California’s most recent flu positivity rate was 14%, according to the state Department of Health and Human Services, well above the level at this point in any of the past five years. In LA County, the rate is even worse — 25% versus 13% last week.

So far, California’s flu hotspot has been in the southeast corner and has included San Diego, Orange, Riverside, San Bernardino and Imperial counties, state data shows.

In a recent statement, the Los Angeles County Department of Health said health care providers “need to prepare for the possibility of a severe flu season this fall and winter.”

“All patients – particularly those over the age of 65 – should be encouraged at any medical encounter to receive both their influenza vaccine and their updated Fall COVID-19 booster as soon as possible,” the message continued.

From early October through November 5, thirteen flu deaths were reported in California, eight of them among seniors.

According to the CDC, California is the only West Coast state with an elevated level of flu activity this early in the season. However, several states — including New York, Connecticut, New Mexico, Colorado, Nebraska, Ohio, and Illinois — have high or very high scores.

Officials have continued to warn of the possibility of a possible serious flu flare-up after two pandemic-related seasons this year, urging residents to get vaccinated and take other measures to protect themselves.

Those calls have gained urgency amid an early strike from RSV and the general expectation that the coronavirus could surge again this fall and winter.

“Knowing that we are faced with the possibility of multiple respiratory diseases circulating at once and putting a strain on our healthcare systems, we can all be assured of doing the things we know will help prevent the spread of respiratory disease : Wash hands, wipe put down surfaces that are touched frequently, stay at home when we are not feeling well, and wear a well-fitting mask with high filter performance indoors, especially when you are around people who are most vulnerable for serious illnesses,” LA County Public Health Director Barbara Ferrer said Thursday.

Children’s hospitals remain busy managing RSV, which can cause significant illness and even death in young children and the elderly.

“In California in particular, we’re seeing higher rates in Southern California,” said Dr. Rohan Radhakrishna, deputy director of the California Department of Health, in a briefing to health professionals last week.

As of early November, 33% of child samples nationwide tested positive for RSV, the highest such rate in California since fall 2019, according to data provided by Radhakrishna.

Orange County — California’s third-most populous country — has declared a public health emergency “requiring hospitalization of children beyond the capacity and infrastructure of our designated children’s hospitals” due to high rates of RSV and other respiratory illnesses. Orange County is particularly at risk because there are only two primary children’s hospitals, both operated by Children’s Health of Orange County. The region’s hospitals are also not always able to accommodate pediatric patients transferred from other regions.

An increase in flu cases — and hospitalizations among adults — threatens to further worsen the situation, according to the Orange County Health Care Agency.

“Influenza hospitalizations are not routinely reported, so we cannot specifically say we are seeing more flu hospitalizations,” the agency wrote in a statement to The Times. “But based on the increased influenza case reports, we can expect influenza hospitalizations [among adults] will increase in the coming weeks. These will occupy beds that would normally also be used for the elderly [pediatric] patients.”

Given current and anticipated hospital needs, state health officials are recommending health care facilities to “review short-term actions to expand capacity for evaluating and treating pediatric patients,” according to a statement from the California Department of Health.

“As we enter a busy winter virus season — with the spread of RSV, influenza and COVID-19 — we urge parents and guardians to get their children vaccinated against influenza and COVID-19 as soon as possible,” Aragón said. “It’s also important to follow basic prevention tips like washing your hands frequently, wearing a mask and staying home when you’re sick to slow the spread of germs.”

Compared to Orange County, LA County reports a relatively lower burden, in part because there are more children’s hospitals. However, one of the top children’s hospitals — Children’s Hospital Los Angeles — says that while it can take patients, its emergency room is so overwhelmed that it isn’t always able to accommodate referrals from other hospitals.

About 62% of LA County children’s hospital beds are occupied, up from 54% in early August. In addition, 70% of pediatric intensive care unit beds are occupied, up from 61% a month ago.

“These numbers do not mean a bad situation in the hospitals at the moment. But we hear anecdotally that hospitals and medical staff are feeling stressed,” Ferrer said.

Officials also note that hospital capacity can deteriorate rapidly in many facilities that have few beds to treat children.

“As little as nine or ten new hospital admissions can have the potential to fill a hospital to capacity for its pediatric patients,” Ferrer said.