Flu, RSV, COVID 'trifecta' fills NJ hospitals and emergency rooms

FREEHOLD — Across New Jersey, a triple-threat is filling emergency rooms. Three serious respiratory infections — influenza, COVID-19 and respiratory syncytial virus, better known as RSV — are straining health care systems as they spread across New Jersey, according to doctors.

"The demand (for care and treatment) that this trifecta has required has definitely left us… shocked and strained," said Dr. Sanjay Mehta, who oversees pediatric emergency care for the CentraState Healthcare System in Freehold.

For the first time in Mehta's memory — he has worked at the hospital for 15 years — other pediatric hospitals across the state have declined to accept transfers of young patients due to a lack of beds, the doctor said.

This season, "the number of kids who are sick has been a lot more (than typical)," he said.

RSV is responsible for many of the cases of pediatric illness in New Jersey, Mehta said. While most healthy adults and older children with RSV have mild symptoms, the virus can be serious in infants, young children, older adults and people with chronic medical conditions, according to the Centers for Disease Control and Prevention. In severe cases, the infection can cause inflammation in the lungs, pneumonia or death.

RSV kills about 100 to 300 young children in the United States each year, and another 6,000 to 10,000 older adults, according to the CDC.

Like Mehta, Dr. Harpreet Pall is seeing a similar influx of children sick with RSV at Hackensack Meridian K. Hovnanian Children’s Hospital in Neptune.

"It's definitely a challenging time in pediatric health care across the country," he said.

COVID-19 lockdowns, masking and social distancing helped to keep young children away from RSV for the past two years, but that changed as life returned to normal for most people, Pall said.

"Children who didn't have immunity to RSV, or who had never been exposed to it in the past, all of a sudden at the same time, all got exposed," he said. "That's what led to a very big spike in the cases of kids who have RSV."

Children's safety:All NJ schools must submit digital maps of properties to law enforcement under new law

Cases of RSV started to spike in New Jersey around early September, roughly at the same time that schools reopened to students, according to CDC data. By mid-October, New Jersey was recording more than 6,000 cases of RSV a week, according to the state health department. Case counts peaked in early to mid-November at about 9,000 cases and appear to now be on the decline, according to state data.

"I was worried about RSV a month ago, and I saw other hospitals and other states with stories of… not enough spaces (for patients)," said Dr. Edward Liu, chief of infectious disease medicine at Jersey Shore University Medical Center in Neptune.

While patient volume rose at the hospital because of RSV, Liu said the workload was manageable for staff.

While RSV cases appear to be in decline, another virus is gaining traction. Flu infections have already reached "high" levels across the state, still weeks ahead of the virus' typical peak, according to the state health department.

Liu said the impacts of Thanksgiving gatherings are being felt in emergency rooms, with noticeable increases in cases of COVID-19 and flu.

"We're seeing a lot of older people, but also people who have not been boosted (with the new bivalent COVID-19 vaccine)," Liu said. "I think people aren't masking regularly anymore. And I think a lot of people are tired of vaccines and they haven't gotten their flu shot."

During the 2021-22 flu season, only 57% of adults and nearly 68% of children and teenagers in New Jersey received flu vaccines, according to the health department.

Since early October, New Jersey health care providers reported more than 44,000 cases of flu to the state health department, compared to just 1,768 cases for the same period in 2021.

"Flu shots have been around for decades, and it's available, and you should get it," Liu said.

Healthcare:Murphy seeks to privatize management of troubled NJ veterans homes ravaged by COVID

At the state health department, Dr. Edward Lifshitz, director of the infectious disease program, has been watching the virus numbers rise and fall. He saw RSV rates start to decline just as emergency rooms began to fill once again with flu patients.

Through it all, Lifshifz said COVID-19 remains active "in the background."

"What we are seeing is not that people are getting sicker, but more people are getting sick," Lifshitz said. "The hospitals are seeing an increased number of cases compared to most years. So any individual person who gets sick, it's not pleasant, but it doesn't look like it's worse than usual. But all those people are filling up the hospitals."

COVID-19 infection rates remain low from their peak in early January at more than 33,000 daily cases; just 2,340 cases were reported as of Thursday.

Yet, the combination of viruses are taxing the existing system. The high rates of infection circulating through New Jersey mean significant numbers of medical staff are also being infected, said Dr. Andy Anderson, executive vice president and chief medical and quality officer at RWJBarnabas Health.

"We are definitely seeing a strain on our staffing and we've had to rely on outside staffing and agency nurses," Anderson said. Maintaining those staffing levels "is definitely on the edge right now," he said.

The three viruses are also straining medical supply chains across the nation. According to the federal Food and Drug Administration, albuterol, a drug used to open airways in the lungs and commonly prescribed in the treatment of severe respiratory illness, remains in short supply for weeks. The supply of albuterol inhalers, which are also used by people with asthma, went into short supply in early 2020 as a result of the COVID-19 pandemic, according to the American College of Allergy, Asthma and Immunology.

Doctors said preventing infection is the best course of action for individuals, through vaccination, hand washing, mask wearing in crowded places, and by staying home from work and social gatherings when sick or a household member is sick.

"If a child has any symptoms, it's important to keep them away from school where they have the potential of infecting other children," said Pall of K. Hovnanian Children’s Hospital. "Hand hygiene is very important. That's how a lot of these viruses commonly spread. And be sure to… encourage kids to wash their hands regularly."

Amanda Oglesby is an Ocean County native who covers Brick, Barnegat and Lacey townships as well as the environment. She has worked for the Press for more than a decade. Reach her at @OglesbyAPP, aoglesby@gannettnj.com or 732-557-5701.