Monday, May 20, 2024

Mount Auburn Hospital in West Cambridge. (Photo: Marc Levy)

Cambridge’s two hospitals don’t offer any medical beds for children, and doctors face an “extraordinary problem” finding hospital care for kids amid spiking respiratory infections and staff shortages statewide, a top city public health official said Monday.

“A colleague called 30 hospitals to find a hospital bed for a small child who had an infectious process going on,” Lisa Dobberteen, medical director of the Cambridge Public Health Department and a pediatrician at Cambridge Health Alliance, told city councillors at their weekly meeting.

The local facilities are Cambridge Hospital, part of the Cambridge Health Alliance, and Mount Auburn Hospital.

Dobberteen said the situation is “one that we as pediatricians have not seen, to this extent, ever.” She spoke after chief public health officer Derrick Neal said health officials have concerns about a “tridemic” of influenza, Covid-19, respiratory syncytial virus or RSV and other respiratory infections that “are putting a strain on the hospital system at the state and regional levels, particularly related to pediatric care.”

Although Covid-19 cases have leveled off, health officials expect a severe flu season after two years of low numbers, perhaps because Covid precautions such as masking and avoiding large gatherings that might have prevented transmission have been discontinued. The state health department’s most recent report, for the week ending Nov. 5, showed low flu activity, though only 30 percent of Massachusetts residents have gotten a flu shot.

RSV cases, though, have soared, doctors say. Respiratory syncytial virus is a common respiratory infection that almost all people get as children. Most have mild, coldlike symptoms, but older people and children under 5, especially infants, can become seriously ill and need hospitalization. In Massachusetts, the proportion of positive tests for it jumped from an average 8.7 percent at the beginning of October to 24.3 percent as of Saturday, according to the Centers for Disease Control and Prevention. The figures were similar last year, but they peaked in early September.

Looking for solutions

To ease the pediatric hospital bed crunch, Dobberteen said Cambridge Health Alliance is considering admitting some older teenagers to its adult wards because its license allows that. CHA spokesman David Cecere did not answer a question Wednesday about the status of that proposal, but did say that “we continue to have limited inpatient capacity.” He said the health care system was working with Boston Children’s Hospital and Mass General for Children around care for pediatric patients. Both of those hospitals have said they are overwhelmed. Cambridge Health Alliance has an affiliation with Mass General for Children.

Cecere said the demand has swelled emergency room visits, especially in afternoons and evenings, “resulting in longer wait times.”  At 10 p.m. Nov. 7, the average wait was four and a half hours at Cambridge Hospital, according to the CHA website. (The health care system posts wait times publicly.) But it can vary sharply; it was only 27 minutes at 8:40 p.m. Wednesday.

Cecere listed recommendations to prevent respiratory illness, including staying home if sick, wearing a mask around other people – especially if those people are at high risk from illness – and to “get plenty of rest, exercise and eat healthy.”

“Nothing we can do”

CHA does have much-needed inpatient beds for youths and children with psychiatric illness, and it recently expanded those services with new units at its Somerville campus. Dobberteen said, though, that “the staffing crisis is enormous and that unit is not fully staffed, just as there are many vacancies throughout the Cambridge Health Alliance.”

“I believe Mount Auburn Hospital is also facing the same staffing shortages, but they don’t have either pediatric inpatient or pediatric mental health care,” Dobberteen said.

“There’s a huge shortage, and there’s nothing we can do,” Dobberteen said.

Plea for support

It’s not only staffing shortages and a flood of respiratory infections that are stressing the hospital system; hospitals have closed inpatient pediatric units, Dobberteen said in a letter published Nov. 13 in The Boston Globe. Dobberteen decried “an inexcusable and untenable situation in which area pediatric hospitals are turning some children away. As a veteran pediatrician working near Boston, this has been my experience as well. Both the institution where I trained and the institution where I work closed their pediatric inpatient units, the former in 2022 and the latter in 2009.” (Dobberteen works at CHA and trained at New England Medical Center, now Tufts New England Medical Center).

“Our patients in need of inpatient care have been sent all over New England. When will we, as a society, value and support the care of our youngest members when they are ill, regardless of the profit margin?” the letter said. She was apparently referring to lower reimbursements from insurers for care for children compared with rates for adult care.

Covid persists

Meanwhile, the Covid-19 picture has improved, with low hospitalizations and low levels in sewage holding steady, Neal said. But deaths from the virus among Cambridge residents are higher than at any time since December, Neal said.

Seven residents died in October and November – two women and five men. Two people were in their 60s, two in their 80s and three were older than 90, Cambridge Public Health Department spokesperson Dawn Baxter said.

“It serves as a grim reminder that while there’s less Covid circulating in the community, the consequences of Covid infection remain high for our more vulnerable residents,” Neal said.