PORTLAND — Amid the worst RSV season on record, Oregon pediatric hospitals are already stretching staff thin to care for all young patients who need specialized care. But health officials believe the situation is going to get worse in coming weeks, and it’s unclear what the state and hospitals will do if the influx of respiratory syncytial virus cases reaches a tipping point.

“Hospital resources are not infinite,” the Oregon Health Authority’s Dr. Melissa Sutton said in an interview Friday, Nov. 25. “At some point, we might reach a scenario in which there is not a hospital bed available.”

As of Wednesday morning, Nov. 23, Oregon had 45 staffed pediatric intensive care beds at the three Portland hospitals that provide that level of care. Of those, six were available, indicating that at present, there is the capacity to meet children’s’ urgent needs. But space availability is at least in part attributable to those three hospitals — Randall Children’s Hospital, Doernbecher and St. Vincent — switching to crisis standards of care this week, a move that allows their staff to care for more patients at a time than they normally would.

That means the risk that a child in need of intensive care right now won’t get it is low, Sutton said, because they are not at the point of having to ration care. But signs point to even more children being hospitalized for RSV. The Oregon Health Authority is helping obtain and coordinate resources to help hospitals manage the influx. But the agency is tracking needs only “day to day,” Sutton said.

“It’s very hard to predict what an escalation would look like,” Sutton said.

For parents, the stakes are serious

Kahealani Knuth, of Lebanon, knew her family of four had a problem when her five-year-old daughter tested positive for RSV.

When the girl came home from kindergarten near the end of October with a cough, Knuth tried to quarantine her with her father, who had also fallen ill, away from her and her newborn son, Izaya, who at that point was less than two months old.

But Knuth knew it was only a matter of time before her son got sick, too. And late on Nov. 1, Knuth and her husband noticed the boy cough. First, they wondered if maybe he just needed to burp up some milk and was having trouble.

“And then, we noticed the cough stayed,” Knuth said.

From that point, the strain and subsequent terror grew. The boy tested positive for RSV, and Knuth was instructed to watch out for signs that the infant was in respiratory distress, which would mean a trip to the hospital.

The 26-year-old mother watched her child like a hawk, periodically sending videos to her two aunts, who are nurses, and asking for advice. The turning point came when she saw the skin between her son’s ribs sucking in when he tried to breathe — a surefire sign he was having trouble getting oxygen.

“You don’t really think,” Knuth said, recalling the distress she felt. “You just get your kid in the car and go.”

But getting to a hospital was only the beginning of the ordeal. It took more than three hours before staff at the Corvallis hospital could focus on Izaya, Knuth said. And even when they did, she said she felt they were stretched too thin to give him the full attention she felt he needed.

Around 1:30 a.m. on Nov. 3, an ambulance came from Portland and took Knuth and Izaya to Randall Children’s Hospital. Paramedics tried to calm the fussing and crying baby as Knuth watched through the small window separating the front of the ambulance from the back.

“That was probably the longest car ride I’ve ever been in,” Knuth said.

RSV hospitalizations rose rapidly

When Izaya was taken into the hospital’s pediatric intensive care unit, he was among the first in a wave of RSV hospitalizations that triggered warnings from the state.

Portland-area RSV hospitalizations for children under 5 more than tripled the week ending Nov. 5 compared to the previous week, from seven to 24, according to state data. By the following week, only four of 40 intensive care beds were available statewide. Days later, Gov. Kate Brown declared an emergency due to the influx of RSV and other respiratory viruses, freeing up some resources for hospitals and allowing them more flexibility in staffing.

While it is a common virus, RSV can be particularly dangerous for infants, primarily because by the time they reach 2, they are likely to have encountered the virus already, said OHSU pediatric specialist Dr. Eliza Hayes Bakken.

The virus tends to migrate to a person’s lower lungs, which can then fill with mucus. That build-up of fluids can also cause a secondary bacterial infection, like pneumonia or an ear infection. There’s no vaccine for the disease, and treatment is limited to helping people breathe and take in fluids.

Bakken said parents should watch out for the following three key signs of distress when deciding whether to take their children with RSV to the emergency room: If the inside of the infant’s mouth is blue, they aren’t getting enough oxygen, and need immediate care. If they appear to be trying to use their stomach or rib or neck muscles to breathe, that also means they’re not getting enough oxygen. And if they aren’t taking in or holding down fluids, they also need to see a doctor.

While the steps the state and hospitals have taken have eased the pressure on the health system, RSV hospitalizations continue to climb. In the tri-county area 35 children under 5 were hospitalized during the week ending Nov. 19. No children have died from an RSV infection this year, as far as OHA knows, though such deaths don’t currently have to be reported to the state, which Sutton said the agency is trying to change.

Already, Oregon’s RSV hospitalizations have surpassed the all-time peak during the five years OHA has data for, Sutton said. And the growth has been far sharper than at the beginning of past seasons. She said she also agrees with an Oregon Health & Science University analysis that forecasts a peak in the next one to two weeks.

The situation could also get worse as the state this week reported an unexpectedly large increase in COVID-19 hospitalizations, as well as an early and substantial influx of influenza cases.

“We do think that things will get worse before they will improve,” Sutton said.