As emergency and pediatric resident physicians, we have seen firsthand the decline of pediatric emergency departments, inpatient units, and intensive care units (ICUs) because of an increase in viral illness in children, including seasonal influenza, respiratory syncytial virus infection, (RSV) is included. ), and COVID-19, together dubbed a “tripledemic”.
Recently, the American Academy of Pediatrics and the Children’s Hospital Association urged the federal government to declare a national emergency. This request was ignored. The current stress experienced by severely limited pediatric critical care units, hospital beds, emergency departments, and staffing is not sustainable. We need to declare a health emergency every time our health care system cannot keep up with new demands, including the sharp rise in viral illness among children right now.
Pediatric health care is unique and requires special attention. A patient whose asthma was triggered by RSV, influenza, or COVID-19 will require frequent assessment of respiratory status, vital signs, and medication management. We have cared for patients with asthma and bronchiolitis who have gone from being well saturated on room air to requiring positive pressure ventilation or intubation within an hour. Without adequate pediatric ICU space or trained staff, we cannot provide this life-saving, high-quality care. Meanwhile, already overcrowded, pediatric emergency departments remain short-staffed. Hospitals are once again setting up tents in parking lots to create new spaces for patient care.
In particular, one of the main issues facing pediatric hospitals is the comparatively lower reimbursement rates from Medicaid compared to adult units. This creates a disincentive for health systems to invest in pediatric care. Yet, the investment shortfall is often underestimated until it becomes abundantly clear in times of crisis.
The current pediatric virus surge follows a perfect storm: increased closures of pediatric units and hospitals; a pediatric mental health crisis; and burnout, attrition and turnover among our health care workers. As the demand is increasing due to the current viral surge, our capacity is getting reduced. The basic financial hardship that pediatric hospitals face is only being exacerbated by the viral surge – clear evidence of how we are failing to support the infrastructure that keeps our children healthy.
Fortunately, there is one concrete step the federal government can take to help directly: declaring a national emergency. This can be accomplished through a variety of pre-existing mechanisms designed for this purpose, including the Defense Production Act, the Stafford Act, or the National Emergencies Act. Historically, the naming of national emergencies has practically served three distinct goals: the allocation of emergency funds to support an influx of much-needed health care space, systems, supplies, and personnel; encouraging innovation due to greater regulatory flexibility; and supporting the coordination and alignment of the health care sector and public health agencies for data transparency and public attention.
When we fail to declare emergencies, there are tangible costs to our workforce, health systems, sustainability of hospitals, substantial financial costs, and most importantly loss of human lives. The sustainability of already fragile health systems depends entirely on how we currently pay for and structure health care. During the COVID-19 pandemic, we quickly hired travel and contract nurses to fill gaps in our health care workforce, but after the spread of COVID-19 subsided and record numbers of health care workers left medicine This additional staff disappeared. As a result, today, we rely even more heavily on an already overburdened and underpaid residency workforce, tasked with somehow filling remaining gaps in health care delivery. National stockpiles of supplies like ventilators proved essential during COVID-19, and mobilizing national stockpiles of drugs like oseltamivir, acetaminophen, ibuprofen and amoxicillin may be necessary in our current surge.
Emergency legislation such as the CARES Act and the HEROES Act support already under-stretched hospitals. It should be alarming that during the COVID-19 pandemic, the financial model of hospital systems across America relied on government bailouts. The funds provided under the emergency law represented only a fraction of their lost revenue, yet, hospitals were still able to meet the threat with personnel, space, integrated systems and equipment to provide care. Emergency funding from Congress, the Federal Emergency Management Agency (FEMA), the Centers for Disease Control and Prevention, and other government entities bridged this gap, and along with “tripledemic”, the declaration supports the existence of pediatric care in the United States. Can Despite its unsustainable economic model.
Regulatory Flexibility and Innovation
Regulatory flexibility and support for innovation allow health care to evolve to meet the needs of emerging threats. For example, our response to COVID-19 allowed for regulatory approvals, reimbursement models and rebates to foster a rapid acceleration of telemedicine. However, these improvements were temporary because this flexibility has an expiration date: Telemedicine will no longer be reimbursed when the COVID-19 public health emergency ends. Innovation coming from disaster response must be supported in a sustainable way through longitudinal grants, new national quality metrics, insurance codes and reimbursements for disaster preparedness, private-public partnerships, and government policy and legislation that support new models of health care reimbursement invests in Through these mechanisms, health care systems can improve from their baseline, prepare to respond to the next threat, and better able to care for a growing population of children with medically complex diagnoses and chronic conditions.
Alignment of health care, public health and the public
We need to create new models of pediatric viral care that stratify patient risk based on disease severity, such as an integrated model of community health centers, pediatrician offices, urgent care, and hospitals that are more efficient and Allows proper care. A national emergency will promote communication between stakeholders and demonstrate the importance of their continued collaboration. When health care and public health officials align their work, it opens the door to coordinated public health messaging about viral disease, transmission, risk and how to access care. Given that our communities are still recovering from the COVID-19 pandemic and celebrating the end of pandemic restrictions, it is difficult and frightening to experience this viral surge. The private and public sectors, even in health care, have lost the coordination that allowed us to survive past pandemics.
We are back to normal operations, which unfortunately include a lack of clear, centralized public health communication, public mistrust and lack of information and resource sharing in health care. Declaring a national emergency demonstrates the importance of the “tripledemic” and represents a call to action. In doing so, it allows for the possibility of public buy-in, attention, data transparency and a sense of community in relation to the severity of the disaster and the importance of a unified response.
COVID-19 showed us the importance and impact of national emergency declarations. Although the nation’s response to COVID-19 was delayed and disorganized, it is clear that the emergency declaration allowed the flexibility and resiliency needed for an already broken health care delivery model to survive a pandemic. It provided health care resources and staffing, support for creative new ways to provide care, and avenues for collaboration between the public and private sectors. There is one essential component to every disaster response that only a national emergency declaration can provide.
The federal government’s inability to recognize the current increase in viral illness in the pediatric population exists against a backdrop of chronic inaction when it comes to disasters in health care. With our high potential for predictive analytics and modeling, we already have the ability to predict when and where disasters will affect health care. Notably, months before the summer of 2022, we already knew to expect the current viral surge. Despite greater knowledge of what is to come, we fail to act, waiting for feedback instead of planning and preparing.
Despite our best intentions, these band-aid approaches have resulted in little or no improvement in healthcare capacity to meet, let alone actively respond to, emerging threats. More appropriate identification of emerging threats will allow political and health care leaders to make a connection between fragile health care systems and the current state of population health. Unless we have the political will, the alignment of private and public sector entities in health care, and regulatory change, we, and our children, will continue to face disaster after disaster.
The views and opinions expressed in this article represent the views of the authors themselves at the time of this writing. They do not necessarily represent the views of the organizations to which the authors are affiliated.