As RSV packs Michigan hospitals, a new need emerges: baby cribs

• Cribs and breathing supplies are running low, as RSV continues to sicken Michigan’s infants and children
• The nation’s pediatricians have asked the Biden administration to declare a public health emergency
• Such a declaration could help with red tape, but it can’t make supplies suddenly appear if they don’t exist

As RSV cases among children continue to pack Michigan hospitals and doctors’ offices, hospital supply chain managers are keeping an eye on inventories they say are running dangerously low.

Hospital-grade baby cribs — cribs that can cost $5,000 or more — have been in short supply in recent weeks. Hospitals are also running low on a kind of specialized tubing that helps keep young patients’ airways moist during treatment.

Henry Ford Health is trying to rent more cribs — something that previously was needed only occasionally and for a few days at a time, said Joe Chirco, a contract sourcing specialist for Henry Ford.

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But, he said, “we’re seeing a lot of the rental vendors already out of supply.”

In years past, when Henry Ford needed an extra crib, “we’d get a bed delivered within a day or a few hours. It would probably come from a warehouse around Detroit.”

Now, he said, suppliers require months-long rental contracts in an attempt to make the most use of a limited number of hospital-grade cribs across the country.

The state’s largest health system, Corewell Health, shifted about a dozen cribs from hospitals on the west side of the state to those in southeast Michigan. There, cases have surged at a steeper clip, according to a recent epidemiology report by the Michigan Department of Health and Human Services.

But the transfer won’t be enough if the surge continues, said Tim Essenmacher, director of supply chain services and materials management at the William Beaumont University Hospital in Royal Oak, part of Corewell.

The system has ordered 50 additional beds — medical-grade cribs that are fitted with extra safety features and manufactured to be sanitized frequently.

They also can support extra breathing machinery and equipment, he said.

“The million-dollar question everyone has is ‘How long and how high will this RSV go?’” Essenmacher said.

Respiratory syncytial virus normally begins circulating during the fall and peaks in the winter. But it appeared unusually high last summer, then returned again late this summer across the country. 

In Michigan, cases jumped from fewer than two dozen a week in a five-week rolling average this past summer to 103 average cases a day in early October to 339 last week, according to data from the U.S. Centers for Disease Control and Prevention.

RSV has hospitalized older Michiganders at a surprising rate, too, this year, though the state doesn’t track numbers. Earlier this month, a 6-year-old Michigan child died from RSV.

Experts theorize the virus has been particularly severe because of the stay-home orders, masking and other social protocols during the coronavirus pandemic that, for two winters, drove down the spread of flu and other respiratory viruses. That means countless infants and toddlers were never exposed, lowering their immunity levels.

“We're also starting to understand that kids may be sicker this time around and we don't know exactly why,” said Dr. Matthew Denenberg, chief of pediatric services at Beaumont Children's Hospital in Royal Oak, part of Corewell Health East.

“We don't know whether it's something different about this RSV virus. We don't know if it's because of the last couple of years of not having severe RSV seasons. Maybe immunity has changed. We don't know yet,” he said.

What is clear is that Michigan hospitals are operating pediatric units “at or near capacity,” said Denenberg, who also is chair of the Council on Children’s Health for the Michigan Health & Hospital Association.

As of Friday, all but 12 of the state’s approximately 200 pediatric intensive care unit beds were occupied, according to Lynn Sutfin, spokesperson for the state health department.

Between shortages in supplies and staff, “we’re still struggling at times to find appropriate pediatric ICU care across the state,” he said.

Specialized cribs are not the only equipment in short supply. 

Hospitals also need more specialized tubing which — with a heating element — delivers warmed, humidified air comfortably to young patients, keeping airways moist so they can expel mucus, said Jean Aphram, director of respiratory care at William Beaumont University Hospital in Royal Oak.

There are also shortages of pulse oximeters, the devices that are clipped onto fingers, toes and ears for frequent oxygen-blood level readings. Some medication shortages nationally, such as amoxicillin, which treats bacterial infections that can result from an RSV infection, and liquid Tamiflu, which can help children with flu-like symptoms, also worry doctors, said Dr. Dennis Cunningham, a pediatric infectious disease specialist at Henry Ford Health.

“These are all little things that start adding up and put more squeeze on health care,” he said.

Last week, the Children’s Hospital Association and American Academy of Pediatrics asked the Biden administration to declare a limited public health emergency, much as was declared for the COVID pandemic.

“Unprecedented” levels of RSV, combined with staffing shortages and mental health problems among young patients, continue to “stretch pediatric care capacity at the hospital and community level to the breaking point,” according to the letter, which noted that three quarters of U.S. pediatric hospital beds are full.

Such a public health emergency can’t make supplies appear if none exist, Michigan doctors and supply chain experts told Bridge. And it can’t supply permanent staff, although the COVID public health emergency provided federal strike teams in several Michigan hospitals.

However, a declaration can help health systems more easily surge bed capacity, move around staffing and transfer patients among facilities, even those across state lines, Denenberg said.

“Quite frankly, we are short pediatric ICU beds across the country,” he said. “We certainly don't have enough capacity for a crisis like this.”

A public health emergency also clears the way for more telehealth visits and assistance from out-of-state specialists, said Henry Ford’s Cunningham.

Flu and holidays

Despite the strain of RSV, other factors have allowed Michigan to avoid even deeper supply chain shortages — at least so far. To date, Michigan has been spared a particularly severe flu season; the state remains one of four states where flu spread continues to be “minimal,” according to the CDC.

Still, it may be only a matter of time before a high volume of flu cases arrive, given holiday gatherings that start this week. Surrounding states — Wisconsin, Illinois, Indiana, Ohio, Pennsylvania — are recording “moderate” and “high” level spread.

But because of seasonal flu, as well as the lessons learned from supply chain problems during COVID, hospitals may have built in more of a “buffer inventory” of respiratory supplies this fall, said Dan Bissot, director of supply chain management at Lansing-based Sparrow Health System, where this month alone, 144 patients with RSV were admitted to the University of Michigan Health at Sparrow Children's Center.

That’s compared to 62 pediatric patients throughout all of November last year, according to a hospital spokesperson.

Right now, Bissot said, “we have what we need to take care of patients, but it requires constant monitoring.”