During the autumn of 2022, a surge of three respiratory viruses—influenza, SARS-CoV-2, and respiratory syncytial virus (RSV)—strained hospitals across the United States. This “tripledemic” led to a crisis in pediatric care, with many children’s hospitals reportedly running out of beds. The situation was particularly acute in pediatric intensive care units, many of which were reported as full. The convergence of these three viruses created a significant public health challenge, testing the limits of the nation’s healthcare infrastructure.
A new study reveals a complex reality behind the headlines of overflowing hospitals. Researchers found that while many hospitals caring for children were indeed at full capacity during the tripledemic, other facilities located nearby had open beds for sick children. This disparity suggests that the problem was not just a simple lack of beds, but also a matter of how patients were distributed across the healthcare system. The findings, published in JAMA Network Open, highlight potential strategies for better managing patient loads during future surges in pediatric respiratory illnesses.
An Unprecedented Convergence of Viruses
The term “tripledemic” was coined to describe the simultaneous surge in cases of COVID-19, influenza, and RSV. This phenomenon was particularly pronounced in the fall of 2022, creating a perfect storm for healthcare systems already battered by the COVID-19 pandemic. The rise in RSV cases was especially sharp among young children. Many children who had been shielded from common viruses during the pandemic lockdowns had reduced immunity, making them more susceptible to severe illness from RSV. Public health officials had anticipated such a scenario since early in the pandemic, recognizing that changes in human behavior and exposure patterns could lead to a resurgence of respiratory viruses.
Pediatric Hospitals on the Brink
The tripledemic placed an immense burden on pediatric healthcare facilities. Children’s hospitals across the country were so overwhelmed that they were running out of beds. One pediatric ICU doctor, Nadir Ijaz of Yale School of Medicine, recounted the difficulty of providing care to all the children who needed it during that time. The surge in pediatric patients led some hospitals to take extraordinary measures. Boston Children’s Hospital, for example, had to postpone elective surgeries in November 2022 to manage the influx of patients. In October of that year, Johns Hopkins Children’s Center, running at capacity, reopened triage tents that had been used during the height of the COVID-19 pandemic. Some hospitals even resorted to placing beds in atriums and any other available flat space to accommodate the overflow.
Defining and Understanding Bed Strain
The study by Ijaz and his team defined “bed strain” as the point at which more than 85% of a hospital’s pediatric beds are full. Research has shown that when a hospital surpasses this 85% threshold, patients often experience much longer waits in the emergency department, sometimes for days. Emergency departments are not designed for long-term care, and delays in moving sick children to a hospital ward or ICU can have serious consequences. Past research has associated pediatric bed strain with longer hospital stays, adverse medical events, and even increased mortality. The analysis of the tripledemic found that almost half of the hospitals studied experienced bed strain during any given week.
The Paradox of Empty Beds
The most striking finding of the recent study was the discovery that even as some hospitals were overwhelmed, others nearby had available beds. The researchers found that in almost two-thirds of cases, hospitals experiencing bed strain were located close to other hospitals with the capacity to admit more sick children. This suggests a mismatch between patient demand and resource allocation at a regional level. While some facilities were stretched to their limits, others had the space to help alleviate the burden. This points to a need for better coordination and load-balancing among hospitals during a public health crisis. Some regions did activate transfer agreements with nearby facilities to manage the patient surge, but the study indicates this was not always sufficient to prevent individual hospitals from becoming overwhelmed.
A System Under Pressure from Multiple Fronts
The challenges of the tripledemic were compounded by pre-existing issues within the U.S. healthcare system. A significant factor was the decline in the number of pediatric inpatient beds in the decade leading up to the crisis. Between 2008 and 2022, the number of pediatric inpatient beds in the U.S. decreased by 19.5%. This reduction in capacity left the system more vulnerable to surges in demand. However, the study did not find a direct association between these long-term bed capacity changes and the bed strain experienced during the tripledemic, though the authors note that the study’s scope may have been too limited to draw a definitive conclusion.
The Workforce Crisis
Another major contributing factor was the healthcare workforce crisis. Many healthcare professionals left the field during the COVID-19 pandemic due to burnout and the physically and emotionally draining nature of the work. In 2021 alone, some 330,000 medical professionals dropped out of the labor force. This exodus of staff meant that even when physical beds were available, there were not always enough nurses, doctors, and support staff to care for patients. This understaffing created a vicious cycle, with the remaining staff facing an even greater workload, leading to further burnout and resignations. The result was a healthcare system that was stretched thin even before the tripledemic began, with little resilience to handle a sudden surge in patients.
Looking Ahead: Lessons from the Tripledemic
The experience of the 2022 tripledemic offers critical insights for preparing for future public health emergencies. The findings underscore the need for better regional coordination among hospitals to ensure that patients can be transferred from overwhelmed facilities to those with available capacity. This could involve developing more robust and dynamic load-balancing systems that can be activated quickly during a crisis. Public health officials and hospital administrators are urged to consider these findings as they develop strategies to prevent future crises. Dr. Michael Mina, a leading epidemiologist, had urged hospitals to prepare for such an event by stockpiling supplies and identifying ways to increase capacity.
The tripledemic also highlights the urgent need to address the healthcare workforce crisis. Without a sufficient number of trained and supported healthcare professionals, even the most well-equipped hospitals will struggle to provide adequate care during a surge. As the nation moves forward, the lessons learned from the tripledemic will be invaluable in building a more resilient and responsive healthcare system, one that can better protect the most vulnerable members of the population during times of crisis. Advocacy for systems that can care for all children, even during surges, is crucial, especially in light of the decreasing number of pediatric hospital beds across the country.
