Becker's Hospital Review

28 CMO / CARE DELIVERY Like playing football with no pads: 6 leaders contextualize the 'tripledemic' By Mackenzie Bean and Mariah Taylor W ith many children's hospitals facing unprecedented capacity issues amid a surge in respiratory syncytial virus, flu season admissions at the highest level in 13 years and highly transmissible omicron subvariants gaining prevalence nationwide, hospitals are bracing for a difficult winter. Becker's asked clinical leaders and virology experts from health systems across the country what analogy they would use to explain the capacity issues at children's hospitals and the looming threat of a "tripledemic" this winter. eir responses are below in alphabetical order. Editor's note: Responses have been lightly edited for length and clarity. Kenneth Alexander, MD, PhD. Chief of Infectious Diseases at Nemours Children's Hospital (Orlando, Fla.): is [so called "tripledemic"] is actual proof that masking works because what we have done is in the course of protecting ourselves against COVID-19 is we have also protected ourselves against influenza and RSV. Now that masking has disappeared, we have not only the return of COVID-19 but also the acquired risk of RSV and influenza. Matt Binnicker, PhD. Director of Mayo Clinic's Clinical Virology Laboratory (Rochester, Minn.): We send our football players out onto the field with layers of protective gear — helmets and shoulder pads — intended to prevent injury. If we were to send the players out onto the field without that protective gear, they would almost certainly get injured and need to go on to the sideline to be tended to by the trainer. One or two trainers can handle a few players at a time, but if all those players went out onto the field without protective gear, the trainers on the sideline would be overwhelmed and wouldn't be able to keep up that capacity. at's really what our children's hospitals are facing right now; we have a large population of young children in the country who don't have the layers of protection either from routine annual flu vaccinations or just normal routine exposures to respiratory viruses like RSV. e viruses are spreading because of relaxed precautionary measures, and we're having a lot of kids come down sick, so children's hospitals are just getting flooded with young kids who are coming in in need of care and hospitalization. I was talking with a colleague in Texas who directs a lab in a children's hospital. ey've had to refer patients as [far] north as Missouri because their beds in their hospitals in Texas are full. at's the situation we're in. It's definitely something that we're keeping a close eye on, and the best thing that we're promoting and asking families to do is if your child is eligible for a flu and COVID vaccine to get that done, because that will help protect them from more moderate to severe illness that might require them to go into the evaluated at the hospital. Aaron George, DO. Chief Medical Officer of Meritus Health (Hagerstown, Md.): One way to think about this fall season is almost like an airplane. Just like our hospitals, airlines run data based on past experience and demand to determine the number of seats and flights available. As a result, airlines will oen oversell seats because they are taking a chance that people won't show up — but what happens when everyone does? It's a disaster. It's the same thing with risky behaviors, lack of masking and not taking precautions when it comes to RSV. Hospitals are running out of beds in a similar way as airplanes run out of seats. When all the other airplanes are full or all the hospital beds are in use, there's no space for everyone no matter how desperate the Like 'an old Western movie bar fight,' supply issues are relentless, devicemakers say By Paige Twenter M edical device manufacturers are struggling to keep up with demand as inflation-driven costs for raw materials shrink their profits, The Wall Street Journal reported Nov. 13. The issue is widespread, according to the Journal, with specialized plastics, metals and resins all in short supply. Stryker, a company that makes surgical equipment and joint-replacement parts, has slowed its production and hiked its prices as it searches for less expensive electronic components. Some semiconductors are hard to come by, meaning Abbott Laboratories can't meet demand for its first-generation Libre 1 blood-sugar monitoring devices in some markets. With medical devicemakers clawing for the same limited amount of materials, Intuitive Surgical CEO Gary Guthart likened the supply issue to "an old Western movie bar fight" at a recent conference, according to the Journal. "It starts in the morning and goes all day." Analysts told the Journal that the medical device industry is partly at fault because these companies have historically prioritized high profits over supply chain improvements. But with recent supply chain hiccups, such as the monthslong contrast dye shortage, industry leaders are seeking new alternatives. "We're all going through a major modernization in our supply chains," Ashley McEvoy, executive vice president of Johnson & Johnson's medtech unit, said at the industry conference. "We have not been pace setters relative to other industries. We're going to have to get masterful at logistics." n

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