About a month ago, I noticed a worrying trend- we started to see a lot more pediatric patients in the ER than we normally did.
This was anecdotal at first, but then I heard my friends in primary care and pediatrics were getting absolutely hammered with a wide gamut of everything. Hand, Foot, and Mouth; enterovirus; norovirus; COVID; RSV; flu; etc, etc. We've had years where this has happened before, like 2013, which I told people was still the worst year in Peds I'd seen.
I was very concerned, but after almost three years of being on the frontlines of an unmitigated pandemic, I treated the warning signs I saw much like a parent does with a toddler who you're trying to get to sleep through the night. You hear the rumblings of noise from their bedroom, and after blearily glancing at the bedside clock you pull the pillow over your head and convince yourself maybe it was the cat- nevermind that you don't own a cat- but it was something, anything else, please, you just need a little more sleep.
Sadly, in both circumstances, the crying begins- and you can't ignore it or wish it away.
I grew more and more concerned as the pediatrics offices locally started staying open until 9pm, started being open six days a week. And here I have to really sing the praises of these absolute heroes. These doctors, nurse practitioners, nurses, and other clinicians understand how beaten down the emergency services and acute care systems are, and they are doing everything they can- just as they did throughout the entire pandemic- to hold things together.
Because especially with kids, there's no alternative. We cannot create extra bed space for kids; kids are not just "smaller adults". Kids metabolize drugs differently. Kids don't have the "reserve" capacity adults do. My body has had thirty-seven years of experience practicing homeostasis; if I'm sick, I've got fat stores (aplenty), stores of essential nutrients and metabolic vitamins and minerals. If I'm septic and dehydrated, they can hammer me with fluids, medication; my heart can handle it, my kidneys can get rid of the excess sodium from the normal saline, my liver can handle the antibiotics. It might not be fun, but I can handle it.
Kids have none of that. They have little to no reserve capacity. They don't decline; they go off a cliff. Give me a little too much fluid, and I'll get puffy skin for a couple days as my kidneys work through it. Give a kid too much fluid, by an amount that wouldn't even be a rounding error on an adult, and you'll give them flash pulmonary edema and THEY CAN DIE. So forth and so on.
And the pediatricians know that. They know that full well. When peds beds are full... that's it. We can't conjure up new ones like we can with adults; even with adults, doing that is supposed to be a tourniquet, not a plan.
Now, what we feared is here. There are Virginia schools with THOUSANDS of kids out sick. A THOUSAND kids in just one school! Every single PICU in Virginia is at or OVER capacity. Every single one. We're flying kids across the Commonwealth or to other states. And I want everyone here to understand what it takes to tell someone no, you cannot send that dying child to this hospital. These hospitals are not turning patients away on a whim. They understand exactly how serious it is.
D'you know what the best part is, folks? And I want those of you in states where your Governor is up for election this year to pay particular attention to this part. The vast majority of these viruses I mentioned above have mitigation strategies that work EXEMPLARILY during surges. Surgical masks were better than nothing against COVID, but we've known for EONS that they work MARVELOUSLY against droplet-based illnesses like flu, RSV, etc. And yet, because our Governor is a semi-sentient sweatervest with a trust fund who got bored and decided he wanted to run for President- and with the assistance of the Republican House of Delegates and one Democratic state senator- any and ALL mitigation strategies in Virginia are now and FOREVER ILLEGAL.
That's right! PICUs all full? Well, maybe we should have kids wear masks for a couple weeks. BZZZT, WRONG, ILLEGAL NOW, SORRY! Which is, of course, what we warned them about months ago when they had their little party on the steps of the General Assembly building "celebrating freedom".
If those people want to celebrate freedom, they can damn well do it by joining us "in the trenches". Volunteer at a pediatric clinic. Clean rooms in the ER and ICU. Or use some of that, what's it called, you know... ohhh, it's on the tip of my tongue, wait... LEADERSHIP! Yeah! The thing that's YOUR JOB! SOLVE CRISES AND SERVE THE PEOPLE OF THE COMMONWEALTH OF VIRGINIA.
But these folks have no desire to do that. They have no skin in the game. If they'd have cared, they'd have used the Governor's vaunted "budget surplus", which is really just a bunch of money Virginia got thanks to Joe Biden and a Democratic House and Senate, to address the shortfalls we haven't yet recovered from in emergency services. Sadly, there was never any interest in doing that, despite the fact that, particularly in my rural Virginia district, emergency services is THE safety net for all of society, AND the glue that connects patients to the health care they need.
If you want to know why decided to run against the most entrenched incumbent in the entire Commonwealth of Virginia, against someone who could write themselves a check for double or triple the amount I can raise from thousands of individual donations- this is why. Because I see every single day the cost of his and Glenn Youngkin’s “leadership” on the people of our Commonwealth, and Richmond is the ONLY place I can go to fix that.
This surge won’t stay in Virginia. It WILL be in your state. So please, please make sure you elect leaders who are more concerned about protecting our children and our communities, rather than being afraid of losing elections and their ability to grift. Get vaccinated. Be safe. And let’s pray our kids get through another of the endless parade of crises and traumas, from gun violence to climate change to rampant and unmitigated pandemics, that our society is inflicting on them
Kellen Squire is an emergency department nurse from Charlottesville, Virginia, running to flip the bluest district the Virginia Republican Party still holds. Donate today, and we WILL flip this seat and send an ER Nurse to Richmond!