A pandemic triage tent is returning to CHOMP; A Natividad doctor reports kids suffering from multiple respiratory viruses at once.

Significant levels of influenza combined with an early surge of Respiratory Syncytial Virus (RSV) and an expected increase in Covid-19 cases post-Thanksgiving week have prompted the Community Hospital of the Monterey Peninsula to bring back a symbol of the early pandemic: a respiratory triage tent.

"Community hospital is seeing cases of severe influenza requiring hospitalization, particularly in the elderly, and continues to care for young children and infants suffering from severe RSV," said Martha Blum, an epidemiologist at CHOMP and medical director of infection protection for Montage Health, in a written statement.

"Currently there are nearly equal numbers of patients hospitalized at Community Hospital with Covid-19 (12 in isolation) and Influenza (10 in isolation), while the number of patients hospitalized with RSV may be showing signs of decreasing (now 2, one pediatric and one adult)," she said.

CHOMP is reinstating its respiratory triage tent outside of the emergency department possibly as early as Monday, Dec. 5, to accommodate any possibly additional surges over the winter season, according to a Montage spokesperson. 

Bringing back the tent is a proactive measure to assist hospital staff in assessing people with respiratory symptoms, including those associated with Covid-19, RSV, colds and the flu, in order to keep them separate from other patients. 

Tents were erected in March 2020, in response to the first pending surge of Covid-19 cases. One year later, the cases had decreased and the tent was taken down.

Meanwhile, at Natividad Medical Center in Salinas, Sarah Smith, a pediatric hospitalist, said today that her hospital is seeing children who are especially hard hit after nearly three years with little exposure to the usual winter viruses that circulate.

"We have a group of kids between newborns and age 3 unexposed to everything for their entire lives so now this is the first winter where they're hitting all of it," she said during a Monterey County media briefing.

"The kids are sicker than they usually are," she said. "They're back out there and all the viruses are out there. Normally they catch all these viruses before they're 5, but they're having it all in one year."

Although they are not seeing a lot of children with Covid, they are seeing patients test positive for a few viruses at once, including RSV, flu and parainfluenza, which which is associated with croup. They test for up to 15 viruses at one time.

Most children do well, but some need a higher level of supportive care at a pediatric ICU elsewhere in the state. (Monterey County has no pediatric ICU beds.)

In the last month Natividad has transferred 25 kids to ICU units elsewhere in the state and Nevada due to a shortage of pediatric beds, Smith said. They look up and down the state, from San Diego up to Sacramento and over to Las Vegas, often finding there are no beds available. Children sometimes wait 36 to 48 hours for a transfer.

The hospital will care for the children making sure they are hydrated and supported until a bed can be found. In some cases kids have improved while waiting and were able to be transferred to an acute care unit within Natividad and then went home. It's not the usual protocol, but it's worked. Hospital staff have their own joke, Smith said, that they have their own "ED PICU (emergency department pediatric intensive care unit)."

When children are that sick, it's hard on parents—and scary. "A lot of our patients it's a stress to even come from Greenfield up to Salinas, let along put their child on a helicopter to Reno, which is a huge tax on any family," Smith said.

There will likely an increased level of virus cases through the coming weekend after families and friends gathered over the Thanksgiving weekend, Smith said. 

The best ways to prevent the spread of viruses are to stay home if sick and wash hands frequently, she said. Masking is a good idea out in public, unless in the case of a child who is having issues breathing. Getting vaccinated against Covid and flu is also encouraged.

People with minor symptoms of a respiratory illness such as a runny nose, sneezing or coughing that can be cared for at home are urged to stay at home and consult with a health care provider, if necessary. Montage offers a free e-visit program to community members with respiratory symptoms at montagehealth.org/care.

People with health emergencies are reminded to not delay seeking treatment at a hospital out of a fear of contracting Covid, RSV or the flu. "The risk to someone’s health is in most cases much greater by delaying care than the possibility of contracting and getting ill from a respiratory illness in a healthcare setting," according to a Montage statement.