Provider News

Viral Season Update: Illness and Volume Trends, and Helpful Resources for Our Community

December 4, 2024

As with past viral seasons, our goal is to share information and resources with our larger community as we all work together to care for patients during this busy time.

Updated Masking and Visitation Guidelines

Exterior of Seattle Children's hospital campus.Due to high rates of respiratory illnesses in our community, we’ve made changes to our masking and visitation guidelines.

We require patients, families, and visitors to wear a medical mask in all clinical areas. This includes exam rooms, waiting rooms, procedure areas, inpatient rooms and hallways. We recommend masking in all other areas of the hospital and clinics, but it is not required.

For patients coming for a clinic visit, Urgent Care and Emergency Department: At all of our clinics, we recommend that only 1 parent or adult caregiver come with a patient to their appointment. However, up to 4 people may come to the appointment with the patient. Siblings who are younger than 1 year old can come and are not included in the total number of people allowed at the visit.

For patients staying at the hospital overnight: Up to 4 adult caregivers are allowed in the room with the patient at any time during visiting hours and 2 overnight. Siblings who are >10 years old, who are not sick and do not have any symptoms may visit. Siblings younger than 1 year old may visit and may stay with the caregiver(s) overnight. No other siblings may visit unless they are a designated caregiver over the age of 18.

For patients in certain types of isolation for respiratory viruses (e.g. patients with confirmed COVID-19): Up to 4 adult caregivers may be designated as visitors, but only 2 adult caregivers are allowed in a room at a time, and 2 adult caregivers can stay overnight. Siblings are not allowed in these rooms unless they are 18 years or older. This includes siblings younger than 1 year old.

For patients coming to the Surgery Center: Up to 2 parents or adult caregivers can come after the procedure to receive care instructions and take the patient home. Siblings who are younger than 1 year old can come and are not included in the total number of people allowed at the visit. No other siblings are allowed unless they are a designated caregiver over the age of 18.

Important Information for Viral Respiratory Testing

During the COVID-19 pandemic, viral respiratory testing saw a significant increase. However, a large portion of these tests do not impact clinical management and are often unnecessary. Third-party payers have now stopped reimbursing for viral panels that test for more than seven pathogens, which are costly (around $700). When reimbursement is denied, either the patient will be billed, or Seattle Children’s must absorb the cost. In contrast, shorter panels that test only for RSV, influenza, and COVID-19 are still covered by insurance. Some patients are referred to SCH specifically for viral testing, and when this testing is not necessary, addressing patient and family expectations can be time-consuming, especially if they believe they are there for viral testing. Families should be prepared that, if viral testing is deemed clinically appropriate, it will typically be performed using a panel that identifies only influenza, RSV, and COVID-19.

Viral Trends and Hospital Volumes

  • ED Volumes: Our ED volumes have increased slightly over the past few weeks.
  • Influenza: Influenza activity continues to be low nationally and locally. Locally, we have not yet seen the steep part of the rise. Most of short panels will still be negative. We continue to monitor national Highly Pathogenic Avian Influenza A (H5N1) news. There have been two pediatric cases, one in Vancouver, BC and one in California. Neither had the usual agricultural exposures. Despite that, most of your index of suspicion should be focused on patients with exposure to known cases or exposure to livestock or poultry. If you are concerned, you should contact public health and infection prevention. PPE is gown, gloves, eye protection and N95 or equivalent.
  • RSV: For the second straight week, RSV positives have risen sharply. We are still 3-5 weeks away from peak, which will likely occur around the new year. Latest data is that nirsevimab reduces RSV-associated medical visits by more than 80%. Encourage patients, friends and family to get it if available and eligible.
  • SARS-CoV-2: National and local COVID numbers are nearing recent nadirs. Wastewater activity across the country is down.
  • Mpox: The ongoing outbreak in Central and East Africa continues. It is caused by the more virulent Clade Ia subvariant. The US has confirmed the first case of Clade I Mpox in California. There was a low-risk exposure to a WA resident from that case. The contact was asymptomatic throughout their incubation period and received post-exposure prophylaxis. Clade II Mpox is still being diagnosed weekly in WA, although rates are much lower than 2022. Mpox testing is available at Seattle Children’s – if you feel your patient may have Mpox and want them tested, please call Mission Control at 206-987-8899.
  • Other Respiratory Viruses: Rhino/enterovirus positives remain the most common positive at Seattle Children’s. Rhino/entero positives happen all year but tend to spike at the start of the school year. Adenovirus and parainfluenza are elevated but remain at relatively low levels. Fall parainfluenza activity is associated with croup and laryngitis and is mostly caused by parainfluenza 1 and 2.
  • Measles: Measles continues to be active nationally and internationally. We ceased active screening in August but remain vigilant to any new outbreaks.
  • Other Respiratory Pathogens:
    • The CDC has recognized that Mycoplasma pneumoniae respiratory infections have increased in the United States in 2024, especially among young children. Per CDC guidance:
      • Have increased suspicion of pneumoniae among patients with community-acquired pneumonia who aren't clinically improving on antibiotics that are known to be ineffective against M. pneumoniae, such as beta-lactams.
      • Perform laboratory testing when pneumoniae infection is suspected to ensure appropriate antibiotic therapy is administered, especially among hospitalized children.

Tips for Treating RSV/Bronchiolitis

With RSV rates currently high in the community, we would like to remind providers that we offer several resources for caring for patients in primary care and supporting families with education materials.

  • Bronchiolitis: Rest Is Best! offers information for providers on diagnosis, treatment, medication and more.
  • Family-facing Bronchiolitis Care Packet  
  • Video for parents on caring for children with bronchiolitis and RSV (included in the care packets above)
  • Bronchiolitis pathway for providers
  • Provider treatment tips:
    • Bronchiolitis is a viral illness needing supportive care measures.
    • Timeline of symptoms: increasing symptoms for two to three days with very slow resolution from day 6 to 22+.
    • During height of symptoms (days 2- 6): clinical course varies minute to minute, clinical decisions and interventions should only be considered for sustained changes in clinical presentation.
    • Viral swab testing and CXRs do not alter the clinical course or parent satisfaction in care and can lead to over prescription of antibiotics (25% of children with bronchiolitis will have atelectasis on CXR)
    • Albuterol is not helpful for bronchiolitis and may lead to side effects (tachycardia, iatrogenic V/Q mismatch, increased cost, or implications for future illnesses, i.e., excess albuterol prescribing in the future.)

How You Can Help

  • If viral testing is deemed clinically appropriate, families should be prepared that it will typically be performed using a panel that identifies only influenza, RSV, and COVID-19.
  • Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. This helps us plan for your patient’s arrival. In appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.

Resources