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Pediatric Respiratory Viral Surge · The SHEA Podcast

• 0:08
  SPEAKER_00: Welcome to the Rapid Response Podcast brought to you by the Society for Healthcare Epidemiology of America, Shay, promoting the prevention of healthcare associated infections and antibiotic resistance and seeking to advance the field of healthcare epidemiology and antibiotic stewardship.
• 0:23
  SPEAKER_00: I am Dr.
• 0:24
  SPEAKER_00: Chrissy Woods and I will serve as your moderator.
• 0:27
  SPEAKER_00: The discussion on the podcast does not reflect Shay's perspective, but facilitates communication of multiple perspectives and experiences as we go through this challenging time together.
• 0:37
  SPEAKER_00: Shay is excited to launch this episode that will provide an update on the RSV search.
• 0:42
  SPEAKER_00: Our speaker today is Dr.
• 0:44
  SPEAKER_00: Larry Kosiolek.
• 0:45
  SPEAKER_00: Dr.
• 0:45
  SPEAKER_00: Kosiolek is a pediatric infectious disease specialist and medical director of infection prevention and control at the Anne and Robert H.
• 0:53
  SPEAKER_00: Lurie Children's Hospital of Chicago and associate professor of pediatrics at Northwestern University Weinberg School of Medicine.
• 1:00
  SPEAKER_00: He has been a member of SHAY and the SHA Pediatric Leadership Council for the past 10 years.
• 1:05
  SPEAKER_00: At Lurie Children's, he leads the hospital preparedness and response activities for COVID-19 and other emerging and high consequence pathogens.
• 1:14
  SPEAKER_00: Dr.
• 1:14
  SPEAKER_00: Kosiolek oversees an NIH funded research program focused on the epidemiology of acetapacile and other pathogens.
• 1:22
  SPEAKER_00: And he is the site principal investigator for the HRSA funded pediatric pandemic network.
• 1:28
  unknown: Dr.
• 1:28
  SPEAKER_00: Kosiolek, thank you for joining us today.
• 1:30
  SPEAKER_01: Thank you so much for having me.
• 1:32
  SPEAKER_00: So obviously, this is a very hot topic.
• 1:34
  SPEAKER_00: Once RSV gets into sort of the mainstream media, everybody starts asking questions.
• 1:38
  SPEAKER_00: And I think rightfully so, a lot of parents concerned, a lot of, you know, caretakers for older people are concerned.
• 1:43
  SPEAKER_00: So during the pandemic, we know that RSV almost disappeared as parents and children mostly stayed at home.
• 1:49
  SPEAKER_00: Do you think that's partly the cause of this year's sharp increase?
• 1:52
  SPEAKER_01: Yeah, that's a great question.
• 1:53
  SPEAKER_01: And one that I don't think we have a full grasp yet, but I think we will as we learn more about the epidemiology of infections, endemic infections that occur commonly, and as those sort of repopulate the community as we move away from COVID-19.
• 2:08
  SPEAKER_01: What we do know is that RSV typically comes every year.
• 2:11
  SPEAKER_01: We know that some years will be worse than others.
• 2:14
  SPEAKER_01: And so this year was a particularly challenging year for RSV.
• 2:18
  SPEAKER_01: And why did this year seem worse and different?
• 2:20
  SPEAKER_01: Well, there's several reasons.
• 2:22
  SPEAKER_01: First, this year's RSV surge was earlier in the season that we typically see.
• 2:26
  SPEAKER_01: Prior to COVID, we would typically see RSV present in the late fall or early winter.
• 2:31
  SPEAKER_01: Sometimes it would be immediately preceding, or sometimes even at the same time as influenza.
• 2:36
  SPEAKER_01: This year we started seeing RSV in late summer, and we saw that increase significantly in the early fall.
• 2:44
  SPEAKER_01: It can seem worse for several reasons.
• 2:46
  SPEAKER_01: First, we know that transmission of infections is dependent on the proportion of susceptible individuals in the population.
• 2:53
  SPEAKER_01: Measles is one of the most transmissible viruses, but we don't see widespread transmission in our community because of widespread immunity from a successful vaccination campaign.
• 3:02
  SPEAKER_01: With RSV, we know that infants develop immunity to RSV almost universally within the first two years of life related to seasonal exposure.
• 3:11
  SPEAKER_01: With COVID-19, a lot of the mitigations that we took on, including staying at home.
• 3:16
  SPEAKER_01: A lot of parents worked from home and infants weren't going to daycare.
• 3:19
  SPEAKER_01: We know that schools had paused in-person learning for a variable duration of time.
• 3:24
  SPEAKER_01: So there weren't a whole lot of children that were exposed.
• 3:26
  SPEAKER_01: Our epidemiology supports that.
• 3:28
  SPEAKER_01: So that means there's a larger proportion of infants and young children who did not have immunity to RSV, who became sick when they were exposed and became symptomatic.
• 3:37
  SPEAKER_01: There's also other things that may have contributed.
• 3:53
  SPEAKER_01: Without much viral infections in the community, between 2020 and 2022, many new parents with young infants had never experienced a respiratory illness before.
• 4:01
  SPEAKER_01: And so we we know that there were a lot of lower acuity patients seeking emergency care and urgent care.
• 4:07
  SPEAKER_01: We also know that children's hospitals experienced a more difficult challenge in dealing with viral surges this year.
• 4:14
  SPEAKER_01: In many cities across the country, including mine in Chicago, many community hospitals had reduced or even abandoned their pediatric emergency and acute care resources to accommodate the additional resources required for COVID-19 in adults.
• 4:28
  SPEAKER_01: And so that resulted in children's hospitals seeing a higher proportion of pediatric patients in a large metro area than they have in the past.
• 4:35
  SPEAKER_01: And so I think all of those things have likely contributed to why this RSV season has felt particularly challenging.
• 4:42
  SPEAKER_00: So a lot of factors there that might play into this increase.
• 4:45
  SPEAKER_00: And I'm going to guess that you've seen quite a few RSV cases in your hospital based on the way that epidemiology has gone nationally.
• 4:52
  SPEAKER_00: But I'd like to know more about what the trend looks like at your hospital, what it looks like compared to the prior year, and what does it look like in comparison to cases of other respiratory viruses that we know we're also seeing in large numbers, like flu, and of course COVID and even entraviruses.
• 5:06
  SPEAKER_01: Yeah, I think in a normal year, what we saw with RSV in Chicago would have been a manageable experience.
• 5:12
  SPEAKER_01: And so there are several things about this year's RSV season that were different in the past.
• 5:17
  SPEAKER_01: Of course, as I just mentioned, we we certainly saw more cases than we had in the past, but RSV started early in the late summer, and it started concurrently with a particularly challenging enterovirus season.
• 5:28
  SPEAKER_01: We know that enterovirus season can cause millions of infections in the US each year, typically in the late summer and early fall.
• 5:35
  SPEAKER_01: This year's enterovirus season was predominated by enterovirus D68, which we know causes worse respiratory infection than other enteroviruses, particularly in children with asthma and other underlying respiratory conditions.
• 5:48
  SPEAKER_01: So we saw a significant spike in enterovirus during this upswing in RSV that started in the late summer and early fall.
• 5:55
  SPEAKER_01: Fortunately for us, RSV has peaked, and currently we are on the downswing, and the number of RSV infections that we're seeing currently is roughly what it was at the beginning of this year's RSV season.
• 6:09
  SPEAKER_01: Influenza over the last few weeks has taken over as our predominant respiratory virus in terms of both a number of cases diagnosed and number of children requiring hospital and ICU care for a respiratory virus.
• 6:19
  SPEAKER_01: When we look back and compare this season of RSV compared to previous, we did not have a winter or fall RSV spike last year.
• 6:28
  SPEAKER_01: We did see a summer RSV spike that was an interseasonal RSV spike that had really never been seen, that was unprecedented.
• 6:36
  SPEAKER_01: However, the number of infections that we saw at that time were relatively small.
• 6:40
  SPEAKER_01: We have to go back to 2019, late 2019, early 2020, when we've seen a normal RSV season in terms of its timing.
• 6:48
  SPEAKER_01: Looking forward, it'll be a challenge to predict what will happen with RSV.
• 6:53
  SPEAKER_01: I think based on the number of infections that we saw, we've certainly recovered some of that immunity debt, but we'll have to monitor RSV epidemiology, particularly in the southern hemisphere, over the next year and try to use those data to predict what RSV season and influenza season will look like next winter and fall.
• 7:11
  SPEAKER_01: When we looked at data in Australia and South Africa, for example, during their winter, we had a sense that RSV and influenza both would come a bit early compared to normal.
• 7:20
  SPEAKER_01: And the US experience looked pretty similar to what was seen in the Southern Hemisphere.
• 7:25
  SPEAKER_01: And so hopefully we can use those data in future years to understand the changes in seasonal variation of RSV influenza and other respiratory viruses.
• 7:35
  SPEAKER_00: Dr.
• 7:35
  SPEAKER_00: Kostielik, are you expecting the surge for RSV to last all winter?
• 7:39
  SPEAKER_00: Or as you said, it looks like the numbers in your hospital seem to be going down.
• 7:42
  SPEAKER_00: Do you think they'll come back up again?
• 7:44
  SPEAKER_01: Well, it's reassuring that our RSV numbers have declined.
• 7:48
  SPEAKER_01: Children's hospitals haven't really experienced a respite as they normally would at the cessation of RSV season.
• 7:54
  SPEAKER_01: And there's a few reasons.
• 7:56
  SPEAKER_01: One, our influenza activity has already outpaced our peak RSV activity for this season.
• 8:02
  SPEAKER_01: We are seemingly approaching a peak or may have already approached a peak for influenza.
• 8:08
  SPEAKER_01: RSV tends to only have a single peak.
• 8:10
  SPEAKER_01: However, influenza, as we know, can have multiple peaks, particularly if we see influenza B.
• 8:16
  SPEAKER_01: We've not seen much, if any, influenza B this year.
• 8:19
  SPEAKER_01: It's mostly all been influenza A.
• 8:21
  SPEAKER_01: We don't have a full understanding of what COVID-19 will do.
• 8:25
  SPEAKER_01: While we're not seeing a significant burden of COVID-19 in children, at least in Chicago currently, we do know with the emergence of variants and waning of immunity related to our last surge of COVID-19 and lagging vaccination rates and booster compliance rates in pediatric populations, that it's possible that we could have a COVID-19 surge as well.
• 8:46
  SPEAKER_01: And so right now, while we're relatively reassured that the RSV surge is likely over for this season, we continue to be concerned about excessive healthcare resources being required for pediatric patients related to other respiratory viruses.
• 9:01
  SPEAKER_00: So, along that sort of path, how are you managing the increased need for more beds in the hospital, particularly in the ICU?
• 9:08
  SPEAKER_00: Obviously, there are a lot of competing needs here as uh flu has been rising.
• 9:12
  SPEAKER_00: So I'd like to hear from you on how you're dealing with that at your children's hospital.
• 9:17
  SPEAKER_01: The management of healthcare resources and personnel has been a significant challenge.
• 9:21
  SPEAKER_01: We know that in Illinois, in the decade leading up to the pandemic, the number of licensed pediatric beds for hospital care and ICU level of care was declining.
• 9:31
  SPEAKER_01: And we know that there's been an additional 20% decline in pediatric capacity in Chicago since the start of the pandemic.
• 9:38
  SPEAKER_01: And so this has required us to be creative in our interactions with other healthcare facilities in the community.
• 9:45
  SPEAKER_01: We have had instances where we've run out of pediatric ICU and acute care beds, and we've had to transfer patients out of the Chicagoland area down to the St.
• 9:52
  SPEAKER_01: Louis or Milwaukee metro area.
• 9:54
  SPEAKER_01: That's been a challenge for families.
• 9:56
  SPEAKER_01: We've worked with the Chicago Department of Public Health to identify resources that we can provide to community hospitals for them to be able to expand their pediatric capacity, such as lowering their minimum age for admission.
• 10:08
  SPEAKER_01: We've increased our hiring and staffing significantly over the last several months, both with hiring nurses employed through our hospital and hiring nurses through travel agencies as well.
• 10:19
  SPEAKER_01: We've had to do the same with respiratory therapists and other support staff.
• 10:23
  SPEAKER_01: We've worked with our pediatric hospitalists to identify how we can expand acute care needs on a general inpatient floor, such as the amount of high flow oxygen therapy that can be provided safely on the floor.
• 10:36
  SPEAKER_01: We've had to work with our emergency department to be able to expand our capacity for patients requiring critical care or acute inpatient care in that emergency department facility.
• 10:46
  SPEAKER_01: We've taken measures to improve efficiency of turnover in both our emergency department and our inpatient floors.
• 10:54
  SPEAKER_01: We have to do this carefully and thoughtfully as we never want to compromise patient safety.
• 10:58
  SPEAKER_01: And I think with activation of our hospital incident command system, temporarily development of hospital leadership teams that are entirely focused only on managing this surge has allowed our hospital to do this safely and thoughtfully.
• 11:12
  SPEAKER_01: We've also expanded our virtual telehealth options for patients requiring care that does not rise to the level of requiring emergency department or urgent care levels of evaluation.
• 11:24
  SPEAKER_01: We've put information about how parents can determine whether or not they can safely do virtual urgent care versus an inpatient appointment and provide education to the Department of Health and through our externally facing website and social media channels to provide this education.
• 11:39
  SPEAKER_01: And we've seen a dramatic increase in the number of families choosing to take advantage of that.
• 11:44
  SPEAKER_00: Are you seeing transmission of respiratory viruses between patients in, let's say, behavioral health units?
• 11:50
  SPEAKER_00: And how are you handling infection prevention in those areas?
• 11:54
  SPEAKER_01: The transmission of respiratory viruses in the healthcare setting continues to be a major challenge that is more significant in pediatric inpatient facilities than in adult facilities, for example.
• 12:05
  SPEAKER_01: Healthcare-associated respiratory viral infections are one of our most frequent healthcare-associated infections.
• 12:10
  SPEAKER_01: And they're also one of the most challenging to manage.
• 12:13
  SPEAKER_01: We know that the acquisition of respiratory viruses can be multifactorial.
• 12:18
  SPEAKER_01: It is oftentimes driven by exposures from non-hospital staff, for example, parent visitors or siblings who may come and who are not recognized to have respiratory symptoms.
• 12:29
  SPEAKER_01: Further, if you have a parent, for example, with a very mild respiratory illness who's at the bedside of a child, particularly a young child who's suffering from a critical illness or some other medically complex condition, it's very difficult for a parent to be able to make that decision to not visit their child.
• 12:46
  SPEAKER_01: And so we have to support that patient-family experience the best we can do.
• 12:50
  SPEAKER_01: We certainly have seen transmission of respiratory viruses.
• 12:54
  SPEAKER_01: The transmission seems to be fairly similar to what we would normally see during a respiratory viral season.
• 13:01
  SPEAKER_01: We've managed that by doing rigorous symptom screening of parents.
• 13:06
  SPEAKER_01: We've limited the frequency with which siblings can visit and only allow them to visit if they've also been symptom screened.
• 13:13
  SPEAKER_01: And we've minimized the number of non-sibling and non-parental or guardian visitors who are able to come.
• 13:19
  SPEAKER_01: We also have to manage presenteism with our ability to provide safe care.
• 13:24
  SPEAKER_01: While ideally we would never have healthcare workers at the bedside who are recovering from a very mild respiratory illness, we know that it's essential for our staffing models to be at the level that's required to provide safe care and continuity of care for families.
• 13:42
  SPEAKER_01: And so we've worked with employee health about how best to educate healthcare workers for understanding when they should come to work and when they should stay home.
• 13:49
  SPEAKER_01: It's likely that the universal masking policies that we have in place for healthcare workers in particular and families, acknowledging that families may not be compliant with the mask when they're in their private inpatient room.
• 14:01
  SPEAKER_01: But we think those masking policies have helped as well, particularly for respiratory viruses that are predominantly spread through the respiratory route and less predominantly through fomites and through contact.
• 14:12
  SPEAKER_01: For example, we have not observed any decrease in our healthcare-associated introviral infections related to universal masking.
• 14:19
  SPEAKER_01: And that's likely because of the significant transmission that occurs through fomites and the reduced susceptibility of enteroviruses to alcohol-based hand rub, for example.
• 14:29
  SPEAKER_01: The behavioral health units continue to provide a major challenge.
• 14:33
  SPEAKER_01: Patients and behavioral health units oftentimes may not be compliant with masks and other mitigation measures.
• 14:38
  SPEAKER_01: We know that face-to-face and congregate activities are part and parcel of behavioral health therapy.
• 14:45
  SPEAKER_01: We've worked very closely with our behavioral health unit leadership to identify when patients can safely receive care in that unit and how to minimize transmission.
• 14:54
  SPEAKER_01: We need to balance the challenges that present if we were to have behavioral health patients taken care of on a medical floor.
• 15:02
  SPEAKER_01: We know their behavioral health care is not ideal in that situation.
• 15:05
  SPEAKER_01: We've had situations where patients with combative behaviors have injured healthcare workers, and we've had to develop strategies for avoiding that.
• 15:14
  SPEAKER_01: And we also know that the medical beds are in high need right now for management of medical conditions and respiratory illnesses.
• 15:20
  SPEAKER_01: And so we have to balance all of those competing challenges.
• 15:23
  SPEAKER_00: That's always a very, very difficult balance to strike.
• 15:26
  SPEAKER_00: And another one is the varying, let's say, opinions on masking.
• 15:30
  SPEAKER_00: Um, so I wanted to know, I think I heard you say it was universal masking, but the official policy in your hospital on masking, uh, where do you stand with that now?
• 15:39
  SPEAKER_01: Yes, it's a also a very difficult and challenging question, and one with a lot of opinions that unfortunately has had some political interference in terms of what's best.
• 15:50
  SPEAKER_01: We have had a fairly similar universal masking policy for the last several months.
• 15:55
  SPEAKER_01: Once COVID transmission levels declined last spring or early summer when the Omicron surge was starting to lessen, we lifted universal masking requirements in our non-clinical areas.
• 16:07
  SPEAKER_01: And so masks are optional in spaces where patients do not receive care.
• 16:12
  SPEAKER_01: And so that would be administrative offices, research buildings, educational conferences, division office suites, et cetera.
• 16:18
  SPEAKER_01: However, we've continued to require universal masking in all clinical spaces.
• 16:23
  SPEAKER_01: And that's despite the change in the CDC language that suggests that based on our COVID-19 level in our community, that we would be able to safely drop that.
• 16:32
  SPEAKER_01: The reason we kept masking was because we, for one, knew at that time that a significant non-COVID respiratory viral season was upon us.
• 16:41
  SPEAKER_01: We also knew that there would be challenges in continually lifting and reinitiating universal masking policies in those clinical spaces.
• 16:51
  SPEAKER_01: And so we made the decision as a hospital that, irrespective of our COVID level, that we would maintain universal masking in our clinical settings until we got through the winter respiratory viral season.
• 17:01
  SPEAKER_01: Patients and families are still required to wear masks.
• 17:04
  SPEAKER_01: We do make compassionate exceptions for children under two and for patients who may have medical or behavioral contraindications to masking.
• 17:12
  SPEAKER_01: While we do get some pushback with families, we have given our frontline staff scripting to help them explain to families why we require masking and the benefit that we believe we're providing to their children and their families.
• 17:25
  SPEAKER_00: And I believe you somewhat touched on this already, but I wanted to kind of bring this back around.
• 17:29
  SPEAKER_00: Obviously, as a children's hospital, you can't really ban all visitors.
• 17:33
  SPEAKER_00: And there's certainly benefit for some of these children to have different family members visiting with them.
• 17:38
  SPEAKER_00: So I just wanted to understand how you strike that balance for anyone who has to stay overnight.
• 17:43
  SPEAKER_00: What is your visitor policy given all the respiratory illnesses that are circulating now?
• 17:47
  SPEAKER_00: And you did mention that there was some kind of screening that was done.
• 17:49
  SPEAKER_00: I'd like you to touch a little bit more about that and share with us what kind of screening is done for siblings and other caregivers that come to visit.
• 17:56
  SPEAKER_01: Visitation policy has been another very challenging aspect of our COVID-19 response and our typical pre-COVID visitation management related to respiratory viruses.
• 18:06
  SPEAKER_01: We throughout the pandemic had a visitor policy that we felt balanced and optimal patient-family experience with safety.
• 18:15
  SPEAKER_01: Early on in the pandemic, we uh did not restrict parents.
• 18:18
  SPEAKER_01: Uh, as the pandemic eased, we allowed a third adult visitor who would be available to provide parents or guardians respite from that inpatient experience.
• 18:28
  SPEAKER_01: And about a year and a half ago, with the exception of a temporary pause during the Omicron surge, we did allow well siblings to visit depending on uh their symptoms.
• 18:38
  SPEAKER_01: And we allow them to visit with a gradually more liberal frequency as the pandemic has eased.
• 18:44
  SPEAKER_01: So, our current policy is that we allow two parents, we allow two additional adult visitors to serve as a respite for families, and we allow well siblings of any age to visit uh no more frequently than once per week, with the compassionate exceptions being available at the discretion of the units and our child life specialists.
• 19:03
  SPEAKER_01: And we think those compassionate exceptions have been well respected and thoughtfully managed throughout the pandemic.
• 19:09
  SPEAKER_01: We have several layers of screening.
• 19:11
  SPEAKER_01: We have an initial point of care concierge staff that provides symptom screen when families check in.
• 19:18
  SPEAKER_01: We have additional screening that's done at the entrance of our inpatient units.
• 19:23
  SPEAKER_01: And then again, that screening is done daily by our nurses.
• 19:26
  SPEAKER_01: We also have child life specialists that are involved and assist with facilitating sibling visits, and they also provide an additional layer of symptom screening for respiratory illness.
• 19:36
  SPEAKER_00: So it sounds like you have a lot of support in terms of being able to screen people and to allow parents to come and visit.
• 19:42
  SPEAKER_00: And I think that's a great balance that you've been able to strike.
• 19:46
  SPEAKER_00: And I'm wondering as you're sort of giving that space to parents and guardians to come in to visit their children, are you able to use those visits for other purposes, like having conversations with those parents or guardians about getting their children vaccinated, whether it be for COVID or for influenza or maybe even other vaccines that may have been missed during the pandemic?
• 20:07
  SPEAKER_01: Yeah, I think a major challenge of this pandemic is that vaccination has become this sort of sub-specialty complex conversation, right?
• 20:15
  SPEAKER_01: You know, we're we're still giving COVID-19 vaccines predominantly in commercial pharmacies.
• 20:20
  SPEAKER_01: Uh, many pediatricians' offices have not been able to facilitate receipt of COVID-19 vaccine, comply with storage and reporting uh requirements, and have been reluctant to do so.
• 20:31
  SPEAKER_01: And so we've been very deliberate in establishing vaccine advocacy as a standard of care for all our providers, not just infectious diseases, physicians, and not just pediatricians either.
• 20:44
  SPEAKER_01: Um, some things we do is we have messaging through our televisions that are in inpatient rooms that provide some information about vaccines.
• 20:52
  SPEAKER_01: We have nurses inquire about vaccine status at the intake, and then we encourage our providers to have those discussions as well.
• 20:59
  SPEAKER_01: We're fortunate to live in a part of the country where our vaccine rates are relatively strong compared to other parts of the country, but we still see highly concerning evidence of vaccine hesitancy and disparities in vaccine coverage among various racial and ethnic groups.
• 21:15
  SPEAKER_01: And so we still have a long way to go.
• 21:17
  SPEAKER_00: So as we kind of work to wrap up our conversation, I was wondering if you had any advice or what you would say to your hospital counterparts and to maybe local departments of health, to the officials there, how to think about this surge, what it could mean for them, and maybe how to prepare for the winter ahead.
• 21:35
  SPEAKER_01: This is a really excellent question, and I think something that needs to be taken very seriously through thoughtful conversations between clinicians, hospital administrators, and public health officials.
• 21:44
  SPEAKER_01: This respiratory surge, I think, is highlighted how fragile our pediatric healthcare system is in the US.
• 21:50
  SPEAKER_01: I think each state jurisdiction needs to understand the inventory of pediatric, acute care, and ICU resources and have plans in place for how those can thoughtfully be expanded with respiratory viral surges.
• 22:02
  SPEAKER_01: It's absurd that a major city like Chicago would not be able to take care of all of their pediatric patients and have to transfer for children to different metro areas.
• 22:11
  SPEAKER_01: No family should have to deal with that.
• 22:13
  SPEAKER_01: Our healthcare system should be more resilient.
• 22:15
  SPEAKER_01: And so those conversations have to continue.
• 22:17
  SPEAKER_01: We have to be prepared to manage shortages in very commonly prescribed and over-the-counter medicines.
• 22:23
  SPEAKER_01: Amoxicillin, osaltamavir, ibuprofen, and acetaminophen are examples of commonly used medications that have been on shortage in many jurisdictions.
• 22:31
  SPEAKER_01: That shouldn't happen.
• 22:32
  SPEAKER_01: The child should shouldn't have to forgo their abuterol therapy because uh inhalers are on shortage.
• 22:37
  SPEAKER_01: I think we also don't have a great system for performing respiratory viral surveillance.
• 22:42
  SPEAKER_01: We've created a wonderful system for being able to do that for COVID, for understanding our healthcare resource utilization for COVID-19.
• 22:48
  SPEAKER_01: Uh, we've done that to a lesser extent for influenza by monitoring ICU admissions for influenza and influenza deaths.
• 22:55
  SPEAKER_01: Uh, we have a much smaller capacity for looking at RSV surveillance and almost no capacity for surveillance for other respiratory viruses.
• 23:03
  SPEAKER_01: We know that there's many respiratory viruses that can occur concurrently.
• 23:07
  SPEAKER_01: We really need to expand uh our surveillance and healthcare resource utilization for respiratory viruses broadly in the pediatric population rather than focusing on specific pathogens.
• 23:17
  SPEAKER_00: Thank you so much, Dr.
• 23:18
  SPEAKER_00: Kosiolik.
• 23:19
  SPEAKER_00: This has been a wonderful conversation.
• 23:21
  SPEAKER_00: I really appreciate all the insights and all of the nuances that you've shared with us.
• 23:26
  SPEAKER_01: Thank you so much for having me.
• 23:28
  SPEAKER_00: Thank you again, Dr.
• 23:28
  SPEAKER_00: Larry Kosiolik, for sharing your perspective on this topic.
• 23:32
  SPEAKER_00: This podcast can be accessed on Shea's online education center, learning CE, under the Rapid Response Program, where you'll also find resources such as the Shea Town Halls.
• 23:43
  SPEAKER_00: This concludes today's episode of the Rapid Response Podcast.
• 23:47
  SPEAKER_00: Thank you for tuning in.