Washington Confirms First Pediatric Flu Death of Season as ERs Enter 'Crisis Mode'


Washington state has confirmed its first pediatric flu death of the 2022-23 influenza season, pushing public health leaders to more urgently sound the alarm on the region's steep rise of respiratory infections this fall.

A King County child in elementary school died last week from complications of the flu, the county's first pediatric flu death in more than two years, according to a Wednesday statement from Public Health — Seattle & King County. To date, at least four adults in the state have died from influenza this season.

The pediatric death is the latest reminder of the region's startling rise in respiratory infections this fall, which are at the highest levels the county has seen since at least 2018, if not longer, said Dr. Eric Chow, who leads King County's communicable disease and epidemiology division.

Cases of RSV, or respiratory syncytial virus, have been increasing since September, but flu infections started skyrocketing in King County in the past month. The number of cases has doubled each week since mid-October.

As of early November, about 8.6% of tests from hospitals and laboratories in the county had returned positive for the flu, compared to less than 1% in mid-October.

About 30% of tests are coming back positive for RSV, according to county data.

The surge has hit younger children and teenagers especially hard, crowding Seattle Children's and other pediatric hospitals and leading to long ER wait times in the region.

In Washington, most flu infections have been found in those between 5 and 24 years old, with infants and toddlers under 4 representing the second largest group.

Children's ER is at nearly 100% capacity almost 24 hours a day and at almost 300% capacity most evenings. At Odessa Brown Children's Clinic, a Seattle Children's community clinic, providers are receiving a record number of calls from worried families, said Dr. Shaquita Bell, the clinic's senior medical director.

"Our average calls a day, during a busy season, are about 30 calls per day. Now, we're at around 100," Bell said. "Part of this is because for the last two years, we've had very low respiratory infection rates because people were doing things to mitigate COVID. ... In 16 years [in health care], I've never seen anything like this."

She's also concerned the wave of cold and flu infections is here earlier than usual, Bell added. In a normal year, infections peak around January or February.

"If we're already up here and at capacity with our health care infrastructure, it's really not great news for what's going to happen in the next couple months unless we do something, really proactively, to diminish the spread," Bell said.

In recent weeks, Children's staffers have noticed more and more cases of combinations of viral infections. Patients are increasingly testing positive for both influenza and RSV, for example, instead of one or the other. If a person has multiple infections, their symptoms will likely be worse, Bell said.

Cases of other respiratory viruses, like rhinovirus, adenovirus and parainfluenza, have also started creeping up, though at much lower levels than RSV and the flu. COVID-19 infections and hospitalizations remain at fairly low levels.

An anticipated wave

Washington doctors and public health leaders have long predicted this year's tough winter season for COVID, RSV and the flu, a period some have referred to as a "tridemic."

Chow, of Public Health — Seattle & King County, said this week several factors have produced a greater concern about the diseases, including a general decrease in widespread mask-wearing, social distancing and remote work and school.

"People often refer to health care and hospital workers as the 'front line,'" Chow said. "But the reality is that the health care system should really be our last line of defense. They have to be there to support us when care is needed ... but we all play a role in our front-line duty to protect ourselves from infections so we can reserve those resources for people who really need them."

State hospital leaders have also pointed to a lag in bivalent booster rates (the newest omicron-specific COVID booster) and flu shots, and  a general reduction in immunity after two years of low levels of respiratory infections.

The wave of respiratory patients now crowding into hospital ERs has put more pressure on the state's health care facilities already at or over capacity, according to several hospital leaders who spoke in a Washington State Hospital Association news briefing last week.

"We are in crisis mode, bordering on, if not already in, disaster mode in our emergency departments across the state," said Dr. Tony Woodward, medical director of emergency medicine at Seattle Children's. "We traditionally like to say ERs are the canary in the coal mine for the hospital systems, and right now, ERs are failing because we're at such high capacity."

While patients with emergencies are treated immediately, those with less urgent illnesses or injuries are waiting hours in the ER, Woodward said. He encouraged those with nonurgent symptoms to contact their primary care provider first, either in person or virtually, before coming to the ER.

"Try to get into alternative levels of care if you don't have a true emergency, but don't ever hesitate to come to the emergency room if you have an emergency," Woodward said.

Steps you can take

Because RSV and the flu generally spread through droplets, including coughing or sneezing, the high-quality, well-fitting masks many used to prevent COVID infection also work for these other respiratory viruses, Chow said.

Flu shots and COVID vaccines are also highly recommended for those eligible. Anyone ages 5 and older who received a COVID shot at least two months ago is eligible for the updated booster. Anyone ages 6 months and older is eligible for a flu shot.

"Because flu activity typically remains elevated for several months, now is a good time for children and adults to get an annual flu vaccine if not already vaccinated, and to take steps to protect those who may be at higher risk, including staying away from others when we are ill," King County health officer Dr. Jeff Duchin said.

For cold and RSV, doctors say you should make sure you're able to breathe comfortably and that you're able to stay hydrated. Suctioning (getting mucus out from your nose) and using medications to control fever are also recommended for most kids and adults.

Typical over-the-counter cold and cough medications are not recommended for young children, and parents and caretakers should instead opt for fluids and fever-reducers.

Chow also recommended people watch for symptoms and test for the coronavirus before meeting in large family gatherings this holiday season. At large indoor gatherings, he also urged residents to open a window or try to improve ventilation.

"I'm eager to have my family meet up with other people this holiday season," he said. "But I worry the same environment where a lot of people are traveling and are indoors with a lot of people is the same type of environment that promotes respiratory virus infections."