Concerns about U.S. Hospitals’ medical oxygen supplies in the face of possible Respiratory “Twindemic”

Preparing Hospitals’ Medical Oxygen Delivery Systems for a Respiratory “Twindemic” This Medical News feature examines the challenges that hospitals face as they prepare for a spike in severe cases of COVID-19 and other respiratory illnesses that require supplemental oxygen. JAMA_current

Regardless of whether another respiratory virus is surging across the US along with SARS-CoV-2—be it the influenza virus or respiratory syncytial virus (RSV)—experts again fear that a twindemic or possibly a tridemic could be in the making. Mirroring last year, several hospitals are reaching their tipping points, which begs the question: can they maintain an adequate supply of medical oxygen for patients experiencing respiratory distress?

Initially, “pediatrics was spared some of the oxygen allocation issues because it was only COVID—it wasn't RSV, it wasn't flu,” Daniel Rauch, MD, chief of Pediatric Hospital Medicine at Tufts Children's Hospital, said in an interview. “Now, we're looking at all of them.”

A US surge in COVID-19 cases after the Omicron variant emerged in autumn included children, who made up about 17% of new cases in early January, according to the American Academy of Pediatrics (AAP). And RSV cases—which often exhibit seasonal hikes during colder months and are the leading cause of infant hospitalization and pneumonia in the US—spiked earlier than usual this year and continue to rise.

Rauch, who also chairs the AAP’s Committee on Hospital Care, is concerned that hospitals won’t be able to accommodate everyone in need. “On any given day, we're asking… ‘If we have a bed, who gets it? Are we going to accept a transfer, or someone from our emergency room? The adult side is bursting at the seams; are we going to take a young adult? How do we juggle the resource that we have the least of—which apparently, at this point, is capacity?’”

Winter is generally tough on hospitals, bringing with it an influx of influenza cases. Although influenza isn’t typically a death sentence, it can result in serious complications, including pneumonia. According to the US Centers for Disease Control and Prevention (CDC), it’s especially dangerous for young children.

Influenza cases in the US remained low last winter due to COVID-19–related social distancing protocols. However, the CDC warned of a resurgence this year, noting that “reduced population immunity due to lack of flu virus activity since March 2020 could result in an early and possibly severe flu season”—which has already commenced. Influenza vaccination among children is also lower now than in previous years, while national cases are increasing. A study by University of Pittsburgh researchers not yet peer reviewed also warns of the risk to young children who likely have little immunity.  ...