'Breaking point': Why German pediatric wards are filling to capacity

The German Interdisciplinary Association for Intensive Care and Emergency Medicine (Divi) said on Thursday that there was a "catastrophic situation" in children's intensive care units. 

According to the physicians, a wave of respiratory syncytial virus (RSV) infections can be expected every year starting in the autumn. 

Yet this year “there are fewer and fewer pediatric hospital beds available overall" as well as a lack of nursing staff, Divi Secretary General Florian Hoffmann explained Wednesday on ZDF's Morgenmagazin.

Because all beds were full in one case, a child was transferred from the Hannover Medical School (MHH) to Magdeburg on Friday night, a distance of around 150 kilometers. 

"My colleagues had called 21 clinics," said Gesine Hansen, Medical Director of the MHH Clinic for Pediatric Pneumology, Allergology and Neonatology, told DPA. 

The child, who was about one-year old, had an RSV infection, which can be life-threatening, especially for babies and children with pre-existing conditions.

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'Catching up'

Some health experts have said that hospitals are now filled to capacity because children had minimal social contact during the pandemic and are now catching up on infections.

According to the Robert Koch Institute (RKI), an estimated 5.6 severe cases of RSV respiratory illness occur worldwide per 1,000 children in the twelve months after birth. 

Within the first year of life, 50 to 70 percent would typically have experienced at least one infection with RSV, and by the end of the second year of life, nearly all children should have experienced at least one infection. 

In the wake of protective measures against Covid-19, however, many such infections had temporarily failed to materialise. 

‘Breaking point’

According to Divi, hardly any clinics had a free crib or free pediatric intensive care bed in the past few days.

"Children have to lie in the emergency room for days," Hoffmann said.

Yet the peak of the current wave of respiratory infections in children has by no means been reached, Hoffmann said. "The situation in practices and clinics will get even worse in the coming weeks."

"We are at the breaking point," said Matthias Keller, head of the Children's Hospital Dritter Orden Passau already. The rooms are often double-occupied, he said. In some cases, there were too few monitors and not enough equipment for respiratory support.

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A child with RSV being treated at the Olgahospital in Stuttgart. Photo: picture alliance/dpa | Marijan Murat

"Some patient rooms are like bed storage areas, where you really have to crawl over the beds to get to the sick child, because the parent bed is lined up with the patient bed," said Keller, who is also chairman of the South German Society for Pediatric and Adolescent Medicine.

This has far-reaching consequences for other young children who need treatment. When an infant who has just been resuscitated is admitted to a children's hospital that is actually fully occupied, a three-year-old has to wait there for the third day in a row for his urgently needed heart operation.

'Responsibility of politicians'

A wave of infections usually lasts six to eight weeks. In Bavaria, Lower Saxony and Berlin, as well as North Rhine-Westphalia, clinics are reporting a "maximally tense situation," reported Divi on Thursday.

The Düsseldorf University Hospital, for example, is experiencing a wave of influenza among its young patients in addition to the RSV wave, which is "causing massive problems primarily for children up to elementary school age," said University Hospital spokesman Tobias Pott.

In the Rhineland, "all beds are completely full" at times, said Jörg Dötsch, president of the German Society for Pediatric and Adolescent Medicine. An ER waiting time of six to seven hours is not uncommon, he says. 

"It is very unpleasant when children and their families have to virtually camp out in the emergency room," says Dötsch, who is also director of the Clinic for Pediatric and Adolescent Medicine at the University Hospital in Cologne. 

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What are the solutions?

At their meeting on Thursday in Hamburg, intensive care physicians and intensive care nurses will discuss approaches to solving the crisis. 

One solution may be to temporarily bring nursing staff from adult facilities into the children's hospitals, says Hoffmann, who is also a senior physician at Dr. von Hauner's Children's Hospital at the University of Munich. 

But above all, he says, many more pediatric nursing staff need to be trained. "We need to strengthen nursing," he explained. "Only then do we have a chance."

Others said more money needed to be invested in pediatric medicine and vaccines, even if it is less profitable.

"The fact that children's lives are currently in danger is the responsibility of politicians," said Jakob Maske, spokesman for the Professional Association of Pediatricians and Adolescents.

"Nowadays medicine has to be profitable - not cure diseases, but make money."

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