Impact Of The 'Tripledemic' On Clinicians
Capacity limits, drug shortage and clinician burnout
Experts have coined the term ‘tripledemic’ in response to the recent emergence of three respiratory viruses at the same time; the Flu (influenza), RSV (respiratory syncytial virus) and COVID-19.
Clinicians are all too familiar with treating patients with RSV or the flu. What they are unfamiliar with is treating these viruses alongside COVID-19 so early in the virus season. Cases of RSV and the flu are not only occurring sooner in the winter months, but at higher rates.
The volume of sick patients has become overwhelming for providers and straining for the healthcare system—and cases are expected to rise. Here you can learn more about the impact of the ‘tripledemic’ and how telemedicine is combating the struggle.
The impact of the ‘tripledemic’
Cases of COVID-19 are notably lower than they have been in the past but are on another slow rise. Occurring months before its typical season, RSV cases began circulating in late spring. Then comes the flu, which began in early October. Not all three viruses are peaking at the same time but their overlap has largely impacted hospitalization rates.
According to the Centers for Disease Control and Prevention (CDC) there has been an estimate of 230,000 hospitalizations, 22 million illnesses and 14,000 deaths (including 74 pediatrics) from the flu. With over 26,000 positive RSV antigen tests and more than 44% of the U.S. experiencing medium to high levels of COVID-19 in just this season.
Overwhelmed Pediatric Units
The unusual spike in respiratory illness is overwhelming pediatric units and ERs putting a strain on children’s hospitals. Many pediatric hospitals are at or reaching capacity across the country. This has forced hospitals across the country to consider contingency plans that were set in place in times of crisis.
As many hospitals run out of room in the ICU some have begun repurposing space in other wards. With some setting up tents in the parking lot and turning gift shops into triage rooms. Many patients are experiencing long wait times in the ER due to staffing shortages and have resorted to traveling as far as other states in search of available beds and care.
Due to the early circulation of RSV, pharmacies across the country are seeing a backorder on some formulations of amoxicillin. The availability of amoxicillin oral suspension products, used in pediatric patients, has primarily been affected. Many distributors have not been able to keep up with the ongoing high demand. Little insight has been provided into the reasons for shortages, other than the surge in demand.
The U.S Food and Drug Administration added the amoxicillin formulation to the Drug Shortage database in late October. Other drugs are also seeing a shortage in response to the surge in respiratory infections, such as:
Liquid Tylenol (acetaminophen)
The shortage has caused a delay in care for many patients that were prescribed the drug. Pharmacists are not able to automatically substitute for other antibiotics when certain medications are prescribed by physicians. Alternatives are limited in some cases, as not all kids can swallow a capsule or tablet. Being a first line therapy for children, the amoxicillin shortage is expected to last several months.
Clinician burnout has been an issue since before COVID-19. At a time when there’s already a disadvantage, healthcare burnout is reaching crisis levels. With a ‘tripledemic’ dangling over their heads and an increase in staffing shortages, many are being pushed to their limits.
According to a study by the National Academy of Medicine between 35% and 54% of U.S. nurses and physicians have substantial symptoms of burnout.
Due to the 'tripledemic' clinicians have been experiencing higher levels of exhaustion with extra hours, limited resources and moral distress. With an overwhelming number of patients, many of them have been forced to prioritize acute care and send patients to other facilities for care.
Thankfully, there are some ways you can prevent or manage it. Prevention starts with being aware of the problem and yourself. What are your limits? What does your body need to function properly? What is your body telling you?
In order to cope with the overwhelming amount of patients, clinicians can mitigate the effects of burnout by practicing good habits. This includes physical activity, getting adequate sleep and eating a balanced diet. But most importantly, asking for help when in need.
Virus similarities and differences
The three viruses have very similar symptoms, including but not limited too:
Fever and/or chills
Cough and/or sore throat
Body or muscle aches
Vomiting or diarrhea
Runny nose and congestion
Although symptoms are similar, there are also some differences. A tell tale for RSV is wheezing while breathing. This is a rattling sound caused by partially blocked airways. The flu is typically accompanied with a very high fever, such as 103 or 104 degrees. While any virus can cause this, COVID-19 has commonly been associated by the loss of taste and smell. A key difference for COVID-19 is the long-term effect.
Note: You can have either virus without having a fever.
The support of telemedicine
Telemedicine is not only convenient but it expands access to healthcare to those in rural or underserved areas. Rural hospitals are already spread thin with limited providers. With a 'tripledemic' taking over, patients and providers have even less resources.
The flu season itself brings in high patient volumes even though it has low severity to a patient's health. It is hard for clinicians to see patients with more serious illnesses while their availability is filled treating those with a minor cough or fever. This is where telemedicine can allow providers to see patients in a more timely manner and better communication.
Rather than going into a clinic for minor symptoms, patients have access to virtual care. This allows clinicians to treat cold-like symptoms virtually while treating high severity and chronic conditions in person. Therefore, reducing the spread of viruses to those with severe symptoms and protecting those who are healthy from contracting them.
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