Staff photo illustration by C.B. Schmelter / Dr. Heather Gilliam takes 5-year-old Case Price's temperature in the Children's Hospital at Erlanger's Kennedy Outpatient Center on Tuesday, Aug. 11, 2020, in Chattanooga, Tenn.

As a spike in pediatric respiratory illness pushes children's hospitals across Tennessee to their limits, officials at the Children's Hospital at Erlanger say they're prepared to handle more pediatric COVID-19 patients as the highly contagious delta variant sweeps through predominantly unvaccinated populations.

The current COVID-19 surge is particularly problematic for children because those younger than 12 cannot be vaccinated, and vaccine uptake among teens is low — leaving these age groups among the most susceptible to new COVID-19 infections.

"We knew with the delta variant that kids were going to be more affected," said Dr. Andrea Goins, a pediatrician and chief of staff at Erlanger Children's. "We do have lots of things in place within the children's hospital setting, as well as within the Erlanger system, to work together and collaborate. So, I don't have any question that we'll do what we have to do to make sure that the kids are taken care of."

During a news briefing Friday, Tennessee Health Commissioner Dr. Lisa Piercey said children's hospitals across the state were already nearing capacity before the delta variant began driving coronavirus cases and hospitalizations. That's because certain respiratory viruses normally only seen in children during winter months — particularly respiratory syncytial virus, or RSV — are sickening kids as they return to more in-person activities without face masks and other precautions that curtail the spread of diseases. In addition, hospitals must continue to treat normal illnesses and injuries.

"So, the extra ... burden of children being hospitalized with COVID is likely just enough to tip the scales in some instances where RSV continues," she said.

Because RSV data isn't something the state normally tracks, and the symptoms of that disease and COVID-19 are so similar — particularly in infants — Piercey said it's hard to say which of the two are most prevalent in Tennessee children currently.

Goins said school-aged adolescents and teens tend to be the pediatric groups hit most by COVID-19, and unless they have serious underlying conditions, they typically fare well against the disease. Congenital heart disease, Type 1 diabetes and asthma are some of the main childhood conditions that contribute to more serious COVID-19 infections in children, she said.

"We haven't seen a lot of infants and newborns that are affected by COVID, and that's certainly the range that is the most affected by RSV," she said.

Several factors complicate resolving capacity issues at children's hospitals, most significantly staffing shortages. The health care industry is grappling with the same workforce shortages as the rest of the country, and children require their own medical specialists to care for them.

"They have different equipment, different medications, different pretty much everything. I think people get into the habit of thinking that kids are just small adults. It's a whole different set of medicine," Piercey said. "That means we don't have as much flexibility to flex our staff and to pull in additional staffing."

Goins said that ventilators are important items that are age and size specific, but at this point, she isn't concerned about Erlanger Children's running out.

"As numbers change, that may be a different discussion. But as of right now, we don't have that concern," Goins said, saying staff are bracing for a continued increase in patients as schools return.

"In pediatrics, we're used to the influx and the changes that happen seasonally, as well as going back to school," she said. "We know, in pediatrics, it's very different in summer months versus winter months, and if we have to treat the summer as if it's winter, we're prepared to do that. We are ready to face what is coming down the pike, whatever it may be."

Contact Elizabeth Fite at or 615-757-6673. Follow her on Twitter @ecfite.