PORTLAND, Ore. (AP) — Children’s hospitals in the Pacific Northwest are struggling to maintain enough space for their young patients, and some report being over capacity amid increasing strain due to a surge in respiratory illness and hospitalizations.

At the same time, the Seattle area’s first pediatric death from flu since the 2019-2020 season was reported Wednesday.

There has been a nationwide surge in a common respiratory illness known as RSV, which can cause severe breathing problems for babies. RSV cases fell dramatically two years ago as the COVID-19 pandemic shut down schools, day cares and businesses.

Two hospitals in Oregon that account for much of the state’s pediatric intensive care capacity have moved to crisis standards of care. The state government standards provide guidelines for hospitals on how to provide care in cases of limited resources.

Both in Portland, the two hospitals are Doernbecher Children’s Hospital at Oregon Health & Science University and Randall Children’s Hospital at Legacy Emanuel.

Cindy Hill, vice president and chief nursing officer at Randall Children’s Hospital, described the decision as “heart-wrenching.”

“We are implementing safe solutions to meet the community demand for pediatric beds, including pulling staff to work extra shifts,” she said in a news release. “To create capacity, we’ve postponed some non-urgent pediatric procedures and will continue to use creative staffing options to ensure we can provide the best possible care through this crisis.”

The two hospitals’ decision to move to crisis standards of care came the week after Oregon Gov. Kate Brown declared a state of emergency due to increasing hospitalizations among children.

Similar challenges are burdening hospitals in neighboring Washington state.

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Health authorities there said an elementary-school-aged child died from flu complications on Nov. 13 in King County, which is home to Seattle, according to the county’s public health agency.

“It’s tragic to lose a child to illness, and our hearts go out to this child’s family and loved ones,” said Dr. Jeff Duchin, Health Officer for Public Health – Seattle & King County. “This death comes on top of a steep and unprecedented rise in illnesses and hospitalizations in King County and nationally among children for infections caused by multiple respiratory viruses.”

Duchin said the infection and hospitalization trends will likely continue in the coming weeks.