Flu surges on heels of RSV, COVID-19 to overwhelm children's hospitals

A flu season that started early, hospitalized far more children than usual and overwhelmed emergency departments has revealed that Canada's health-care system is chronically underfunded when it comes to the most vulnerable citizens, a pediatric infectious diseases specialist says.

Dr. Jesse Papenburg, who works at Montreal Children's Hospital, said a system that was already struggling with a surge of respiratory syncytial virus, or RSV, on the heels of COVID-19 is now overwhelmed in much of the country.

"Certainly, Ontario and Alberta in particular have been hit very hard with an early and really quite explosive influenza season in pediatrics when it comes to more severe disease requiring complex hospitalization. And we're also observing in Montreal as well that our influenza admissions are really starting to pick up," he said.

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The last week of November saw the highest number of pediatric hospitalizations for a single week in the past decade, said Papenburg, who is also an investigator for IMPACT, a program that monitors hospitalizations for vaccine-preventable diseases at 12 children's hospitals across the country.

A typical flu season sees about 1,000 kids admitted to hospital. Due to pandemic public health measures, he said last season saw only 400 and there were none the season before that.

Up to the end of November, over 700 children had been hospitalized with the H3N2 strain of the flu, which typically takes a toll on older adults.

But the season could continue until March or April, Papenburg said of the unexpected epidemic.

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"When you're already stretched to the limit under normal circumstances and there's something exceptional that takes place, it really has a greater impact on the type of care that we can deliver to Canadian children," he said. "It's unacceptable, in my view, that this is happening, that we are having to delay important surgeries for children because we need those resources for dealing with acute respiratory infections."

While the number of RSV hospitalizations is stabilizing, there's still a "significant burden of disease requiring complex hospitalization," he said of the Montreal hospital.

Alex Munter, president of Ottawa pediatric hospital CHEO, said the Red Cross will be helping take some of the pressure off critical-care staff starting this week.

He said two teams of nine people will work rotating overnight shifts and that some will be porters while others get supplies or sit with patients.

"Having these Red Cross teams on-site will allow us to send back redeployed staff to their home base," he said.

"The test positivity rate last week for flu was 30 per cent compared to 10 per cent at the end of October. That's a big increase and it's still climbing so flu hospitalizations are increasing and RSV is plateauing," Munter said.

CHEO, including its emergency department and urgent care clinic, is also getting help from pediatricians, family doctors and nurses in the community while some patients are being transferred to adult hospitals, Munter said.

"We can't run our hospital this way in perpetuity. I think the moral of the story here is that we have undersized child and youth health system in Canada."

SickKids in Toronto continues to see high patient volumes in the pediatric intensive care unit and since November has reduced the number of surgeries so staff can be redeployed to provide care in that unit.

"We have been co-ordinating closely with other hospital partners that have the ability to care for some pediatric patients," the hospital said in a statement, adding it is not currently seeking staffing support from external organizations.

Dr. Shazma Mithani, an emergency room doctor at both the Stollery Children's Hospital and Royal Alexandra Hospital in Edmonton, said a temporary closure of a pediatric hospice in Calgary is "tragic" as staff are being diverted to a children's hospital.

"It means that kids who are dying are not getting the palliative and comfort care that they deserve and need, and that acute care is taking priority over that," Mithani said.

Federal Health Minister Jean-Yves Duclos has said Ottawa recently gave provinces an additional $2 billion as calls grow for both levels of government to do more to help hospitals facing unprecedented challenges.

Mithani said funding has to be targeted for children's hospitals and could also go to staffing after-hours clinics, for example.

She said people planning large indoor gatherings over Christmas and for New Year's Eve should consider scaling back, while schools should transition to temporary online learning if they have a large number of viral illnesses

Health officials also need to make a concerted effort to educate the public on the importance of vaccination amid misinformation on social media, Mithani said.

"The most vulnerable people in our society are suffering as a result of the decisions that adults made. That's what's happening here, that kids are suffering from the poor decisions of adult decision-makers who can't seem to do the right thing in order to protect our kids."

With files from Jordon Omstead in Toronto

This report by The Canadian Press was first published Dec. 5, 2022.

This story is produced with the financial assistance of The Canadian Medical Association. It has no say in editorial choices.