“It’s the threat of both RSV, which mainly affects the very young and the very old, the flu and COVID 19,” Dr. Kieran Moore told CP24 when asked what keeps him up at night.  “And we’re starting to see the risk of influenza increasing across Ontario.”
Moore said there are already 18 people in Ontario’s intensive care units with the flu, eight of them on ventilators.
“So the vaccine is now available to the general public and we absolutely encourage all Ontarians to show up to get vaccinated,” he said.  “The next two weeks are going to be so important in maintaining protection with the flu vaccine.”
He also urged people to get their COVID-19 souvenirs and noted that uptake of the boosters was generally low, with only about 1.5 million people in the province receiving the vaccine.
The latest data from the province shows that the number of COVID-19 shots handed out over the past two months has increased and now averages about 42,000 a day, the vast majority of them booster shots.  But this is still considered to be a long way from the levels needed to cushion the impact of the virus this season.
Both influenza and COVID-19 vaccines are now widely available in public health clinics and pharmacies.
The flu shot is available free to anyone six months of age and older.  According to the province, the vaccine is especially important for children under five, those who are pregnant and those 65 and older who are at higher risk of flu-related hospitalization and complications, such as pneumonia, heart attack or death.
The province is focusing its flu vaccination efforts on those most at risk from the virus, such as the elderly and those with underlying medical conditions.  However, Ontario estimates there are about 6 million people who are considered a higher risk of ending up in hospital if they get the flu.  
Exacerbating respiratory disease concerns this season is an increase in RSV, a respiratory virus that primarily affects young children and older adults.  There has already been an outbreak of the virus, with emergency rooms flooded with parents bringing young children.
There is no vaccine available for RSV yet, although at least two companies are testing vaccine candidates.
At the same time, emergency rooms in Ontario have been overwhelmed in recent months, with long wait times and chronic staff shortages.
Toronto’s Hospital for Sick Children (SickKids) told CP24 last week that their patient volume is “unusually high” ahead of flu season and urged parents and caregivers to consider other options before coming to the emergency department.
Moore urged people to use online resources to assess whether they should seek treatment for a respiratory illness and said the province is trying to build the capacity to assess people with respiratory illnesses.  In the meantime, he said, getting vaccinated is the most important step people can take to protect themselves and others heading into what’s expected to be a tough flu season.
“Unfortunately, this risk will increase.  But we all now have an opportunity to prevent this increase by getting vaccinated,” Moore said.  “The flu vaccine – the one that’s out there right now seems to match the vaccine very well – so we expect it to have a strong protective effect against the need for hospitalisation.
He added that “we have a couple of weeks” to protect as many Ontarians as possible as the flu season starts earlier than usual this year.
“We’re absolutely watching the data so closely — both the impact of COVID in the hospital, the impact of RSV and the flu,” Moore said.  “That way we’ll know if it’s starting to take off.”
He said it usually happens when the percentage of tests that are positive for the flu exceeds five percent.
“(That’s when) we know it usually starts to escalate in our communities, peaks about six weeks later and then slows down,” Moore said.  “So it’s often a quarterly annual epidemic that we’re going to be dealing with, and we know some of the tools that can help us, and number one, is vaccinations.  Number two, if you are at risk, please consider getting coverage as the risk is increasing across Ontario.”
There are a few locations where masks are still mandatory in the province, but health officials advise people to cover up in higher-risk areas such as transit, especially if they are vulnerable to infection or are immunocompromised.