Pediatric health care professionals warn that most children’s hospitals are operating at or above 100 percent capacity, emergency room wait times can be as long as 24 hours, and some non-emergency surgeries are already delayed. One germ in particular, respiratory syncytial virus (RSV), has particularly stretched the boundaries of hospitals. RSV is a common childhood respiratory infection that usually leads to cold-like symptoms that go away after a week or two, according to the US Centers for Disease Control and Prevention (CDC). However, the Public Health Agency of Canada (PHAC) warns that severe cases of RSV can lead to hospitalization. RSV can also cause secondary bacterial infections, such as pneumonia. There is no vaccine for RSV and no medicine to clear an infection, so care usually focuses on treating symptoms and secondary infections. While RSV infections normally peak in December and January, PHAC’s Oct. 29 respiratory virus report warns that the number of both RSV and influenza A cases are “above expected levels for this time of year.” . So far, the agency has identified 1,045 cases of RSV, with a positivity rate of seven percent. Some health professionals attribute the rise in RSV infections to the fact that physical distancing and public health restrictions during the pandemic prevented children from contracting the virus for two years, so their immune systems have less experience fighting it now that these restrictions have been lifted. Dr. Robert Barnes, associate director of professional services at the Montreal Children’s Hospital, said that while the wave of the virus is affecting all pediatric age groups, younger children seem to be bearing the brunt. “We have a huge number of our very young children in the community who didn’t get as much of a turn with these viruses last winter or even the winter before that,” Barnes told CTVNews.ca on Wednesday. “So the virus spreads much more and much faster among our young people.” Meanwhile, hospitals across Canada are already over capacity in emergency rooms and inpatients and struggling with long wait times. When her asthmatic three-year-old James Pinder became ill on Oct. 17 with a fever, cough, congestion and lethargy, Calgary mom Michelle Maguire decided she needed to see a doctor. Her first choice, Alberta Children’s Hospital, reported a wait time of more than seven hours online, so she went with her second choice, Rockyview General Hospital. “All hospital wait times are flooded right now,” he told CTVNews.ca in a phone interview Wednesday. “But the doctor we saw at the hospital informed us that virtually every child they see has symptoms of RSV.” James was diagnosed with RSV and released that day to recover at home. Maguire said she is feeling much better, but that it was the most serious illness her oldest child has had.
NATIONAL PROBLEM
Emily Gruenwold, president and CEO of Children’s Healthcare Canada, said conversations like the one Maguire had with the doctor at Rockyview General Hospital are happening at hospitals across Canada right now. “Across the country, almost without exception, our children’s hospitals are all operating at 100 percent occupancy or more,” Gruenwald told CTVNews.ca in a phone interview Thursday. Part of what’s driving high occupancy rates, he said, is the ongoing shortage of children’s Advil and Tylenol across the country. “Parents see their little ones not feeling better, perhaps struggling with high fevers, body aches and headaches, and they try to control those symptoms at home,” Gruenwold said. When they can’t find what they need to treat these symptoms on pharmacy shelves, she said they often turn to hospital emergency rooms. Gruenwold said CHU Sainte-Justine, in Montreal, was operating at 300 per cent capacity this week and that, as of Thursday morning, the pediatric ICU of the Children’s Hospital of Eastern Ontario (CHEO) was operating at 200 per cent capacity. HSC Children’s, in Winnipeg, Manitoba, reported Oct. 27 that its emergency department saw an average of 139.5 patients per day in September, an increase of nearly 11 percent year over year. In an interview with CTV News Channel on Wednesday, Bruce Squires, president of McMaster Children’s Hospital, said the hospital’s inpatient occupancy was approaching 135 percent. “As our teams work to meet this level of demand, we have had to open a significant number of extra beds on a daily basis,” he said. Squires attributed the situation at his hospital to the culmination of several factors, including the ongoing COVID-19 pandemic and a “significant increase” in viral infections, including RSV and influenza. Pandemic-related delays for specialized pediatric treatments, he said, have also led to an influx of young patients who are sicker than they should be. “Unfortunately it seems to be coming together at the same time and has resulted, for us at McMaster Children’s, in unprecedented numbers of children presenting to our emergency department,” he said, as well as “unprecedented numbers requiring either inpatient admission or, in some cases , admission to our intensive care units.’ Staff are facing a similar situation at Montreal Children’s, where Barnes works. The hospital had an emergency room occupancy rate of 193 percent Tuesday night, up from an average occupancy rate of 113 percent over the same period in 2019. The hospital’s ICU is at about 115 percent capacity while the medical unit is operating at about 106 percent. According to hospital staff, emergency room wait times for less critical hospital visitors are between 18 and 24 hours. Diane Piques took her eight-year-old daughter, Chloe Santangeli, to the hospital on October 8. Chloe, who has asthma, appeared to have a viral infection and was struggling to breathe. He was diagnosed with RSV and pneumonia and admitted overnight so he could receive IV antibiotics and supplemental oxygen. Chloe is slowly recovering, but Piques is haunted by the experience and how many other children on her daughter’s hospital floor seemed to be battling the same illness. “The whole floor he was on either had pneumonia or had the virus,” he told CTVNews.ca in a phone interview Wednesday. “The doctor who saw her said he had never seen such a rise.” Barnes said the hospital doesn’t reserve floors for specific illnesses, but he wasn’t surprised it appeared that way to Pickes. “There is no special RSV or pneumonia floor,” he said. “However, we are so overwhelmed that it wouldn’t surprise me if almost every patient on a certain floor might have this problem.” The hospital has added more admissions beds than it would normally need at this time of year, and Barnes said those admissions have begun to displace resources for other areas, such as surgery. “It has had an impact on our ability to carry out our surgical program for those children who need surgery or who need a hospital bed or an ICU bed after surgery,” Barnes said. As a result, some patients who have been waiting weeks or months for surgery may have to wait a little longer. Fortunately, Barnes said, the hospital has not had to postpone any cancer-related emergencies or surgeries. To manage the influx of admissions, Cindy McCartney, associate director of nursing, said the hospital has relied heavily on staff to volunteer overtime. He compared the experience of children’s hospitals at this time with the experiences of general hospitals throughout the COVID-19 pandemic. “I think everybody is tired,” he told CTVNews.ca on Wednesday. “I think the adult health care system has had a very difficult time during COVID, and this is like our COVID and the demand on our staff is very high.” Gruenwold made the same comparison. “I feel like this is our moment for 2020,” he said. “In 2020, when the pandemic hit, we saw unacceptable levels of care and outcomes for our seniors. Now, we’re seeing the same for our children.”
HOW PARENTS CAN HELP
Gruenwold believes it is up to the provincial and federal governments to give Canada’s hospitals and health care system the resources they need to be more resilient and better prepared to deal with public health crises. But she, Squires, Barnes and McCartney agreed that for now, there are steps parents can take to make sure they’re using the right health care services in order to maintain hospital capacity for the children who need it most. . “It’s helpful to review your options when you have some concerns about your child’s health,” Squires said. “Certainly, in an emergency situation, be sure to call 911 or proceed directly to an emergency department.” However, in cases where an illness doesn’t seem that critical, Squires said parents can sometimes take advantage of a primary care provider’s after-hours urgent care clinic if that clinic offers pediatric treatment. For families who do not have a primary care provider or whose primary care clinics are closed, provinces and hospitals offer online and telephone screening and consultation services. For example, people in Quebec can call 811 to describe their symptoms, get advice on the most appropriate care options and make an appointment over the phone. Ontario offers a similar service in Telehealth. Some children’s hospitals, such as CHEO and McMaster Children’s Hospital, offer a telephone triage service that allows parents to speak to a nurse or doctor in an emergency…
