Similar increases are being reported at hospitals across Canada. While no other province releases as much respiratory disease data, experts say Ontario’s figures help paint a clearer picture of the extent of the problem nationally. The number of children ages five to 17 who visited emergency hospitals with respiratory problems last week was more than triple the average for the season, according to Ontario’s Acute Care Enhanced Surveillance (ACES). database. For children up to age four, daily ER visits for respiratory illnesses during the same period were more than double the usual number, ACES showed Wednesday. Combining the two age groups, it means about 2,160 children visited ERs each day for respiratory illnesses in the province last week, a time of year when that number historically averages about 800. The trend is occurring at comparable rates across Ontario and, in some cases, is putting hospitals under such pressure that they’ve had to cancel surgeries or divert patients. Medical experts have linked the rise in illnesses among children to the withdrawal of preventive public health measures, such as wearing masks, that have been in place since the start of the COVID-19 pandemic.
“Immunity is not where it used to be”
Without distancing and mask orders, children are exposed to more germs. And because of public health measures, these germs are those to which children’s immune systems have had little recent exposure, such as rhinovirus, enterovirus, and respiratory syncytial virus (RSV). This means that the viruses that usually give children a common cold are opposites riding an autumnal wave of ER visits and hospitalizations. “Part of the complexity right now is that there are a lot more diseases that are spreading because of changes in our public health mandates,” said Dr. Charmaine van Schaik, a pediatrician and chief of staff at Southlake Regional Health Center in Newmarket, Ont. “At the same time, we’ve gone through two years of relatively protected environments for young children, so their immunity isn’t quite where it was.” Another contributing factor some doctors report: lower-than-normal availability of acetaminophen and ibuprofen for children. The intermittent shortages of children’s Tylenol and Advil; means a greater number of parents are unable to control their children’s fevers at home, prompting more to make a trip to the ER. Mask use and other public health measures against COVID-19 have helped protect children from respiratory illness during the past two cold and flu seasons. Now, children are exposed to viruses with which their immune systems have little experience. (Ryan Remiorz/The Canadian Press)
Admissions are putting pressure on hospitals
Dr. David Carr, an emergency physician who works in ERs in downtown Toronto and suburban Vaughan, Ont. and Richmond Hill, Ont., says it sees and admits a disproportionate number of children. “This is something I’m not used to,” Carr said. “Pediatric patients rarely require admission, at least compared to our adult patients,” he said. “Usually you see a kid, they have an ear infection or a sore throat, they go home.” The ACES database confirms that hospitals across Ontario are admitting an unusually high number of children for respiratory illnesses: 2.5 times the pre-pandemic average for this time of year. Dr. Joe Wiley, chief of pediatrics at Oak Valley Health in Markham, Ont., describes the number of children coming to the hospital with respiratory illnesses as unprecedented. “It’s much higher volumes and much earlier in the typical cough and cold season than I’ve ever experienced,” Wiley said in an interview at Markham Stouffville Hospital. Dr. Joe Wiley is chief of pediatrics at Oak Valley Health, which includes Markham Stouffville Hospital in Markham, Ont. (Dean Gariepy/CBC) “We’re definitely seeing an increased number of admissions,” Wiley said. “We are under pressure here and from talking to colleagues at other hospitals, I know they are experiencing similar pressures.” The increase in sick children is affecting hospital operations across Ontario.
McMaster Children’s Hospital in Hamilton is preparing to transfer teenagers to adult hospitals and reduce scheduled surgeries because of the “extreme challenges” in the emergency department, intensive care and nursing wards, according to a memo from hospital leadership last Friday. The University Health Network in Toronto notified staff last Thursday that Toronto General Hospital’s emergency department was at capacity and urged doctors to refer patients to other emergency departments and specialty clinics. CHEO, the children’s hospital in Ottawabegan canceling some scheduled surgeries and reallocating staff last week amid what its CEO described as “an unprecedented increase in demand” in the emergency room.
ERs are already thinned out
The spate of illnesses among children this fall comes at a time when hospitals have been grappling with staffing challenges for months. Meanwhile, many in the system expect to see an increase in flu and COVID-19 cases in the coming weeks as colder weather keeps people indoors, making it easier for infectious diseases to spread. WATCHES | Respiratory diseases are increasing in children:
New data reveals extent of ER growth at children’s hospital
Children’s hospitals in parts of Canada continue to face an unprecedented increase in ER visits and admissions due to the huge increase in respiratory illnesses among children. In Ontario, children aged five to 17 go to the ER with respiratory problems at more than three times the seasonal average. Emergency departments have been under constant pressure for months, with large numbers of admitted patients stuck in the ER because there are no beds available for them in hospital wards, said Anthony Dale, CEO of the Ontario Hospital Association. This translates to longer than normal ER wait times for people whose cases are less urgent and ambulance shortages as paramedics spend hours waiting to unload their patients. “This is a very, very difficult and ongoing challenging situation in Ontario hospitals,” Dale said in an interview. In other provinces:
The Montreal Children’s Hospital had more than twice as many patients as beds occupying its emergency room Wednesday morning, according to publicly released wait time data. The hospital is seeing “an unprecedented number of children coming to the emergency department and higher volumes of sicker children, many with respiratory illnesses,” medical director Dr. Lori Plotnick said in an interview last week. Overall emergency room visits at BC Children’s Hospital in Vancouver are 20% above normal for this time of year, a spokesperson for the Provincial Health Services Authority said in an email. Atlantic Canada’s premier children’s hospital, IWK Health Center in Halifax, is seeing a sharp increase in the number of children coming to the emergency room and being admitted for respiratory infections, according to its chief of pediatrics. he told CBC Nova Scotia on Monday. Winnipeg’s Children’s Hospital is seeing a spike in the number of children admitted to hospital with respiratory problems
