Coming down from the height of the COVID-19 pandemic, children’s hospitals across Canada are struggling to handle a new surge of young patients with viral infections in what pediatric health-care workers are calling their version of 2020.
Pediatric health-care professionals warn most children’s hospitals are operating at or over 100 per cent occupancy, that emergency room wait times can be up to 24 hours and that some non-emergency surgeries are already being delayed.
One germ in particular, respiratory syncytial virus (RSV), has especially stretched hospitals’ limits. RSV is a common childhood respiratory infection that normally results in cold-like symptoms which clear up after a week or two, according to the U.S. Centers for Disease Control and Prevention (CDC).
However, the Public Health Agency of Canada (PHAC) warns severe cases of RSV may lead to hospitalization. RSV can also cause secondary bacterial infections, such as pneumonia. There is no vaccine for RSV nor any medication that clears up an infection, so care is normally centred on treating symptoms and secondary infections.
While RSV infections normally peak in December and January, PHAC’s Oct. 29 Respiratory Virus Report warns the number of both RSV and Influenza A cases is “above expected levels for this time of year.” So far, the agency has detected 1,045 cases of RSV, with a seven per cent positivity rate.
Some health-care professionals attribute the spike in RSV infections to the fact that physical distancing and public health restrictions during the pandemic kept children from being infected with the virus for two years, so their immune systems have less experience fighting it now that those restrictions have lifted.
Dr. Robert Barnes, associate director of professional services at the Montreal Children’s Hospital, said that while the viral surge is affecting all pediatric age groups, the youngest children seem to be bearing the brunt of it.
“We have a huge amount of our very young children in the community who did not get so much of a turn with these viruses last winter or even the winter before that,” Barnes told CTVNews.ca on Wednesday. “So the virus is spreading much more, and much faster among our young people.”
Meanwhile, hospitals across Canada have already surpassed their emergency room and in-patient capacity levels and are struggling with long wait times.
When her asthmatic three-year-old James Pinter fell ill on Oct. 17 with a fever, cough, congestion and lethargy, Calgary mother Michelle Maguire decided he needed to see a doctor. Her first choice, Alberta Children’s Hospital, listed 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,” she told CTVNews.ca in a phone interview on Wednesday. “But the doctor we saw at the hospital did let us know that basically every child they’re seeing is presenting with RSV symptoms.”
James was diagnosed with RSV and released that day to recover at home. Maguire said he’s feeling much better, but that it was the most severe illness her eldest child has had.
A NATIONAL PROBLEM
Emily Gruenwoldt, president and CEO of Children’s Healthcare Canada, said conversations like the one Maguire had with the doctor at Rockyview General Hospital are happening in hospitals throughout Canada right now.
“Across the country, almost without exception, our children’s hospitals are all running at 100 percent occupancy or more,” Gruenwoldt told CTVNews.ca in a phone interview on Thursday.
Part of what’s driving high occupancy rates, she said, is the ongoing shortage of children’s Advil and Tylenol throughout the country.
“Parents are seeing their little ones not feeling the best, maybe struggling with high fever, body aches and headaches and they’re trying to control those symptoms at home,” Gruenwoldt said.
When they can’t find what they need to treat those symptoms on pharmacy shelves, she said they often turn to hospital emergency departments.
Gruenwoldt said CHU Sainte-Justine, in Montreal, was running at 300 per cent occupancy this week and that, as of Thursday morning, the Children’s Hospital of Eastern Ontario’s (CHEO) pediatric ICU was running at 200 per cent.
HSC Children’s, in Winnipeg, Manitoba, reported on Oct. 27 that its emergency department saw an average of 139.5 patients per day in September, an increase of almost 11 per cent year-over-year.
In an interview with CTV News Channel on Wednesday, Bruce Squires, president of McMaster Children’s Hospital, said the hospital’s in-patient occupancy was approaching 135 per cent.
“As our teams work to respond to that level of demand, we’ve had to open a significant number of additional 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 spike” of 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 all at the same time and it’s resulted in, for us at McMaster Children’s, unprecedented numbers of kids presenting to our emergency department,” he said, as well as “unprecedented numbers who require either an inpatient ward admission or, in some cases, an admission to our critical care units.”
Staff are facing a similar situation at Montreal Children’s Hospital, where Barnes works. The hospital saw an emergency room occupancy rate of 193 per cent Tuesday night, up from an average occupancy rate of 113 percent around the same time in 2019. The hospital’s ICU is at approximately 115 per cent occupancy while the medical unit is operating at about 106 per cent.
According to staff at the hospital, emergency room wait times for the hospital’s least critical visitors are between 18 and 24 hours.
Diane Piques took her eight-year-old daughter, Chloe Santangeli, to the hospital on Oct. 8. Chloe, who has asthma, seemed to have a viral infection and was struggling to breathe. She was diagnosed with RSV and pneumonia and admitted overnight so she could receive IV antibiotics and supplemental oxygen. Chloe is slowly recovering, but Piques is haunted by the experience, and by how many other children on her daughter’s floor of the hospital seemed to be struggling with the same illness.
“The whole floor she was on had either pneumonia or had the virus,” she told CTVNews.ca in a phone interview on Wednesday. “The doctor that saw her said she’s never seen a rise like this, ever.”
Barnes said the hospital doesn’t reserve floors for specific illnesses, but that he isn’t surprised it seemed that way to Piques.
“There is not a dedicated RSV or pneumonia floor,” he said. “However, we are so overwhelmed that it would not surprise me if just about every patient on a particular floor might have that problem.”
The hospital has added more beds for admissions than it would normally need for this time of year, and Barnes said those admissions have begun to displace resources for other areas, like surgery.
“It has had an impact on our ability to carry out our surgical schedule for those children who need an operation, or who need a hospital bed or ICU bed folowing a surgery,” Barnes said.
As a result, some patients who have waited weeks or months for surgery may need to wait a little longer. Fortunately, Barnes said, the hospital has not had to postpone emergency operations or surgical procedures related to cancer.
To manage the influx of admissions, Cindy McCartney, associate director of nursing, said the hospital has leaned heavily on staff to work voluntary overtime. She compared the experience of children’s hospitals right now to the experiences of general hospitals throughout the COVID-19 pandemic.
“I think everyone is tired,” she told CTVNews.ca on Wednesday. “I think that the adult health-care system had a really difficult time during COVID, and this is like our COVID, and the demand on our staff is very high.”
Gruenwoldt made the same comparison.
“It feels like this is our 2020 moment,” she said. “In 2020, when the pandemic emerged, we saw unacceptable levels of care and outcomes for our seniors populations. Now, we’re seeing the same for our children.”
HOW PARENTS CAN HELP
Gruenwoldt believes it falls 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 face public health crises.
However, she, Squires, Barnes and McCartney all agreed that for now, there are steps parents can take to make sure they’re using the appropriate health-care services in order to preserve hospital capacity for children who need it most.
“It is helpful to review your options when you have some concerns about your child’s health,” Squires said. “Certainly, in an emergency situation, make sure you do call 911 or proceed directly to an emergency department.”
However, in cases where an illness doesn’t seem as critical, Squires said parents can sometimes take advantage of their primary care provider’s emergency after-hours clinic, if that clinic offers pediatric treatment.
For families who don’t have a primary care provider, or whose primary care clinics are closed, provinces and hospitals offer online and telephone triage and consultation services. For example, people in Quebec can call 811 to describe their symptoms, receive advice about the most appropriate care options and book appointments over the phone. Ontario offers a similar service in Telehealth.
Some children’s hospitals offer a telephone triage service that allows parents to speak with a nurse practitioner or physician in the emergency department who can help determine a child’s care needs before a family has left their home.
Finally, Gruenwoldt encouraged parents to make sure they and their children are up-to-date on all their routine immunizations and COVID-19 vaccines, to help reduce overall strain on the health-care system.
“Even before they get sick, we encourage parents to get their kids caught up on routine immunizations, and make sure they’ve got their flu vaccine and their COVID boosters to set them up for success,” she said.
With files from CTVNews.ca producer Jennifer Ferreira, CTVNews.ca writer, producer Olivia Bowden, CTV National News correspondent Heather Wright and CTVNews.ca writer Daniel Otis.