As flu season approaches in Canada, officials at children’s hospitals across the country say they are “gravely worried” about how an influx of children with influenza, COVID-19 or other viruses could exacerbate challenges within an already overburdened health system.
Over the last several months, children’s hospitals in many major centres across Canada have been under considerable strain, with higher volumes of young patients pouring into pediatric hospitals that are dealing also with acute staffing and bed shortages.
At CHEO in Ottawa, the intensive care unit has been significantly busy for much of the last two weeks and medical in-patient units are currently at 124 per cent capacity, according to a hospital statement.
The emergency department is also facing significant strain. The last six months have been the busiest period ever for the emergency department, the hospital says, and on Monday, the ER saw 61 more patients than it was built to accommodate, forcing sick children to wait for many hours for care.
“We’re really seeing an influx of respiratory illnesses that are getting admitted to the hospital as well as to our intensive care units,” said Tammy DeGiovanni, CHEO’s senior vice-president of clinical services.
The same is true at the Children’s Hospital at London Health Sciences Centre, which has also been seeing significant influxes of sick kids in recent weeks and months, said Dr. Rodrick Lim, medical director and section head of the hospital’s pediatric emergency department.
“It’s definitely not business like usual. It’s extremely challenging,” he said.
“The volumes and the acuity and the juggling that is necessary in order to try to see people in care spaces has been extremely distressing.”
Like many hospitals and critical care centres across Canada, both of these Ontario hospitals have been trying to cope with significant staffing shortages, especially nurses, which means fewer health practitioners are available to care for higher volumes of patients.
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Now, with flu season fast approaching, front-line health workers already experiencing burnout from what they call a staffing “crisis” across the country are now bracing for an even more challenging fall and winter.
“We’re really worried that the combination of (capacity issues) plus other respiratory viruses that have the same timing, whether that’s RSV (Respiratory syncytial virus) or COVID or parainfluenza,” Lim said.
“It’s going to be a little bit of a perfect storm in terms of having so much acuity at once.”
Over the last two years, Canada’s flu season was almost non-existent, which health experts attribute to COVID-19 public health measures that were mandatory in most of Canada during the height of the pandemic.
But this year, that trend is expected to reverse.
Earlier this year in Australia, whose flu season is often used by experts to predict what could happen in Canada, there was a significant rise in flu cases which peaked earlier than usual after two years of almost none.
Children up to 19 years old suffered the highest rates of flu, according to data from Australia’s health department.
Seeing those trends emerge from the Southern hemisphere prompted CHEO to start planning for a busy flu season in Ontario, including opening “Kids Come First” health clinics for lower-acuity patients to divert them from ERs, as well as beefing up staffing as much as possible.
At the Alberta Children’s Hospital, in addition to a push to recruit much-needed health-care workers, staffing schedules are being adjusted to ensure more physicians and nurses are working at peak times, such as at night. It is being done in anticipation of a busy flu season, said Dr. Antonia Stang, department head for pediatrics for the hospital’s Calgary Zone.
A new mental health centre is also slated to open soon that will offer an alternative to the increasing number of youth in need of mental health care since the onset of the pandemic, Stang said.
“It’s really important that we have those kind of extra things so that patients go to the right places and don’t need to go to the emergency department when they can go somewhere else to access care.”
An additional concern for pediatric hospitals going into the flu season this year is a nation-wide shortage of children’s pain medication, such as Tylenol and Advil.
When their children spike a fever overnight, parents are now more likely to rush to the nearest ER for help without access to these meds, leading to even higher volumes in pediatric emergency departments.
When asked about this Tuesday, Canada’s chief medical health officer, Dr. Theresa Tam, urged parents to get their children vaccinated ahead of flu season to avoid needing these medications.
“Prevention is key and getting up-to-date with vaccination is one way of preventing certain respiratory infections,” she told a committee of MPs.
Stang says parents don’t need to seek emergency care for a fever if a child is otherwise well, as a fever alone is not cause for alarm.
“We treat it to provide comfort and there are other ways you can provide comfort at home,” she said, suggesting fluids, hugs and moderating the temperature of the child’s home.
Going to an ER won’t provide faster or easier access to these pain medications, Stang added.
Meanwhile, as they prepare for what is expected to be a busy flu season coming on the heels of an unusually strenuous summer due to a recent wave of COVID-19, health practitioners say long-term solutions are needed to address the significant strains within the health system.
Those solutions must include increased capacity in hospitals and better access to family doctors and primary care to ensure patients have alternatives to ERs, Lim said.
“I think all the people that are working are stating unequivocally this is the worst that we’ve ever seen our health-care system in. And we are gravely worried about this upcoming fall winter.”
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