Respiratory illness, dropped masks, worker shortage, factors in kids' hospital waits

Ontario children's hospitals are reporting longer-than-usual wait times as providers see rising rates of respiratory illness amid dropped public health measures and ongoing worker shortages, and experts say the situation could worsen as cold and flu season ramps up.

Toronto's Hospital for Sick Children warned patients this week to prepare for unusually long wait times at its emergency room. A week earlier, the Children's Hospital of Eastern Ontario in Ottawa shared a similar message, advising people to bring snacks, blankets and toys to help the time pass comfortably.

McMaster Children's Hospital in Hamilton is also seeing long wait times, sometimes "in excess of 24 hours in the emergency department," amid a fall surge in illnesses that's occurred "much earlier than in previous years," said a spokeswoman for Hamilton Health Sciences, which runs the hospital. Wendy Stewart said September saw a "historic high" of 120 per cent occupancy for pediatric beds.

Dr. Anna Banerji, a pediatric infectious disease specialist at the University of Toronto, said Thursday that while she can't speak to the situation at specific hospitals, she and her colleagues have seen "a lot" of respiratory illness since children returned to school in Ontario with essentially no public health measures in place.

She said the rise in respiratory illnesses – including influenza, COVID-19 and RSV – and related hospitalizations was "completely expected" with mask mandates dropped in schools and low vaccination rates among children. She said she expects more children will fall ill during the upcoming flu and cold season.

"This is the beginning," Banerji said by phone. "I think it's going to be a very bad respiratory season, because normally we don't have so many respiratory admissions or visitations so early in the year."

It's not clear how many children have been hospitalized due to COVID-19, Banerji said, due to a lack of data now that gold-standard PCR tests aren't being used to regularly test for the virus. In some cases, she said, children's asthma or other conditions may have been triggered by a COVID-19 infection, and they do not test positive when arriving in the hospital.

An ongoing shortage of children's pain and fever medication – such as Tylenol and Advil – may also be a factor behind long wait times, Banerji added, as some parents may be bringing their children to the emergency room when fevers are not manageable at home.

Dr. Katharine Smart, who has a pediatric practice and works at a community hospital in Whitehorse, said she's also observed an uptick in kids sick with respiratory illnesses.

Smart, a past president of the Canadian Medical Association, said she's heard similar reports from colleagues across the country, as children's hospitals see "unprecedented volumes" of visits to emergency departments while viral illnesses circulate in greater numbers than what's typical of the current season. 

"We're seeing volumes that are really typical more of winter, of peak viral season," she said. The phenomenon is partly due to people gathering in larger numbers with fewer public health protections, and children being exposed to more viruses they had been shielded from when more pandemic restrictions were in place.

The possibility of worsening patient volumes as flu season approaches is a "real concern," she added, noting that the effect of a potential future COVID-19 wave is unknown with hospitals already struggling to keep up. 

"It's really worrisome in terms of, how are we going to cope with more volume if these numbers continue to escalate getting into the fall and winter, which is traditionally our very busy time, and we're already seeing numbers that we've never really seen before," she said. 

Stewart of Hamilton Health Sciences said the children's hospital is "concerned about the fall and winter months" given the current surge in viral illnesses. She said Ontario children's hospitals are working with the government on a plan to deal with the viral season.

The Children's Hospital of Eastern Ontario didn't provide comment to The Canadian Press on Thursday, though president Alex Munter spoke about the current strain on his hospital in testimony at a standing committee on health meeting focused on children's health last week. Last month was the busiest September on record since the Ottawa hospital opened decades ago, he told federal MPs. 

The long wait times are partly due to the high number of patients with respiratory illnesses, including COVID-19, he said, as well as a shortage of health-care workers that hospitals across the country are contending with. Children are being transferred to the hospital from faraway communities due to a lack of beds in facilities near their homes, he added.

The high number of admissions and related bed shortage has led to cancelled surgeries and diagnostic procedures, Munter said –  delays he argued can have lifelong effects.

"It could affect, and it will affect for many, the entire trajectory of their lives," he said.

Bruce Squires, president of McMaster Children's Hospital, also spoke to the committee about growing surgical wait-lists due to a lack of beds, and said some children in Hamilton were being transferred as far as Ottawa because no intensive care beds were available.

Smart noted that long wait times for surgical, diagnostic and mental health needs also contribute to strain on hospitals as children who are "deteriorating in the community" eventually present at emergency departments for care.

Munter and others in children's health care called on the federal committee last week to back a national child and youth health strategy.

Banerji said people should wear masks and get vaccinated to blunt the effect of the current waves of disease, and urged people to keep their kids home when sick.