Hospitals prepare for the holidays with surge clinics and second ICUs

With primary care shortages, pandemic backlogs and widespread respiratory illnesses putting intense pressure on hospitals across Canada, physicians and health leaders say they are adapting their operations to ensure the system is there for those who need it as the busy holidays approach.

BC Children’s Hospital in Vancouver is one of several pediatric institutions that have opened pop-up clinics in recent weeks to contend with the overwhelming numbers of children with respiratory infections coming to emergency rooms. David Goldfarb, a medical microbiologist and pediatric infectious disease physician at the hospital, said its surge clinic is seeing a lot of patients who don’t have access to primary care or can’t get appointments for several days or weeks.

“With acute respiratory illness, there is a tight time frame if you’re going to be assessed. And, if you need medications or other interventions, you need to be seen in a fairly short window,” Dr. Goldfarb said. “We don’t have a lot of capacity in our primary care system to have kids be seen in that window when they should be seen.”

Ontario has retooled its more than 80 COVID-19 assessment centres to deal with other types of respiratory illnesses as well. Now, people of any age can go to those centres to get rapid tests for COVID-19 and influenza. They can receive prescriptions for Tamiflu, an antiviral used to treat the flu.

“We’re going all out to try to ensure that we maintain an assessment capacity,” Ontario Chief Medical Officer of Health Kieran Moore said in an interview on Thursday.

The Children’s Hospital at London Health Sciences Centre, in London, Ont., is increasing capacity by opening a second intensive care unit. It should be up and running in the next few days, Rod Lim, medical director of the hospital’s pediatric emergency department, told reporters on Thursday.

London Health Sciences has also asked anyone in the organization with pediatric experience to redeploy voluntarily to the pediatric emergency department, he said. The centre is delaying pediatric surgeries that require admission to the hospital.

Dr. Lim said Ontario should follow British Columbia’s lead and publicly release the number of children who have died from influenza. In a news release last week, the B.C. government said it was aware of six such deaths in the province this season.

“That information can be useful to encourage people to listen to public health advice,” Dr. Lim said.

Theresa Tam, the country’s Chief Public Health Officer, said in a briefing this week that pediatric influenza hospitalizations remain a concern, especially among children under five.

Dr. Tam also warned of a potential uptick in COVID-19 in the new year. Genetic sequencing data in recent weeks have shown a continued increase in the prevalence of immune-evasive COVID-19 variants, particularly BQ. 1 and BQ. 1.1, as variants of the previously dominant BA. 5 lineage decline, she said. This suggests, at minimum, Canada could see a slower decline and higher plateau in the number of infections and hospitalizations than in previous surges, she added.

But Dr. Moore noted there could be some hope for a reprieve, with new national data suggesting the influenza season may have peaked in Canada. The latest flu report from the Public Health Agency of Canada, which covers the week ending Dec. 11, shows that the test positivity rate for the flu is starting to decline, he said. (Test positivity provides a good sense of viral spread in communities by looking at the proportion of confirmed infections in people who seek help for respiratory symptoms.) In Ontario, for instance, the highest test positivity rate for the flu was roughly two weeks ago, at 16 per cent. As of Dec. 11, test positivity had fallen to about 13 per cent, Dr. Moore said.

“To me, that is a good trend,” he added.

National data show that respiratory syncytial virus, or RSV, may also have peaked. The virus was a top concern among pediatric physicians earlier in the season.

David Pichora, president and chief executive of Kingston Health Sciences Centre, in Kingston, Ont., said the hospital’s pediatric ICU, which typically accommodates six patients, recently had to expand to 10 as a result of the surge of viruses. The hospital was able to do this by moving adult patients into a flex space that is kept open for such situations. But this is the first time the hospital has had to move adult patients to accommodate children, he said.

Many who work in health care, both on the pediatric and adult sides, describe the past few months as unprecedented. There have been huge numbers of patients, they say, and a constant need to find on-the-spot solutions to ensure people continue to receive care.

“It’s a tough slog, I think, if you talk to anyone across the country,” said Sam Wong, director of medical affairs with the Canadian Paediatric Society. “I’ve gone through a lot of RSV and influenza outbreaks, but I’ve never seen anything like this.”

Even in parts of Canada as remote as Nunavut, health officials are pleading with residents to take precautions over the holidays, including by keeping gatherings small, staying home when sick and getting vaccinated against the flu and COVID-19.

Concern is particularly high in the territory because of holiday staff shortages at local health centres, the only sources of medical care in Nunavut’s fly-in communities. The territory has managed to recruit enough temporary nurses and paramedics to keep more health centres open over the winter break than originally expected.

“Our system across Nunavut is fragile right now,” Nunavut Health Minister John Main told reporters Thursday.

With reports from Wency Leung, Karen Howlett and Kelly Grant