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It feels like everyone is getting sick right now. Hospitals are struggling with what the Canadian Medical Association called an “avalanche of patients,” and many of you have questions about what’s causing the illness and what to do about it.

The Globe’s health reporter Carly Weeks joined The Decibel podcast to explain how this year’s respiratory virus season is shaping up, answering reader questions about COVID-19, RSV, the flu, and more.

(To listen to the episode, find it on the podcast player of your choice using this link.)

How would you describe this virus season that we’re having?

We’re right in the thick of it in respiratory virus season, we see this every year. What’s really different is that for the past few years, it’s really been unusual. I don’t have to remind people that we’ve just been through a pandemic and according to who you ask, we’re kind of still going through it. That’s because COVID-19 is not yet at a predictable enough place to really say that it’s a seasonal virus, like the flu, and that can complicate things. There were a few really quiet years when a lot of people were at home, masking, and things were closed down because COVID-19 was top of mind, so flu numbers were down. Last year, we saw numbers come back in a huge way. This year, there are a lot of regions in the country that have had a really hard time, or are having a hard time currently.

No matter where you look, there are pockets of the country that are really seeing a lot of sick patients coming in and the health care system is seriously under strain. But at the same time, the overall numbers themselves don’t look as though they’re beyond the scope of what you might see in a say, a very bad flu year. But the important context is that our health care system is already at or over capacity. So adding any sort of regular flu season on top of that, let alone a bad one is going to have a great impact.

Where are we seeing cold, flu and RSV season the worst?

If you look across the country, there are various regions that are seeing different things. A few weeks ago, I was speaking to officials and clinicians in Alberta and they were getting absolutely hammered by the flu. They were seeing lots of people getting admitted, including children. In Ontario, they were seeing higher numbers of RSV. This week, we’re hearing from B.C. health officials that they’re basically in a state of crisis because of flu numbers and other respiratory viruses going around. Quebec has seen really, really high numbers and a health care system that is barely functioning. As one region peaks and starts to decline, another region is seeing a huge increase. That’s just how virus is spread, right? It’s not going to be all at once.

This is likely a warning to the rest of the country. If you haven’t seen really bad numbers, or if you’re in a province where cases aren’t yet at their peak, they likely will start to peak.

What’s the difference between RSV, COVID-19 and flu? And how would you know if you have one versus the other?

They’re all common respiratory viruses that get spread around. The virus likely enters through the upper respiratory tract when someone coughs or sneezes nearby.

The difference between them can be a bit hard to distinguish. You can typically tell if it’s the flu based on how severely impacted you are, as it’s more severe than the common cold. The flu symptoms are more extreme – you have a high fever, you’re totally aching, lots of fatigue.

RSV is another very common virus that essentially everyone gets by the time they’re age two, and then you can get reinfected with it. For most people it basically is a common cold: coughing, sneezing. But it can be very serious for young children, particularly those two and under, especially six months and younger or older adults.

COVID-19 is a bit of a different beast, it’s continuously shifting, and it’s not yet very predictable. The symptoms can look like common cold in some people, there’s still things like the loss of sense of taste and smell. What we’re hearing from a lot of people now is that the symptoms may not look the same person to person, it’s a very tricky thing to tell. Unless you’re in an emergency room and a doctor’s ordering a panel of tests, you may not know what you have.

Are we seeing higher numbers of illness now that COVID-19 is in the mix?

It’s hard to say without a really deep, well researched study if we are seeing more people getting sick more often. I think it is fair to say that we have been through a very unusual period, and we’re not necessarily out of it yet. So when you do have an extra virus added into the mix, it has certainly had a big impact.

According to the most recent federal data, there are nearly 5,000 patients with COVID-19, who are currently in hospital right now across the country. So having that extra virus, on top of our other seasonal viruses, is certainly adding to the challenge.

Do we have reduced immunity because we didn’t really get sick during the pandemic?

There was this idea going around, that has largely been debunked, that because we weren’t sick for so long we’re now more at risk from illness. Really what’s happened is that people who didn’t necessarily get impacted by illness for a couple of years just started getting sick again when we started mixing again, and illnesses started going around.

Are illnesses lasting longer right now?

Anecdotally, a lot of people are getting sick, and a lot of people are getting sick with numerous things. Whether or not people are getting sick for longer periods, is a bigger question. What experts would say is that because there are so many viruses going around and a lot of people who are at risk – maybe they haven’t been vaccinated, maybe they’re in close contact with people they haven’t seen in some time – they’re likely getting a couple of different things.

We know that viruses like COVID-19 can lead to longer lasting symptoms in some people, feeling unwell for weeks on end. I think it’s fair to say that people are going to be experiencing more illness in the coming weeks before things start to settle down.

Are we seeing data about flu numbers and kids across the country?

We actually don’t know what’s going on with flu deaths in children across the country. This is highly unusual because every year the Public Health Agency of Canada collects this information and published it weekly, as part of the Public Health Agency of Canada’s flu watch program. This is the first year in decades that that data has not been made available during the respiratory virus season.

We discovered after a lot of reporting on this that the Public Health Agency of Canada switched service providers on who is collecting that data. For whatever reason, that data has not been made available.

So this is a huge black hole that can really compromise the ability of clinicians and health policy experts from mounting a response in real time or giving a warning signal to the rest of the country as to what might be coming their way.

What kind of impact are all of these illnesses having on our public health care system?

It’s been a very challenging few years for health care in Canada, and the hospitals are struggling across the country. You add in a respiratory virus season and there are patients who are in hallways, elective procedures are being cancelled or postponed, children are waiting unacceptable amounts of time. It’s a very difficult period right now in health care.

Should we be paying attention to new COVID-19 variants these days?

The sub variants remain vitally important. JN1, which is a sub variant of Omicron, is kind of similar in a sense to Omicron, in that it is infecting a lot of people and has quickly – within a matter of weeks – become the dominant COVID-19 variant spreading in Canada.

There are researchers and clinicians who are studying variants all the time and it’s vital that they do so because we need to continue to understand where this virus is heading, how it’s changing.

So far, there’s nothing to suggest that we’re in a much different, more severe place with JN1. It just continues to be something that we need to respond to and probably should be taking more protective actions against in just in terms of getting vaccinated and staying home when sick.

How accurate are rapid tests in detecting these new strains of COVID-19?

There’s a number of clinicians and experts who have seen – and a lot of us anecdotally have seen – that the test effectiveness seems to have gone down. Experts say they’re likely not as sensitive any more, because the variants that are in circulation are looking a lot different than the variants that the tests were designed to look for.

At the same time, there was a recent report out from Global News suggesting that the company producing the tests actually edited some of the results to make the tests look more sensitive than they were.

But if you have those respiratory virus symptoms, and you think you have COVID-19, and you test negative, test again. If those symptoms persist, just act as though you do have COVID-19 or another contagious virus. You don’t want to be heading out to a large family gathering if you have the flu, or COVID-19.

How well are the COVID-19 vaccines matched to the variants that are in circulation now?

The vaccines that are currently available are actually a pretty good match for the sub variant that is in circulation. The latest vaccine approved by Health Canada was designed to protect against a sub variant that was in circulation in early 2023. Now there’s a new sub variant on the scene – JN1 for instance. But all of these variants are sub variants of Omicron. They’re close enough relatives that you’re going to get good enough protection from them.

It may not be 100 per cent, you may still even get some symptoms if you’re infected with COVID-19. But you’re not going to get severely ill, there’s less chance of spreading it, there’s less chance of severe outcomes, which is better, especially for those individuals who are at heightened risk of severe outcomes.

Are people still getting vaccinated?

The most current data from the federal government suggests that only around 15 per cent of the population received a booster this fall. So essentially, the vast majority of the population has little protection against the COVID-19 sub variants that are in circulation. So when you hear a lot of people saying they’re infected with COVID-19, that’s likely one of the reasons why. There’s a very contagious sub variant out there. And almost no one has been vaccinated against it.

Public confidence in booster shots started to decline. Part of that is vaccine fatigue, COVID-19 fatigue. Part of it is also maybe lack of access, there’s not as many mass vaccination clinics. Part of it is also that lack of confidence. There’s so much information out there now, on questioning the vaccine. You’ve seen, legitimate health authorities in places like the United States actually saying it doesn’t work.

These vaccines do work. And I think there’s a there’s a challenge here that we need to answer with lack of confidence.

How effective is the flu shot? Are people getting it?

The flu shot has been available every year, and every year the vaccination numbers are pretty low. We don’t have numbers for across the country yet. If you look at Alberta, a place that does give out a lot of data, the numbers there are quite low. Overall, less than one in four people have been vaccinated. It’s the older age groups (60 plus) that have the highest vaccination rates. People in the younger age categories, even at risk children, the vaccination numbers are very low, even in the single digits.

Some years the flu shot is not as good a match, this year is actually a really good match. The dominant strain of the flu going around is H1N1, and one of the strains that this year’s flu shot protects against is H1N1. So if you’re going to get vaccinated for the flu, this is a great year to do so because we know that there’s a really good match there.

This interview was taken from a transcript of The Decibel podcast, and has been edited and condensed for clarity.

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