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The “triple threat” of a bad flu season, COVID-19 and the resurgence of a childhood viral illness is putting a strain on the health system, Ontario’s top doctor said Wednesday, with a decision on masking recommendations possibly coming in a couple of weeks.

Dr. Kieran Moore has said if COVID-19 starts affecting the ability to reduce the surgical backlog he would suggest the government make a recommendation on masking in certain indoor settings, and if there are further effects he would recommend reinstating mask mandates.

Some public health experts, such as former COVID-19 science advisory table head Dr. Fahad Razak, have said Ontario is already at the point of needing mask mandates again.

Many hospitals across the province, both smaller ones in rural areas and large ones in cities, have been overwhelmed with patients, reporting large volumes and long waits.

Emergency departments have closed periodically – a trend that first began in the summer largely due to nursing staff shortages. Children’s hospitals in Ottawa, Toronto and Hamilton have reported unprecedented surges of pediatric patients, many coming in with respiratory illnesses.

Moore said he is monitoring COVID-19 indicators, ICU occupancy, and even flu activity in weighing his decision on masks. This year’s dominant flu strain is particularly virulent, he said.

“It does cause high hospitalization rates and morbidity,” Moore said. “On a normal season we see 12,000 Canadians admitted to hospital … that may be higher with (this strain).”

Flu shots are now available to people in Ontario aged six months and older, and Moore is urging everyone to get them as soon as possible because they don’t take effect until 10 to 14 days postvaccination, and that is about when flu activity will really start to pick up.

“We really do have a couple of weeks to maximize the benefit of the influenza vaccine,” Moore said.

“It’s pointless getting vaccinated after the epidemic is over. You really want to protect as many Ontarians as possible in advance of the rise in risk and really, these next two weeks are key to protecting as many Ontarians as we can.”

Moore said the influenza test positivity rate is expected to rise about five per cent this week, and if there are two weeks at that level the virus will spread more dramatically, so he will let Ontarians know at that point whether more people should be masking.

There are already 18 Ontarians in ICU because of the flu, with eight on ventilators, Moore said. There are 1,796 people in hospital with COVID-19, with 138 in ICU and 52 on ventilators, he said. As well, respiratory syncytial virus, or RSV, is returning to pre-pandemic levels, with the season even starting a bit early, Moore said.

People who are particularly vulnerable to respiratory viruses should definitely be masking now, Moore said.

“We strongly recommend as we head in with this triple threat, that anyone susceptible to this virus with the underlying illness or older members of our community, as you go indoors, please, we’re asking you to mask up,” he said.

Vaccination is also key, Moore said, and urged all Ontarians to get their COVID-19 booster shots as well as flu shots. It is safe and effective to receive both at the same time, he said.

Immunity from COVID-19 vaccines wanes after about six months, he said. And the Omicron subvariants BQ. 1 and BQ. 1.1 are “becoming a dominant strain” in Ontario.

Public Health Ontario has said the BQ subvariants are growing twice as quickly as the BA. 5 strain and have a high risk potential for transmissibility, reinfection and lowered vaccine effectiveness.

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