Some of the largest pediatric hospitals across the country are being overwhelmed by an unprecedented surge in sick children, forcing them to keep families waiting for hours in emergency departments, cancel surgeries and transfer some teens to adult facilities.
An unusually early upswing in respiratory syncytial virus (RSV) infections is partly to blame. But other problems – including the inability of many families to find primary care providers and a shortage of over-the-counter fever and pain medication for infants and children – are adding to the crisis.
With emergency rooms seeing far more seriously ill children than normal and pediatric in-patient and intensive-care units at or near capacity, doctors say they are unsure how the health care system will cope when cold and flu season hits its peak in the next few months.
“People are pulling together and are positive about this, but there’s a limit to what we can do with the resources that we have,” said Karen Gripp, the child health medical director in the emergency department of the Children’s Hospital at the Health Sciences Centre in Winnipeg. “This winter is going to be very difficult.”
Dr. Gripp said the pediatric hospital’s emergency department was designed to see 100 patients a day, but has been treating about 180 for each of the past four days.
“Everyone is very stretched right now,” she said. “I don’t think any emergency department in Canada is unaffected.”
RSV is a very common seasonal virus, but it can cause serious infections in infants and even require hospitalization in a small number of cases. Dr. Gripp said the virus doesn’t appear to be more severe this year than in the past, but she said the volume of children being infected has changed. Some of them had not previously been exposed to RSV and other viruses as a result of pandemic protocols, such as school closures and mask mandates. Their lack of immunity partly explains the upswing in pediatric patients.
Dr. Gripp said most of the children coming to the emergency room have fevers and are having difficulty breathing, or are experiencing other issues related to respiratory viruses. And a higher proportion than normal are seriously ill.
Prior to the pandemic, she said, about 60 per cent of pediatric patients in her hospital’s emergency room were lower acuity, meaning their cases were not urgent and they could be seen by doctors outside the hospital. Now, the situation has flipped: about 60 per cent of patients are being triaged as high acuity, meaning they need urgent medical attention.
The pediatric intensive-care unit at Dr. Gripp’s hospital is also running over capacity, and the hospital is transferring some patients to the neonatal ICU, she said.
At the Children’s Hospital of Eastern Ontario in Ottawa, the ICU was operating at 160-per-cent capacity on Wednesday. While the hospital may be able to send some teenage patients to adult hospitals, the vast majority of children in the ICU are younger than two, Mona Jabbour, the hospital’s interim head of pediatrics, said in a briefing with reporters.
“We really need to do what we can to look after those children here,” Dr. Jabbour said. “We really aren’t able to send them elsewhere.”
Toronto’s Hospital for Sick Children said in a statement that it still has ICU capacity, but that a small number of ICU patients 14 and older may be transferred to adult facilities to ensure there is enough space for children who require specialized pediatric critical care. A memo this week from Ontario’s critical care command centre directed hospitals to accept pediatric ICU patients 14 and older because of widespread capacity issues.
Limited access to ICU beds has also forced SickKids to cancel some surgeries, but the hospital did not say how many.
McMaster Children’s Hospital, in Hamilton, Ont., said in a statement that it is nearing 135-per-cent in-patient occupancy, and that children are waiting longer than normal for care. The situation is so critical that the hospital is temporarily limiting pediatric surgeries requiring hospital admissions to one case a day, or less than five a week, down from the 15 a week it typically performs.
Andrew Lynk, the chair of pediatrics at the IWK Health Centre in Halifax, said the hospital has seen an increase in RSV cases in the past week, and that another cold virus has also kept staff members occupied this fall. A busy 24-hour period for IWK’s pediatric emergency department would typically mean seeing 120 children. On Thursday, the hospital saw 169 children, Dr. Lynk said. The facility is over capacity, its ICU is almost full and staffing is a challenge, as workers deal with their own illnesses and sick kids, he added.
“If you add COVID, flu and RSV all together, it’s like the perfect storm,” he said.
He would like to see a return to public-health protocols, such as wearing masks indoors, to avoid making the crisis worse this winter.
“I don’t think it’s a whole lot to ask people to wear masks in public places or in schools if it means preserving the health care system and protecting people,” he said.
Emily Gruenwoldt, the president and chief executive of the advocacy group Children’s Healthcare Canada, said pediatric care across the country was in need of an urgent fix even before the pandemic, with not enough hospital beds and lengthy wait times for certain services.
“This is an all-hands-on-deck kind of issue,” she said.