BC Children’s Hospital doubling up patients to tackle surge in admissions for respiratory illnesses

BC Children’s Hospital is preparing to double-bunk patients in its single-occupancy hospital rooms to accommodate a high volume of sick children during an early and intense flu season that has overwhelmed pediatric hospitals across the country.

In recent weeks, the Vancouver hospital, which provides care to British Columbia’s most seriously ill or injured children, has also had to triage patients in its emergency department in an overflow area and cancel non-emergency scheduled surgeries in response to an influx of children sick with respiratory illnesses, including influenza and respiratory syncytial virus, or RSV.

Other hospitals have had to take similar measures, with the Red Cross shoring up staffing at the Children’s Hospital of Eastern Ontario in Ottawa, and Alberta Children’s Hospital in Calgary opening a heated trailer to accommodate overflow from its emergency department and pausing respite care so it can redeploy nursing staff to care for the acutely ill.

Provincial Health Officer Bonnie Henry said B.C. is experiencing an unusual flu season with an “intense” surge in cases. Still early in the season, six children in the province have died from influenza.

In a memo sent to staff on Friday, leaders at BC Children’s Hospital said that while it is preferable for patients to be in single rooms, two patients may share a single-patient room when medically appropriate.

David Goldfarb, a medical microbiologist and pediatric infectious disease physician at the hospital, said the policy change is largely in response to high patient volumes and staffing issues. However, putting two patients in one room also makes more sense in certain scenarios, such as when there are two siblings and only one care provider.

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“We’re in a newer building that was built with the objective to have single rooms, and so certainly we would prefer that,” Dr. Goldfarb said in an interview on Sunday. “But we have a process to do co-rooming in the safest way possible, including testing of patients to make sure there’s no evidence of different infections in the same room.”

The decision must be made in consultation with an infection prevention and control team and is based on several factors including the patients’ conditions, and whether they have an infection that would require additional precautions, the memo said.

“If we are going to be combining two children that have a respiratory infection, we’ll look to see that they do not have a different respiratory infection that would add potential risk of transmission,” Dr. Goldfarb said.

Of the close to 30 children admitted to BC Children’s Hospital last week who tested positive for influenza, more than a quarter required intensive care. Of the six children who have died from influenza in B.C., one was under age 5; three were between the ages of 5 and 9; and two were teenagers.

By way of comparison, there were no influenza deaths among children last year and between one and three each year going back to 2015, according to the BC Coroners Service. Those figures represent cases in which influenza was identified as either the immediate, antecedent or underlying cause of death or as a significant condition.

The BC Centre for Disease Control reported that “several” of the six children who died experienced secondary bacterial infections contributing to severe illness, which can be a complication of influenza. Dr. Goldfarb said influenza is believed to disrupt the respiratory tract, making it susceptible to bacterial infection. He advised parents to watch for symptoms such as a fever that lasts more than four or five days; a fever that goes away for a day but then returns; signs of laboured breathing; a dark hue around the mouth; and a rash that can resemble a sunburn.

Health officials are urging parents to immunize their children. While more than half of British Columbians over the age of 65 have received their flu shots, as of last week, only about 20 per cent of children aged six months to 11 years, and 15 per cent of teenagers, had gotten their shots. The province launched a walk-in influenza immunization blitz on the weekend in hopes of bringing numbers up. Studies have shown vaccination is associated with a 75-per-cent reduction in risk of life-threatening influenza and ICU-admission in children.

Dr. Goldfarb also advised against social gatherings and going to school or work if people are sick, and to wear a mask when in crowded, indoor settings.

“Masking indoors is certainly reasonable at this time, when we’re seeing so much viral spread,” he said. “The question around mandating it, I know it has layers of complexity and I can’t speak too much about the absolute need for a mandate, but certainly, I would advocate for masking indoors right now with what we’re seeing, to help reduce the burden of this illness.”