Like so many mothers of healthy, cheerful toddlers, Jill Promoli McGee was not terribly concerned when her two-year-old son, Jude, awoke with a low-grade fever one morning last May.
Promoli McGee gave him Tylenol, which brought the fever down, then entertained Jude and his twin brother, Thomas, with blocks and robots until it was time to lay the boys in their side-by-side cribs for their afternoon naps.
When Promoli McGee, now 34, returned a few hours later to wake the twins, she found Jude motionless on his crib mattress. He wasn't breathing.
"I started compressions and I called 911 right away," she recalled. "I left Thomas in his crib and I ran out to the driveway to get help because I knew I was hysterical and I was going to need help."
Neighbours on Promoli McGee's Mississauga cul-de-sac took turns frantically performing CPR until paramedics arrived to whisk the red-haired, brown-eyed boy to the hospital. But it wasn't enough. Jude McGee died on May 6.
For months, Promoli McGee and her husband, Craig McGee, 35, lived in the exquisite hell of not knowing what had killed their son.
Then, in August, they were tipped into a fresh sorrow when the coroner told them that Jude had died of the most prosaic of causes: the flu.
"Honestly, that was the first time I felt any anger about the situation," Promoli McGee said. "It was a weird anger because it wasn't directed at anybody, just at the situation. I felt really just sad and angry about it, because it is so preventable. And we know that."
Promoli McGee is now trying to put her heartache to good use with a social media campaign designed to propel as many Canadians as possible to their local flu shot clinic. By the middle of last week, 227 people had posted their flu shot pictures to Instagram with the campaign's hashtag #forjudeforeveryone, including Calgary Mayor Naheed Nenshi.
The campaign's Facebook and Web pages have received more than 800 likes and nearly 20,000 unique visitors, respectively, since Promoli McGee launched the effort last month with a blitz of local television news stations and an appearance on the new CTV morning show with Ben Mulroney.
Most of the public feedback has been overwhelmingly enthusiastic, Promoli McGee said. But a cadre of Internet trolls and vaccination opponents has also stepped on her message, suggesting on Facebook and elsewhere that it must have been the Tylenol or even the flu shot – which Jude received last December – that killed him.
The fact that Jude was vaccinated against influenza makes Promoli McGee's campaign a tricky sell, something she is well aware of. The flu shot, which is generally about 50-per-cent effective, did not save Jude.
Nonetheless, Promoli McGee often thinks of the chain of infection the virus had to travel to reach her son. What if one person – one link – had chosen vaccination, breaking the chain? "Then it could have been stopped somewhere before it got to Jude," she said. "Then he never would have gotten the flu and he would still be here."
The case Promoli McGee is making is the same one public-health officials make every fall: The flu vaccine is not perfect, but it is the best armour against a virus that can be deadly, especially for the very old, the very young or the very ill.
"It is true that the more people are vaccinated, the better your chances of preventing transmission to your close contacts, and then potentially to the community at large," said Dr. Bryna Warshawsky, a communicable disease expert with Public Health Ontario. Yet only about one-third of Canadians got a flu shot last season, according to the Public Health Agency of Canada (PHAC.) The vaccination rate was much higher among senior citizens, but for children between the ages of 6 months and 17 years, the rate was only 22 per cent.
The apathy surrounding kids and the flu shot likely has a lot to do with how common influenza is.
In a house with young children, the fever, sore throat, cough, aches and occasional vomiting that signal the flu can seem like the dull background hum of life in the fall and winter. The flu rarely kills children. "But it does happen," Warshawsky said. "It does show that flu is a very complicated virus. It can do very unexpected things. It's not a benign virus."
In 2015-16, influenza seemed to take a higher-than-usual toll on children. The provinces and territories that report flu figures to PHAC recorded 1,532 flu-related hospital admissions for children under 19. That was 610 more than the previous season's total, and more than in any of the previous five seasons.
It's difficult to pinpoint why. Last season's vaccine was a fair match for the influenza strains that circulated most, unlike the season before, when the shot provided scant protection against the virus.
PHAC, using a statistical model, estimates that 3,500 people in Canada die from the flu every year.
During the 2015-16 flu season, the provinces and territories that report flu deaths to PHAC logged a total of 13 influenza deaths among children younger than 19; of those, five were 4 or younger.
"Sometimes, tragically, you really can't predict which child is going to get very sick," said Dr. Theresa Tam, PHAC's deputy chief public health officer. "It can happen to a healthy child."
Jude McGee was one of those children.
Dr. Howe Sim, the coroner who investigated his death, said the autopsy, along with toxicology and metabolic studies, showed that the two-year-old was in perfect health, other than the evidence of bronchitis and early pneumonia in both his lungs. Influenza B was found in both of his nostrils and his lung tissue.
In general, about a quarter of all flu cases are influenza B. Rates of influenza B tend to be higher in children. "You don't see as much influenza B impact in adults," Tam said. In 2015-16, influenza A accounted for 10 of the reported pediatric deaths, while B accounted for three. (It's not clear whether Jude's death is included in that total because the cause of his death was not identified until late August.)
The National Advisory Committee on Immunization recommends that children Jude's age receive what is known as a quadrivalent vaccine, which covers four types of flu – two A strains, and the two main lineages of influenza B. The coroner's report did not identify precisely what type of influenza B killed Jude.
"It was a thorough investigation," Sim said. "There was nothing else going on. This was an otherwise healthy child who, unfortunately, died as a result of influenza B infection involving his respiratory tract."
After Jude's death, Promoli McGee was in a daze. The couple's daughter, Isla, now 5, was old enough to understand the tragedy, but Thomas was barely 2 and sick with the flu. It was Mother's Day weekend.
"We just took turns sleeping on the couch with [Thomas] for a couple of days," Promoli McGee recalled. "At one point, Craig tried to put him down for a nap. He just looked at Jude's crib and screamed. So that was the end of that. That afternoon, while he slept on me on the couch, Craig took the crib apart and we got rid of it."
Jude's crib may be gone, but memories of the boy are everywhere in the house. The dining room is wallpapered with family photos shot by Promoli McGee, a professional wedding and family photographer. She is working again, but finds it too gut-wrenching to photograph twins.
Caring for Isla and Thomas helps to keep her afloat. So does remembering Jude. Whenever she and her husband and the kids see a dandelion, they think of him and make a wish. Jude loved dandelions. When he spotted one of the yellow weeds, he would always point to his favourite knitted lion hat and laugh hysterically.
"I never want to not talk about him. I'm sad that I only have a little bit more than two years of stories about him because he was hilarious," Promoli McGee said. "But it's helpful to put it out there, that this is what happened."
With a report from Carly Weeks