Ontario, like other provinces, is seeing a disturbing rise in cases of viral chest infections in young children. Whether it’s the flu or respiratory syncytial virus (RSV), many of the province’s hospitals are being overwhelmed by the surge and are limiting critical services.
Parents and their children, meanwhile, face frightening wait times of up to 12 hours in emergency rooms, and then more waiting after that if their child needs to be admitted.
It’s yet another perfect viral storm: a hospital system struggling with the late stages of the COVID-19 pandemic and severe staff burnout meets a tsunami of respiratory infections in young children who, during the pandemic’s mask mandates and lockdowns, were never exposed to common viruses that inevitably infect them in their early years.
The question now is, what to do? Should Ontario reintroduce indoor mask mandates in indoor public spaces, to protect children and ease the load on the health care system? Should other provinces?
On Monday, Ontario’s chief medical officer of health, Dr. Kieran Moore, “strongly recommended” that all Ontarians wear masks in indoor settings, including schools and daycares, to protect against what he called the “triple threat” of influenza, RSV and COVID-19.
His recommendation follows similar ones from Dr. Theresa Tam, Canada’s chief public health officer, and from many doctors and hospital officials in Ontario. They also urged people to get updated flu and COVID-19 vaccinations; these offer protection against both infection and severe outcomes.
There are many public health expects who believe that, under the current circumstances, that does not go far enough. Dr. Fahad Razak, the former scientific director of the province’s prematurely disbanded COVID-19 Science Advisory Table, said in late October that “the criteria to require something like a mask mandate is clearly here.” And the situation have grown worse since then.
It’s a thorny issue. And it’s important to understand how today’s challenge is like COVID-19, and also unlike COVID-19.
When drastic public health measures such as business shutdowns and mask mandates were imposed in 2020 and 2021, the threat was a novel virus that had the power to kill hundreds of thousands, and did in fact kill tens of thousands of Canadians. The current threat is not like that.
The flu and RSV can be dangerous, but they are well known, and there are a number of effective treatments for them. Flu vaccines have been around for decades. As for COVID-19, it rarely has severe outcomes in small children, and there are vaccines available for children under five.
Some experts predicted that a spike in pediatric respiratory viruses would happen after the COVID pandemic. As The Globe and Mail reported, they foresaw that the end of two years of masking and social distancing would result in a supersized group of young kids simultaneously getting their first exposure to otherwise common viruses.
That’s now happening – and it’s what makes part of the current challenge somewhat like COVID-19.
One danger with pandemic-era COVID waves was that, if the peaks got too high, hospitals could get overwhelmed – and at times they were overwhelmed. Childhood respiratory viruses pose a similar threat to pediatric health care. In Ontario, the system has already been pushed beyond capacity.
Lowering the pace of the spread of COVID-19, flu and RSV among children would ease the strain on the health care system. But a mask mandate, even one lasting only a few weeks, could impose real burdens on businesses and students.
Instead, Ontarians – especially those in contact with small children or the aged, or working or living in confined spaces – are being asked, but not told, to mask. And everyone is being reminded to get their flu shots and COVID boosters.
Is that enough? Is it the right trade-off? One of the difficulties in answering those questions is the dearth of data. It’s one more reason to mourn the loss of Ontario’s Science Table, which for more than two years crunched numbers and provided models that allowed governments and the public to appreciate those trade-offs with regard to COVID-19.
Big public health decisions were accompanied by models showing just how bad things could get – how many people could end up in the ICU and the morgue – if government did not act. On Monday, as Ontario declined to impose a mask mandate but encouraged voluntary mask-wearing, the costs of that choice were unclear.