Respiratory illnesses, especially among children, are alarmingly widespread right now, according to data from Ontario hospitals, which shows hospital visits and admissions are far higher than normal for this time of year.
The number of children in the province aged five to 17 who visited hospital emergency rooms (ERs) so far this flu season is more than three times the seasonal average, according to Ontario’s Acute Enhanced Surveillance (ACES) database. Meanwhile, the number of children under five who have been to the ER for respiratory illnesses so far this season is more than double the seasonal provincial average.
In an interview on Thursday, Nov. 10, 2022, Dr. Piotr Oglaza, Medical Officer of Health (MOH) for Kingston, Frontenac, Lennox and Addington (KFL&A) Public Health, explained that, despite the most recent local data (the week of October 30 to November 5) showing KFL&A among the health units labelled “high” for respiratory visits to the ER, “I wouldn’t say that the KFL&A region is an outlier compared to the rest of the province, because at this point, pretty much every emergency department in the province is seeing these high rates of visits.”
Oglaza went on, “In KFL&A, we’ve already surpassed the 20 per cent mark last week; so basically, 20 per cent of all emergency room visits are due to respiratory complaints — which is, again, an unprecedented high for this time of year.”
When asked why such high levels of respiratory illness are appearing in children compared to other years, Oglaza replied that, firstly, “it reflects what we know about the age groups that are particularly vulnerable to respiratory illness… Typically, those who are younger or those who are older are more likely to have a more serious illness. It is also coinciding with the circulating pathogens.”
Our area, he explained, is “already seeing a rapidly rising number of Influenza A [cases]… That’s seasonal influenza, which typically peaks around the end of the year — but this time, we’re already seeing it increase early on.”
Respiratory Syncytial Virus (RSV) is also circulating at an earlier and higher level than is normal for this time of year, Oglaza pointed out.
According to the KFL&A Public Health website, RSV causes respiratory illnesses in people of any age, but it most commonly affects infants and young children. Almost all children are infected at least once by two years of age. In infants and young children, RSV is the cause of most bronchiolitis and pneumonia. The illness is spread through direct or close contact with infected secretions, and the virus may live for half an hour on the hands.
RSV can also affect the elderly and immunocompromised adults. Symptoms of RSV in the elderly are similar to those of influenza and can cause serious health complications. RSV tends to occur in annual epidemics during the winter and early spring.
When asked why this high level of respiratory illness is happening so early, Oglaza said, “We don’t know, exactly… but we know that COVID-19 has been a dominating virus for the past two and a half years, and it seems that during that time, other respiratory viruses were suppressed.”
“So, we haven’t really seen much influenza in the 2020 and 2021 respiratory seasons. There was an unusual later peak of influenza just earlier this year… This is a very different pattern from previous seasons, but they’re consistent patterns that we’ve seen in the southern hemisphere.” He explained that Australia also had an earlier influenza season this year.
Oglaza pointed to an expert hypothesis that the surge in respiratory illnesses is a result of children not being exposed to these viruses circulating at a regular rate in previous seasons, because of increased precautions to mitigate the spread of COVID-19. “Maybe that’s what’s driving this resurgence. But again, these are just theories. I don’t know if there’s any concrete evidence, but that’s what experts are hypothesizing might be the case.”
He emphasized, “Moving forward… we know that there are some very simple and effective infection prevention and control measures that will serve us well through this season: staying home when sick, maintaining hand hygiene, and really looking at masking as one of the tools that we have at our disposal in our toolbox, especially when around vulnerable people or [in] places that are crowded.”
Masking alone, Oglaza said, will not prevent transmission, “but it’s one of the tools we have that, when used with other interventions, will reduce the risk. I think that’s really an important message to convey.”
Unprecedented shortages of some key medications, such as children’s pain and fever relievers (acetaminophen and ibuprofen products including pediatric Tylenol and Advil), could also be contributing to increased visits to the ER, Oglaza acknowledged. But he stressed that “it would not be… responsible for increased [hospital] admissions. If someone needs to be admitted, [it would not be] for something that could be managed at home with over-the-counter medications.”
Oglaza concluded by calling attention to some fact sheets and tools being distributed by primary care providers and the Ontario College of Family Physicians. These resources are designed to inform parents about symptoms to watch for in children and how to manage respiratory illness at home — in situations where it’s safe to do so — to avoid unnecessary emergency room visits. He emphasized, however, that there are signs and symptoms for which individuals should not hesitate to seek professional assessment.