By: Jason Magder
It may be warm outside, but it’s the dead of winter again in the emergency room of Ste-Justine children’s hospital in Montreal.
Since major restrictions on public life eased at the end of May, young patients have been overwhelming the ER with typical winter ailments: colds, respiratory viruses and gastroenteritis. The surge has come as a surprise to health-care workers in children’s hospitals, which have seen lower than normal volume since the pandemic began.
“Viruses that usually present in the fall and winter are starting to reappear,” said Antonio D’Angelo, the head of Ste-Justine’s pediatric emergency department. “It’s sort of like they were gone for a year because we’ve been covering our faces and cleaning our hands. Now they’re coming back.”
And those diseases often cause more severe outcomes for younger patients than COVID-19, D’Angelo said. In the last month and a half, the hospital’s ER has swelled to a volume of patients not seen since before the pandemic. In fact, the ER is the busiest that D’Angelo can recall in his more than 25 years of experience.
“We’re seeing record levels; this is our COVID crisis,” D’Angelo said. “Part of the reason is that we have organized the health-care system to deal with COVID, but it hasn’t been reorganized to deal with COVID and the regular other stuff that we usually see.”
He said the situation is complicated by the fact that many pediatricians and family doctors are still using COVID-19 protocols, so they aren’t seeing patients in person. That means the ER is often the only place where children can be seen in person by a doctor. There is also a shortage of staff in the health-care system, as many nurses have been reassigned to work on COVID-19 prevention or treatment, or vaccine administration. Other staff are on summer holidays.
D’Angelo explained that while many adults who get colds don’t have severe symptoms, children can develop worrisome complications that require a doctor’s care.
“We can see dehydration and pneumonia and (acute ear infections known as) otitis media,” he said.
Despite long wait times, D’Angelo said parents should seek medical help if they have children with fevers or respiratory problems due to colds.
While there are very few cases of COVID-19 being reported among the younger population, D’Angelo said there is now a “huge soup of viruses” that are often seen in winter, as well as others that are usually seen during the summer.
Young patients’ immune systems have had little exposure to these viruses in the last 16 months, so they are much more prone to strong reactions.
“Patients have more fever; they have more coughs,” D’Angelo said. “This is an exceptional year. We’re definitely getting a strong dose, and our immune systems are being challenged.”
The situation isn’t unique to Montreal, said Matthew Oughton, an infectious-diseases specialist and associate professor of medicine at McGill. In fact, this is a worldwide phenomenon.
“In all cases, everyone believes the same thing: this is happening partly because the usual cold and cough season didn’t happen, probably because of the precautions people were taking to reduce COVID transmission,” said Oughton, who works at the Jewish General Hospital. “It’s not that there is a shockingly huge absolute number of cases, but it’s more the fact we are seeing these viruses at a very unusual time of year. Everyone thinks of cough and cold season as being during the wintertime, between November and March.”
Oughton said those most susceptible to complications from respiratory viruses are young children and the elderly population.
“They run the gamut from minor runny nose and cough, all the way up to difficulty breathing, high fevers and need for hospitalization for supplemental oxygen, and perhaps other supportive care.”
With the virus calendar out of whack, Oughton said there is now a concern that this may also bode badly for the upcoming influenza season.
“Does this mean that influenza will stick to its usual seasonal schedule? I would say that all bets are off.”
Oughton is concerned that if an influenza outbreak occurs before the seasonal flu vaccine can be developed, the only way to protect the vulnerable population will be to put in place measures that have been in effect to prevent the spread of COVID-19: wearing masks and restricting gatherings.
“This is almost like the ripple effect from the huge disturbance that COVID-19 caused,” he said. “I think we have less ability to rely on usual predictions, and we have to accept there is more variability and unintended consequences moving forward.
“I think we will see several more ripples yet. Some of them, I think, will be very difficult to predict. It’s like there’s been a great disturbance in the force.”
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