Quebec kids' hospitals packed, not with COVID-19 but 'unprecedented' surge in other viruses

Montreal's overcrowded children's ERs concerning Children's ERs are overcrowded in Montreal but not with kids infected by COVID-19.

Montreal — Any Montrealer who’s gotten in the habit of checking hospital statistics has probably been alarmed if they looked them up recently, especially if they have kids.

Quebec schools are coping with a surge of COVID-19 cases due to the more-transmissible Delta variant. Meanwhile, the stats showed, the emergency room of the Montreal Children’s Hospital was over 150 per cent capacity this week.

Parents wondered if this summer’s warnings had come true: a big uptick in severe Delta cases among kids.

No, doctors say, Montreal kids with coronavirus aren't the ones filling the ER. But some of the overcrowding is still related to the pandemic, and it’s still serious, with an extraordinary spike in viruses that normally appear in winter circulating now among children.

“Honestly, what we’re seeing now has never been documented before,” said Montreal pediatric epidemiologist Jesse Papenburg.

One virus that can cause respiratory infections is spreading hugely, whereas it’s normally unheard-of to see it before November. There were also strange summer outbreaks of croup and other kids’ illnesses.

Ste-Justine Hospital's ER is warning parents the wait is long. At the Children’s, the ER officially has only 12 stretchers, but by Wednesday morning, “we had 18 patients on stretchers,” wrote hospital spokesperson Christine Bouthillier.

“We are seeing many, many more patients than we usually do at this time of year,” said the head of emergency care at the Children’s Hospital, Dr. Laurie Plotnick, confirming that out of-season viruses are helping account for the trend.

Of course, for many parents this fall, a sudden fever in a child feels like even more cause for concern than normal, sending confused droves of families seeking help.

Quebec has taken note of the strange times and the pressure on children’s ERs, creating a series of 20 pediatric clinics this fall for kids who have no family doctor and who aren’t critically-ill to the point of needing ER care.

“This initiative will help promote rapid access and care for children and young people who present symptoms similar to COVID-19, while helping to alleviate emergency rooms,” the province said.

WHY THE SUMMER VIRUSES?

What happened? Kids went unexposed for so long to various bugs, experts believe, they all started circulating at once, in their off-season. It’s now hard to forecast the next few months, experts say.

“We’re living in unprecedented times, where… our social networks were practically completely shut down for several months and then reopened,” said Papenburg, who teaches at McGill University.

“And that’s made for a different kind of susceptibility pattern out there to these different viruses. It’s unprecedented and it's somewhat unpredictable.”

Part of the mystery: other Canadian cities don’t seem to be seeing the same uptick yet, especially in a virus called respiratory syncytial virus or RSV.

The same virus, when it infects adults, causes the common cold. But it’s often more serious for infants, who have never been exposed before and who run an extra risk of it infecting not just their upper respiratory tract but their lungs.

Their tiny airways can also get more easily “plugged up” than adults’, Papenburg explained.

Normally, RSV is common in winter, with two per cent of all North American babies hospitalized for it before their first birthday. But in August, more than 30 per cent of samples tested for the virus in Quebec were positive, a shocking number, Papenburg said.

It’s “fascinating” to him as a scientist, and “it doesn’t seem to be happening elsewhere in Canada yet,” he said.

Maybe Quebec, which did fairly well keeping its COVID-19 numbers down in the late spring, reopened things sooner than other provinces and that helped non-coronavirus viruses to spike, Papenberg said.

On the other hand, the flu, also a winter illness, hasn’t appeared in Quebec this summer. But each year’s flu strains usually arrive north from South America, Papenburg pointed out, and that isn’t happening as much because of the lack of travel.

“To be honest, each virus has its own factors that account for the seasonality of transmission,” he said—some are affected by sunlight or humidity, as well as people spending time in close quarters in winter, as they suddenly did this summer instead.

PREPARING FOR THE UNKNOWN

Experts can’t predict how these other viruses will behave, given all the new variables. RSV, for example, could keep skyrocketing, or could “hover” at a stable level all winter, Papenburg said.

There are also some other unusual needs at the Children’s right now, Dr. Plotnick said, though she didn’t go into detail.

On top of kids with infectious disease, “we also are seeing children who are observed for a longer period of time in our emergency department for a variety of reasons,” she said.

Then, of course, there’s COVID-19 and the Delta variant, which come with their own questions.

New research this week from the U.S. Centers for Disease Control suggests the Delta variant does not, in fact, create more severe cases among kids than the previous variants, said Papenburg.

So far, in Montreal, there’s also no sign that Delta is more likely than previous COVID-19 variants to land kids under 12, who cannot yet be vaccinated, in the hospital, said Plotnick.

And at the Children’s, “the children we’ve seen with COVID-19 have generally been milder [than adults],” Plotnick said.

The numbers are low, but COVID-19 is landing a few kids in hospital. According to public health data, across the entire province there are currently six children under 10 hospitalized for COVID-19, including two in intensive care.

KIDS’ CLINICS TO HELP HANDLE THE RUSH

The symptoms of many viruses can look similar in kids, of course, whether it's COVID-19 or something else: fever, cough, difficulty breathing, fatigue, sometimes diarrhea or sore throat. It's no wonder that many worried parents are seeking help and reassurance at the first sign of illness.

The province’s 20 new pediatric clinics, announced Tuesday, will be set up in regions that are normally stretched in terms of health care. Some will be in Montreal, but none of the locations have been announced yet.

“The regions identified are those for which the population’s front-line access (without an appointment) represents a challenge in normal (non-pandemic) times and where there is a large number of patients without a family doctor,” a ministry spokesperson wrote.

They’ll be open seven days a week and will be available without a prior appointment, though people do need to book a time slot just before going.

Families will be able to go there directly if they call a nursing line or book online at the RVSQ provincial appointment website. Otherwise, ERs may refer them to the clinics if children show up but aren’t critically ill.

This year, it makes sense to prepare for anything, said Papenburg.

“I don't know what's going to happen during the wintertime,” he said.

“Certainly, I’d be worried that we're going to have, potentially, in paediatrics, a combination of not only a bad [RSV] season or a bad cold and flu virus season, in combination with COVID-19. But that remains to be seen.”

--With files from CTV's Cindy Sherwin and Angela Mackenzie