Children’s hospitals under pressure in Canada’s 6th wave of COVID-19

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As Canada’s sixth wave of COVID-19 continues, hospitals caring for the country’s youngest patients are facing both high patient throughput and high levels of staff sickness.

At this time of year, Ottawa’s Children’s Hospital of Eastern Ontario (CHEO) normally sees up to 150 patients a day in its emergency department, but lately the number can double, with waits lasting hours.

Tammy DeGiovanni, CHEO’s senior vice president of clinical services and chief nurse executive, said about two-thirds of these children come with COVID symptoms.

The hospital was also forced to cancel some surgeries.

“The double for us is that we also have a lot of staff, medical staff and volunteers who are also off due to COVID symptoms or COVID in the household,” DeGiovanni said.

She said that on any recent day, about 10 to 15 percent of the hospital’s workforce was out of work — with each staffer taking 10 days to recover.

“This is causing additional pressure on the system at the moment, as opposed to previous waves,” she said.

According to the hospital, CHEO’s daily record for the number of staff, medical workers, students and volunteers denied entry for COVID-related reasons was 199 in early January — just as the first post-holiday Omicron wave hit .

The next highest day was April 11 at 7:00 p.m., with the facility still suffering from severe staff shortages on a daily basis.

Children with COVID, other diseases

In Saskatchewan, health facilities are grappling with a surge in sick children alongside record hospitalizations – provincial data on Wednesday showed a new all-time high of 417 people hospitalized with COVID-19.

“There’s just a tremendously increased number of children with upper respiratory diseases and related complications. Many of them have, as you would suspect, COVID,” said Dr. Alexander Wong from the Saskatchewan Health Department.

Esther Shi Berman, 10, receives a dose of a COVID-19 vaccine at a Toronto clinic on November 25, 2021. (Evan Mitsui/CBC)

“That creates a lot of pressure on the acute care side, both in terms of hospitalizations and admissions to the ICU and ER.”

Data from BC Children’s Hospital in Vancouver shows a mix of COVID-19 and other respiratory illnesses emerging in young patients in recent months.

In February, 76 children in the hospital’s emergency room tested positive for COVID-19, while another 29 tested positive for other respiratory diseases. The following month, that ratio changed, with 37 children suffering from COVID-19 and 72 from other respiratory illnesses, including one case of influenza. (The hospital did not provide April data.)

Health workers in children’s hospitals, like their adult counterparts, are “similarly impacted by the spread of disease in their communities,” said Dr. Srinivas Murthy, a pediatric critical care physician and infectious disease specialist at BC Children’s Hospital.

At McMaster Children’s Hospital in Hamilton, Ontario, the number of pediatric COVID patients admitted has remained low and relatively stable during the fifth and sixth waves, a hospital spokesman said in a statement to CBC News.

But the number of children who come to hospital emergency rooms with respiratory symptoms — some of which are related to COVID — is very high. The spokesman said this, combined with the pressure on staff, has meant the system is “very challenged”.

Visits back to pre-pandemic levels

The same is true at one of Canada’s largest youth health centers, the Hospital for Sick Children (aka SickKids) in Toronto.

The entire hospital is “under pressure” in part because about 10 to 30 percent of staff are sick on any given day during the two Omicron waves, Dr. Jason Fischer, Head of Emergency Medicine at SickKids.

Hospitalizations and ICU admissions remain high across Ontariojust as the number of patients coming to the SickKids emergency room is expected to return to pre-pandemic levels, hospital data shows.

In April 2019 there were more than 7,000 total emergency hospital visits, but that number fell in April 2020 in the early days of the pandemic, when many healthcare facilities saw a sharp drop in visits.

dr Jason Fischer, director of emergency departments at SickKids, says the entire hospital is “stressed,” in part because about 10 to 30 percent of staff are sick on any given day during the two Omicron waves. (Sick Children/Delivered)

In April 2021 the total was around 4,400, and in the first half of April this year almost 4,000 young patients showed up – a daily average of 222 visits, about the same as before the pandemic.

Despite those crowds, Fischer said it was crucial to keep employees at home with COVID-19 for a full 10 days.

“We see a lot of children from the ages of zero to five who are not vaccinated and so we are extra conservative when it comes to making sure nobody comes to work sick,” he said.

Low childhood immunization coverage

Across Canada, immunization rates among youth remain low. The latest nationwide data shows that only 40 percent of children aged five to 11 are fully vaccinated, while younger children do not yet have access to an approved vaccine.

With millions of children still vulnerable to infection — while hospitals are under pressure — some parents are wondering what’s best to do if their child gets COVID-19.

Nicole Rajakovic, a mother of two from Toronto, faced this dilemma last month. Her entire family became ill, with her five-year-old son being the first to show symptoms in late March. At that point, she said, he had only received one dose of vaccine while the rest of the family was fully vaccinated.

“He had a really bad coughing fit that brought on shortness of breath and that was the scariest moment for us,” she recalled. “Shall we call 911?”

Nicole Rajakovic, right, and her family all contracted COVID-19 this year, one at a time, starting with her five-year-old son. (Supplied by Nicole Rajakovic)

Rajakovic ended up taking care of her son at home, who has since recovered from his illness. But she said it was a tough decision.

“Where we would normally go to a doctor or emergency care, we no longer make those decisions because we know they’re understaffed and exhausted.”

Fischer from SickKids agreed that caregivers often have to work long hours while families face long waits for care.

Even so, he stressed that if parents are concerned about their child’s symptoms, they should still take them to an emergency room or emergency center, or use virtual care options.

According to the Canadian Pediatric Society, mild symptoms do not require hospitalization, but parents should seek medical advice if their child is not drinking well, has a high fever, is having trouble breathing, or if symptoms persist or worsen.

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