'Intense' flu season for Canadian kids needs solutions now and longer term, doctors say

Flu infections are raging among children and hospitalizing them across Canada, say pediatricians who are calling for urgent and longer-term solutions.

Last weekend, hospitals across the country were forced to scale back regular service to deal with a surge in influenza illnesses:

• CHEO in Ottawa said the Red Cross will be deployed to help out with its surge of cases. 
• A respite care facility in Calgary closed to redeploy staff to a children's hospital.
• BC Children's Hospital declared an emergency for 30 minutes on Saturday to quickly boost capacity and resources.
• Newfoundland and Labrador's children's hospital cancelled some scheduled surgeries and appointments.

Doctors say the moves reflect a surge in influenza on top of long-standing pressures on both pediatric hospitals and care providers in the community. Cases of respiratory syncytial virus (RSV) have, in the meantime, stabilized after spiking earlier this season. 

For the week ending Dec. 3, a total of six influenza-associated deaths were reported among adults, according to the Public Health Agency of Canada's FluWatch report.

In the same week, participating provinces and territories reported 212 influenza-associated hospitalizations and 31 ICU admissions among children 16 and under.

That's up from an average of 11 influenza hospitalizations, with a maximum of 35, at pediatric hospitals from 2014-15 to 2019-20, said Dr. Jesse Papenburg, a pediatric infectious-disease specialist at Montreal Children's Hospital.

"This shows that we have had an early and intense influenza season so far this year, hitting the pediatric population particularly hard," he said in an email.

Across Canada, influenza activity continues to remain higher than expected for this time of year, the FluWatch report said.

Similarly in the U.S., Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Monday that flu is at its highest level that country has seen for a decade. So far this season, 21 children and youth in the U.S. have died.

In Canada this season, five influenza-associated pediatric deaths have been reported federally, as of Dec. 3. Annually, the number of deaths for that age group were in the single digits before the COVID-19 pandemic.

Bend the curve with flu shots

Influenza is "overwhelmingly … causing a lot of problems," particularly for children under five, said Dr. Fatima Kakkar, a pediatric infectious diseases specialist at Ste. Justine's Hospital in Montreal.

But it's not necessarily the flu, alone, that's the problem, she says.

Rather, kids catch the flu, which leaves them prone to "really significant bacterial infections," like pneumonia — and that's when they land in hospital. 

Kakkar says she'd like to see an emphasis on influenza vaccination for children, including publicity campaigns.

"I say this because I think it's not too late and especially in parts of the country where influenza hasn't taken hold, I would really like to see people encouraging and making it easier for parents and their children to be vaccinated."

Whitehorse-based pediatrician Dr. Katharine Smart called it "immensely concerning" that children who are acutely ill and need attention quickly are having trouble receiving it.

But there are other, bigger-picture problems throughout the pediatric health-care system that deserve attention, she says.

Smart, a past president of the Canadian Medical Association, cites wait-times for surgery for young people with scoliosis, or curvature of the spine, as an example.

"I've had patients that had to put off their post-secondary school planning because they don't know when they're going to get the operation and the recovery," Smart said. "They say, 'Well, how do I go off to college if I don't know that I'm going to now have to have a massive spine surgery and be out of commission for weeks or months?'" she said. "Some of these [teens] have been waiting three to four years for this operation." 

Effective vaccine

Other health-care needs for children are provided outside of the hospital, which is especially important in the first years of life, such as autism services. Some kids aren't able to access services to improve their speech, social skills and cognition. Once a child is in kindergarten, they may no longer be eligible for certain help because the developmental window to intervene has closed.

"These are problems that we're seeing across the country," Smart said. She suggests bolstering nurse staffing and retention. 

She also wants to see more uptake of the flu vaccine among children and adults, to "bend the curve" for overwhelmed health-care systems. 

The good news, Papenburg says, is that the influenza A H3N2 strain that is mainly circulating in Canada now is genetically the same as the strain in this year's influenza vaccine. "That bodes well for good vaccine effectiveness, although that needs to be assessed in field studies now underway."

In the long term, researchers are evaluating newer vaccine technologies for better, longer-lasting flu immunization, he said.

Like Smart, Papenburg suggested governments "invest in our child health care systems capacity, so that we can better handle these types of unpredictable surges of infections in our pediatric population."

"When you look at Canada, we rank 30th out of 38 countries for childhood well-being," Smart said. "It's really shocking to think a country, as wealthy as ours, is doing that poorly for our kids, but it's because we do not have a strategy for children." 

Health officials also recommend that people mask in indoor public places, screen daily for respiratory symptoms, stay home when sick, practice hand hygiene and keep surfaces clean to reduce the spread of respiratory illnesses such as RSV and flu.