Physicians worry surge in influenza, other viruses, could last several more months in Alberta

Alberta is three months into influenza season and pediatric hospitals in particular are feeling the pressure of what Alberta Health Services is calling an "unprecedented" season.

AHS said Monday that the pediatric ICU at the Stollery Children’s Hospital in Edmonton has been close to 100 per cent capacity for the last three weeks.

Measures are being taken at the Stollery, according to AHS, like turning a unit that was temporarily being used for adult patients back into one that can treat kids.

“Six beds were opened last Friday, and we will be increasing that to 13 beds in the coming weeks,” AHS spokesperson Kerry Williamson said in a statement.

Doctors at the Stollery are also picking up extra shifts to help meet the demand.

“We deeply appreciate the hard work of staff and physicians in recent weeks and throughout the last few years,” the statement said.

Meanwhile, Alberta’s Children's Hospital in Calgary added a heated trailer outside the emergency department to accommodate surges in patient volume.

And even more recently, AHS announced that respite staff at Rotary Flames House in Calgary would be temporarily redeployed to assist with the high volumes of acutely ill patients in hospital.

“I think this flu season is different than what we’ve seen before; I think the impact is substantial and I think we’re really struggling to get care to all the sick children right now,” said Dr. Katharine Smart, a pediatrician and past president of the Canadian Medical Association in an interview with CTV News Edmonton on Monday.

Dr. Smart thinks one of the reasons behind the surge in illness comes from the removal of public health protections that were put into place to prevent the spread of COVID-19, with the result being a dramatic uptick of influenza and other viruses.

She also believes that the early start to the season has led to low numbers of people being immunized against influenza, allowing it to spread throughout the population.

“The number of people already infected is much higher than we would typically see, the number of kids hospitalized with flu already this early in the season is dramatically higher than what’s typical,” Smart said of the current situation.

On Tuesday, Health Minister Jason Copping said that there are signs that Alberta may be hitting its influenza peak. He said the government looks at school absenteeism rates and wastewater levels from across the province for trends.

“It looks like the number, the transmission in the community is coming down. Now, it takes a little time for that to actually show up in the hospitals but we expect that pressure on the hospitals will come down,” the minister said.

“A number of measures are in place short-term to deal with this current spike and then, longer term, we continue to build capacity and improve processes.”

Dr. Tehseen Ladha, a pediatrician that works in Edmonton, doesn’t think the end is in sight.

“I don’t think we’ve seen the worst of it yet. I think when we do look at wastewater data, when we look at the trend of influenza cases, I think we’re still on the upswing and I think unfortunately the situation within pediatrics will get worse before it gets better.”

She says that in a normal season, they expect to see the influenza peak in January or February.

“Right now we’re not seeing any signs of slowing and so I think we’re in for at least another month or two of this, if not more.”

She says that many physicians and health-care providers are worried about that timeline. “If it continues to increase…there’s going to be more children who are unable to get timely access to high-quality care.”

WHAT CAN BE DONE TO PREVENT INFLUENZA?

Dr. Smart wants to emphasize the importance of vaccination when it comes to influenza.

“It’s so important for parents to understand that young children, including infants, can be vaccinated,” she said. “This year, our flu vaccine is an excellent match to the circulating versions of flu that are in our communities.”

She also says that viruses can be prevented in other ways, such as wearing a mask in indoor spaces, good hand hygiene and staying home when feeling unwell.

“It’s important that the public takes this seriously and do what they can to help mitigate what’s happening.”

Also knowing when your child requires hospital care and when they don’t is important, says Dr. Ladha.

“Fever itself is not necessarily a reason to go to the emergency room,” Ladha explained. “Fever is a sign that your child is fighting an infection and fever itself doesn’t harm the child.”

If fever lasts five to seven days or longer, the doctor says that is when parents can take their child to their family doctor, or pediatrician, but not necessarily to the emergency room.

Difficulty breathing and or dehydration in children, however, does warrant a trip to hospital.

HOW DOES THIS INFLUENZA SEASON COMPARE TO OTHERS?

According to Alberta Health Services data, it has already investigated 391 respiratory virus outbreaks between Aug. 28 and Nov. 26 this year. The closest comparison is when 510 outbreaks were investigated in all of 2019.

Fifty-one per cent of outbreaks so far this season have been in the Edmonton Zone followed by 20 per cent in the Calgary zone.

K-12 schools have experienced 88 per cent of outbreaks with 343. That’s a 573 per cent increase compared to last season, which had the second-highest number of outbreaks in school settings with a total of 51.

Child-care facilities have had 33 outbreaks over the last three months. The season prior, there was a total of 106.

SPECIMENS

“Other viruses are also circulating, so it’s not only influenza that’s impacting children,” said Dr. Smart. “It’s RSV, it’s COVID, it’s other viruses happening all at the same time with massive pressures on our children's hospitals.”

According to AHS data, the majority of lab specimens this season have tested positive for rhino enterovirus (1,911), or RSV (1,005). However, tests are also coming back positive for coronavirus, parainfluenza, adenovirus, and HMPV.

Edmonton has seen the most cases of rhino enterovirus (696), coronavirus (211) and Parainfluenza (162) in the province, whereas Calgary has seen the most cases of RSV (547), adenovirus (90), and HMPV (60).

CASES

The highest number of laboratory-confirmed cases in a single flu season in the province was 9,115 in 2017-18, according to an influenza report released by Alberta Health in October 2020.

This year's 5,163 cases so far has been enough to surpass the majority of past season totals, meaning it may soon be the fourth highest of the last 13 seasons.

Children in Alberta, especially those under the age of four, have long been a demographic likely to catch influenza, data analysis shows.

Between 2017-2020, a range of eight per cent to 18 per cent of laboratory-confirmed cases of influenza were in children aged 0-4. So far this flu season, 16 per cent of cases have been in that age group.

HOSPITALIZATIONS

Influenza, like many other respiratory viruses, are more dangerous in young children and elders, according to Dr. Smart.

With regards to hospitalizations, children under four usually have the second highest rate per 100,000 population. In the 2018-19 season, they had a hospitalization rate of 72.8 compared to 73.0 for those 65 years of age or older, according to Alberta Health data.

In the 2019-20 flu season, the influenza B strain led to a hospitalization rate of 37.9 in the 0-4 age range, compared to a rate of 55 in people 65 or older. The Influenza A strain in the same year led to a hospitalization rate of 24.1 in kids under four, compared to a rate of 30.5 in people 65 and older.

In terms of this flu season, a similar trend is unfolding with children under a year old having the second highest rate of 82.7 compared to a rate of 123.8 in Albertans 90 years or older.

ICU

Young children have also had historically high ICU rates after being infected with influenza.

“Young kids are more susceptible to getting actual lung involvement from viruses,” said Dr. Smart. “With the flu, it can get down in the lungs. It can cause inflammation, difficulty breathing, pneumonia and it can also predispose children to invasive bacterial infections after having had the flu.”

In the 2017-18 season, children under a year old were the most likely to be admitted to the ICU while children between the ages of 0-4 had the highest rate of admission in the 2018-19 season. In the 2019-20 season, only people 65 years or older had a higher ICU admission rate than children under four years of age.

Children under a year old have the highest ICU admission rate this year so far at 8.3, the second highest being kids between one and four with a rate of 5.7 per 100,000 population.

Over the last three months, 17 per cent of hospitalizations and 20 per cent of ICU admissions have been for kids under four.

DEATHS

According to a spokesperson with Alberta Health, children have died from influenza in six of the nine years between 2011-2019. In that time frame, 16 children died of flu in Alberta. The largest number was in 2016 when six children, all under the age of five, died from the virus.

This year, in the span of 90 days, a four-year-old and another child between the ages of five and nine has died.

The province’s next influenza update is on Thursday.

With files from CTV News Edmonton's Amanda Anderson, CTV News Calgary's Jordan Kanygin and CTV News Calgary's Damien Wood.