'Unprecedented' surge in pediatric admissions for respiratory virus continues to tax Quebec hospitals

MONTREAL -

A highly unusual surge in visits to Quebec’s pediatric emergency rooms during the late summer and early fall, has in turn, led to an “unprecedented” number of young children being admitted to hospital - a trend that continued through October, according to hospital figures.

The patients, the vast majority under one year old, are sick with Respiratory Syncytial Virus (RSV), that may start out like the common cold, but can sink into the lungs, causing a more serious infection like pneumonia or bronchiolitis.

While there’s been “a slight decrease in the number of patients coming to the Montreal Children’s emergency [room],” according to spokesperson Christine Bouthillier, the higher numbers of children now filling beds, on oxygen, or requiring rehydration, is straining hospital resources and overburdening staff like respiratory therapists.

Services were reorganized, and some elective surgeries and other types of admissions were postponed as a result.

“It’s been very difficult to manage,” Dr. Jesse Papenburg, an infectious diseases specialist at the Montreal Children’s Hospital, told CTV News.

“It has affected the care that we’ve been able to offer children. Although we’re doing our best to keep up and give the best care possible, we have had to reallocate some resources for sure,” he said.

In September 2021 there were 77 RSV admissions to the Montreal Children’s Hospital including to the pediatric intensive care unit (PICU). That’s 3.5 times higher than during pre-pandemic September 2018, when 22 children were admitted.

There was only a slight improvement this October, when admissions fell to 60, which is still 2.5 times the number of children (24) who required beds during the same month in 2018, according to data provided by the hospital.

The admission rate “is not out of keeping with the typical winter time surge, so it's unprecedented. Nothing like this has ever been documented before,” said Dr. Jesse Papenburg, an infectious diseases specialist at the Montreal Children’s Hospital.

He said that means doctors are “very cautious of our predictions for the next few months,” but it is possible cases won’t abate, right through March, with the situation intensifying as regular seasonal viruses like influenza also make the rounds.

Doctors at Ste-Justine Hospital are equally off-balance when it comes to planning ahead for this year and next, as they too have experienced the same influx of young patients needing in-hospital care, during late summer and fall.

While that hospital provided CTV News with a different breakdown, the figures show that over a seven-month period in 2021, from April 1 to Nov. 1, which doesn’t include the usually viral-loaded winter months, 413 children were admitted with RSV infections, just 55 fewer children than during the entire year in 2018-2019.

Out of 413 sick children admitted to Ste-Justine in 2021 so far, 413 were between the ages of 0-11 months old.

WHY THE EARLY RESURGENCE OF RSV?

As pediatric specialists have previously explained, it’s believed COVID-19 public health measures prevented the usual viruses, like RSV and influenza from circulating widely during the 2020 winter season - giving families a brief reprieve.

But that drop-off in cases created a perfect storm, said Papenburg.

“When the virus did wind up coming back into our community, and it started off really in Montreal, you had a lot more people that were now really susceptible to it, and they were getting infected and transmitting,” he said.

Pregnant women also benefitted from the disappearance of other transmissible bugs from their environment because it made for healthier months as pregnancy progressed. The downside: they also weren’t exposed to RSV and so weren’t passing on antibodies to their baby during the third trimester as they might usually.

Papenburg explains that passive transfer of some immune protection to the baby may “not completely protect from infection, but for the first three to four months that can help mitigate the infection so it doesn't become severe enough to require hospitalization.”

BABIES AT RISK

Also a common virus among adults, RSV is the leading cause of hospitalization in children under one year of age. By the age of two, 90 per cent of all children have had at least one bout.

It’s that first infection that babies with no immunity catch that poses the greatest risk, because it is less likely to be contained in the nose and throat, and instead can travel to the lungs.

There, it can cause pneumonia or bronchiolitis which “plugs the small airways and they have difficulty breathing," Papenburg said.

Aside from requiring oxygen, some babies become so congested they’re unable to drink and become dehydrated.

20 per cent of the children hospitalized wind up needing ICU care, where they might be intubated and placed on a ventilator.

About half of all children hospitalized need to stay put for three days, while others need extra time in hospital once they're over the worst of it, so they can be observed or receive a bit more supportive care.

“It’s a tough three days, even if they’re only in for three days,” cautions Papenburg.

He recommends that families continue to rely upon the usual COVID-19 infection control measures to help protect children under one and especially babies under three months old from RSV and even from rhinovirus - the common cold.

“It’s the basics, frequent handwashing, respiratory etiquette, if you’re sick, avoid contact with others, even wear a mask at home if you’re feeling sick,” he said - and even as COVID health measures are being relaxed in Quebec.

In Canada, deaths from RSV are infrequent. There are about five cases per year, almost always associated with significant underlying health conditions, Papenburg said.

In the developing world, however, RSV is a leading cause of mortality in children under five years old, he said.