As Canadians continue to enjoy the last sun-soaked days of summer, physicians are preparing for a possible “triple disease” of influenza, respiratory syncytial virus (RSV) and COVID-19, which would signal the imminent start of respiratory flu season, according to doctors.
The last flu season — which typically lasts from November to March in Canada — saw surges in all three respiratory viruses across the country, especially among children, exacerbated by shortages of painkillers, resulting in more hospitalizations and more frequent community visits emergency room led.
The triple threat of respiratory viruses is expected to hit Canadians again, said Dr. Toronto Public Health Assistant Health Officer Vinita Dubey at a virtual Ontario Medical Association (OMA) conference on Aug. 24.
“We're aligning ourselves with what's happened in the southern hemisphere because winter is ahead of us there,” she said.
“And they certainly had a busy season with those three viruses and we saw that again here last year. We therefore anticipate that there will be a tough respiratory virus season this fall, particularly with the three viruses RSV, influenza and COVID spreading alongside the other viruses at this time.”
It may be the first year since the pandemic is no longer considered a global health emergency, “but COVID is still here,” she added.
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Canadian health experts have long been studying flu season in Australia in preparation for flu season here. This year's flu season in Australia revealed a significant trend: children aged 16 and under bore the brunt, accounting for 72 per cent of hospital admissions. according to Australian health data. The season was also celebrated high RSV rates.
dr Prabhat Jha, an epidemiologist at Unity Health Toronto, said the severity of this flu season is still uncertain for now, but a clearer picture could potentially emerge in terms of COVID-19 cases by the end of September.
“If schools reopen in September and post-holiday activity picks up again, by the end of September we will have an idea of how big the increase might be and we will have sewage and other data that will give us a sense of how widespread it is,” he said.
“Flu season, when it comes, is usually a bit later, as is RSV season.”
What to expect during fall flu season
While cases of respiratory disease are currently relatively low, Dr. Andrew Parks, the president of OMA, warned that the number of cases would likely increase as the fall and winter began.
“Historically, rates of these viruses increase in the fall, when temperatures drop and people spend more time indoors,” he said during Thursday's virtual conference.
Influenza, RSV, and COVID-19 are all transmitted primarily through respiratory droplets. When people congregate indoors, especially in close proximity, during the colder months, these viruses can spread more easily.
RSV and flu, which usually appear slightly later in the fall and winter seasons, started earlier than usual last year, meaning all three viruses peaked around the same time.
During the last flu season, children's hospitals across Canada reported a significant increase in patient numbers, prompting many to cancel major surgeries in order to reallocate staff to help in crowded emergency rooms and intensive care units.
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The situation has been exacerbated by a shortage of paracetamol and ibuprofen for children and the reopening of schools, workplaces and indoor gatherings as COVID-19 regulations are lifted.
Anthony Crocco, a pediatrician in the emergency room at McMaster Children's Hospital in Hamilton, Ontario, said he experienced the worst rise in respiratory viruses in his two-decade practice during last year's flu season.
“Broadly speaking, we saw not only high volume, but also high visual acuity in children who required significant respiratory support and ICU admission,” he said. “With that experience, we now look at this as our pinnacle to be prepared for.”
How doctors and hospitals are preparing
Whether at the provincial, regional or institutional level, there is concern that there will be “further multivirus surges this fall season,” Crocco warned.
There needs to be a plan to deal with the coming season, such as increasing staff and bed capacity and ensuring operating theaters continue to function, he said.
Another plan to relieve hospitals is to divert patients (with less severe symptoms) out of the ER and direct them to alternative healthcare facilities such as cough and cold clinics, GPs, or emergency care.
He said, for example, that McMaster Children's Hospital will open a rapid access area to treat children with less severe symptoms of viral infections from mid-September.
“To try and direct them away from the ER, where we may need the resources that are being made available for more severely affected children,” he explained.
The clinic will act as an ‘overflow' for the emergency department and will operate in the evening hours as most respiratory patients tend to present at night. The goal is to examine patients promptly and release them in a timely manner, he said.
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“So we're confident that that will fix some of the increased volumes that we're seeing,” Crocco said.
Preparations for the upcoming flu season go beyond hospitals and emergency rooms, but also involve primary care physicians, Park said.
“From a practical perspective, it's about making sure our GPs have a stable supply of their vaccines and are ready to go. That they have a stock of personal protective equipment (PPE) to ensure their patients protect themselves when they are sick,” he said.
To curb transmission of the three viruses, RSV, influenza and COVID-19, Dubey is urging Canadians to prioritize hygiene practices and ensure their vaccinations are up to date.
“If you're sick, stay home. If your child has a fever, if they have a new or worsening cough, if they have respiratory symptoms that can spread to others, vomiting and diarrhea… leave your child at home,” she said.
“The goal isn't to keep them home indefinitely, but if symptoms improve for 24 hours, they can go back to school.”
Similar to the measures implemented during the pandemic, Dubey emphasized the importance of preventative measures, including frequent hand washing, appropriate cough etiquette, maximizing time outdoors, and acknowledging the need for increased precautions for those at higher risk (such as wearing masks). ).
And then there's the importance of vaccines, she said.
In early August, Health Canada approved the first vaccine against RSV for adults age 60 and older. There is no RSV vaccine for children, but there are two types of antibody injections that can be given to high-risk babies to prevent serious illness.
“We know that RSV and influenza, these two viruses, can be more serious in children, especially young children. What we have learned from the southern hemisphere, Australia and New Zealand is that children have been hit harder by the flu this season. But we also learned that the circulating influenza virus strains are a good match for the vaccine,” Dubey said.
WHO concerned about COVID resurgence
The fall flu shot isn't available yet but is usually rolled out in October, she said.
“S0 parents can add to the list by getting the flu shot in the fall. Especially getting their kids vaccinated and that's going to be really important to prevent kids from actually getting the flu,” she said.
“The flu vaccine and the COVID vaccine can be administered at the same time this fall.”
As new COVID-19 variants circulate around the world and in Canada, updated booster shots are also expected to be rolled out in the fall.
Canada's National Advisory Committee on Immunization (NACI) released guidance for fall booster shots in July, recommending a dose of the new formulation of the COVID-19 vaccine.
NACI said All Canadians five years and older should receive a booster shot against COVID-19 in the fall if it has been at least six months since their last shot or infection, whichever is later.
In an email to Global News on Monday, a Health Canada spokesperson said the department was “actively reviewing applications received from Pfizer-BioNTech and Moderna seeking approval to use their respective COVID-19 vaccines with the XBB.1.5 Apply for Omicron.” Sub-variant, for individuals six months or older. Checks are ongoing.”
– with files from Teresa Wright and Isaac Callan and Saba Aziz from Global News