Front Burner - What’s sending more kids to the hospital?

Episode Date: November 8, 2022

This fall, most Canadian kids returned to school and daycare with few or no COVID-19 measures. Beyond the coronavirus itself, that's meant all sorts of other viruses have started circulating more widely among children — which is, in some ways, a return to normal. But some are spreading earlier in the season than usual, and hospitals across Canada are reporting a surge in child admissions. Data from Ontario says triple the seasonal average of kids have been heading to the province's ERs with respiratory illnesses. Today, Dr. Fatima Kakkar returns to explain what's driving the surge of kids' admissions, and address parents' concerns over drug shortages and their children's immune systems. She's an infectious diseases pediatrician at Sainte-Justine Hospital in Montreal.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. This is a CBC Podcast. Hello, I'm Jamie Poisson. This fall, most Canadian kids have returned to school and daycare with little or no COVID measures. And putting COVID itself completely aside here, that's meant kids are catching all sorts of other viruses, just like they were before the pandemic. But there's also something unusual happening as our kids get sick, namely in our hospitals.

Data from Ontario says triple the usual number of kids have been heading to its ERs with respiratory illnesses. In Winnipeg, daily admissions at its children's hospital have reached 50% above last November's average. And Montreal Children's Hospital is showing more than twice the amount of patients than beds in its ER. Together, it suggests a surge of common viruses while kids' immune systems are less prepared. And it's happening as our wider healthcare system has been in crisis for months. To explain why and address some of parents' fears, I'm joined once again by Dr. Fatima Kakar. She's a pediatric infectious diseases specialist at St. Justine Hospital in Montreal. Hi, Fatima. Thank you so much for joining me again. Hi, it's nice to be here.

So before we get into what's driving these hospitalizations, I want to understand the scope of this problem. What has the rise in children being admitted look like in the halls of your hospital in Montreal? I have to say, I think it's as bad as I've ever seen it. So I've been at this hospital for just over 10 years and I've never seen it this fall. And I think it's the situation across hospitals. So there's really just no beds. So the wards are filled to capacity. The ICU is filled to capacity and the eMERGE is full. So there's a huge backlog of children waiting for beds, but also children on the wards and in the beds. So we're looking to send home kids and find beds and create new beds,

but there's just so little capacity in the system that it's really oversaturated, as you've described, across the country. And I'm just seeing it all over our hospital here. You mentioned it's as bad as you've ever seen it. So just to be clear, it's worse than COVID. Absolutely. So we were really lucky in pediatrics in that most kids did not suffer the same way adults did. So during the COVID times, there were actually pediatric ICUs that went out to help adults or were taking adults because we had that capacity. And we've never been this busy where our beds were absolutely full. We do get busy usually around December and January when these viruses tend to hit, but it's never been at this level where from all levels from eMERGE to ICU to the regular

pediatric wards, they are full. And so why? Like what is driving all these kids to the hospital? It's really a surge of multiple viruses at the same time. So it's actually not COVID that's causing the majority of hospitalizations. There's a few viruses. And so the one that we're seeing the most is called RSV, respiratory syncytial virus. And that's a virus that we're used to in pediatrics. We've seen it for years and it usually comes around end of December, January, February. We have what we call bronchiolitis, which is really a major respiratory infection that

happens when children get RSV for the first time. And part of what's happening across country is that during COVID, people were taking a lot of precautions. There wasn't the same level of spread of RSV. So we have almost two to three years worth of children who've not been exposed. And so they're getting it for the first time. And when they get that first infection, it's really severe and it can bring them into hospital. And I think if it was just RSV, we'd be able to cope. But in addition to RSV, we have all of these

other viruses and viruses like enterovirus, which causes hand, foot, and mouth, adenovirus, parainfluenza. I mean, just on my list of patients today, I have a whole gamut of viruses. And each one of them, when you catch it for the first time, can cause this level of symptoms. So not only is RSV surging when it shouldn't be, all of these other viruses have come together at the same time. And how sick are kids becoming when they get RSV? Like, let's just use RSV as an example, versus previous years. Like, how likely is it that a kid infected with RSV is ending up in hospital right now? So it's an important point, because I think people are under the misconception that children's immunity has changed. So it's not that a child's immune system has changed or they're weaker. It's just that when they get it for the first time, if they have certain conditions, they can get very

sick. And for example, if you get it for the first time and you're very young, newborn under a month of age, or even in those first few months of life, you really don't have any antibody protection, so you can get it. And we know that up to a third of infants, so under a year of age, when they get RSV for the first time, they can end up with that, what we call severe lung disease, bronchiolitis, and about 2% of them will end up needing hospitalization. So it's not something that's severe in all children. It's just that because there are so many, 2% of the population ends up being quite a bit. And then the other group that's at risk are children who have things like lung disease, like asthma or cystic fibrosis or heart disease. The minute they get a viral infection, it just makes their asthma worse or their underlying

disease worse. It does increase the risk of needing extra hospital care. So just to be clear, is it that just more kids are getting RSV because they're being exposed now versus it being a more severe strain of RSV? And so that's why there are more kids in the hospital? Exactly. So it's not that the RSV is more severe. It's just that instead of having it staggered over the year, and so our hospitals were able to cope, it's just because everybody's getting it at the same time, and they're getting it for the first time. That's why it's so severe, and it appears like it's such a burden of disease. Are we seeing kids die from this?

So we're not thankfully seeing kids die. And most kids, even when they get very severe and they need to be in the ICU and on a ventilator, they will recover from their RSV. Some kids, though, do die, and some kids the same with influenza, but it is very rare. The biggest challenge with RSV is that it just takes a long time to recover. So if you get to the point of needing to be in the ICU, you could easily be hospitalized for two or three weeks until your lungs recover. And so most kids are going to recover from RSV, but it's just a very prolonged hospitalization. Do we know if there's any correlation between kids who previously had COVID and kids who are getting more severe RSV?

Like, is a previous COVID infection making it so that their RSV is worse? No, and I know there's a lot going around on social media and a lot of thought that COVID has changed children's immunity. There's really zero evidence of that, absolutely no evidence to say that the kids have had COVID and they're getting RSV. And this is looking at all our studies, looking at our surveillance data. That said, we are seeing evidence from last winter of a correlation between RSV so if you get RSV you could get what we call pneumococcal disease in the months or in the weeks after it and that's something that children should be vaccinated for and we have vaccines here in Canada but that's an

infection that causes pneumonias and could be quite severe. So there's a correlation between RSV and pneumococcal disease, but not between RSV and COVID. Right. And just picking up on what you've been talking about, I know a lot of parents personally who had children during COVID or have young children, and there's this feeling they have like an immune debt, right? Like because they weren't exposed to viruses for these years that we were in lockdown. And that there's going to be long-term consequence here. Like it's permanently weakened their immune system. And is there merit to the claim that there's an immune debt here? Sure.

This is a great question. And I think I want to dispel some of this because I know people are worried that their children's immune systems have changed. That's not at all the case. And there's really no data. And even in our most severe cases, when we look at their immune profiles, there's really no immunodeficiency just from not having been exposed to these diseases. Their inherent immune system is working fine. immune system is working fine. What's happening is because they're seeing these infections for the first time, and so many of them are circulating at the same time, they're getting them one after the other after the other. So it leaves parents with the impression that their child's nose is always running, they're always running a fever. But once you've had that infection for the first time, the second, third, fourth is going to be much milder and it's just going to be running nose or a slight cough. And eventually you're going to be immune to all of these infections. The next few months and next year and the year after that are going to be much easier.

I have to just say I have a two and a half year old and I feel what you just said so hard that it's just one thing after the next thing after the next thing. It feels like as a parent, you're doing something wrong, you know? No. And again, and especially if there's a child in daycare, I mean, it's going to spread to the whole family. And so they're just cold after cold after cold. But I do want to give parents some hope and some optimism. And that we had something similar here in Quebec last year with RSV and all these seasons. And what happened is by January, February, things were much quieter, much calmer.

The other thing I wanted to talk to you about is related. There's been a shortage of kids' medicines recently, and I'm talking specifically about kids' ibuprofen and Tylenol. And why have they been in such short supply? You can't find them anywhere right now. It is a huge problem. And so what they're telling us is that the manufacturers have no stocks because there has been such a use and people have been hoarding supplies. So the shelves are bare and manufacturers don't keep here in Canada, large backup supplies. And what they're telling us is that they're all backordered because the manufacturing chain getting those primary supplies takes time.

And not just Tylenol, we're now we're looking at children's antibiotics. Amoxicillin, right? Yeah. Absolutely. So we were just discussing this actually on rounds today. And it's really a question of the fact that manufacturers don't keep large stocks of these products. And how is that affecting the treatment of kids? Like, I'm just wondering if more kids are ending up in the hospitals because there's no Tylenol or Ibuprofen. And I mean, amoxicillin is a pretty helpful drug if you have a bacterial infection. So how is this affecting treatment? Yeah, absolutely. It's affecting what's coming

in to emerge. And I can't blame parents because when their child has a fever, you know, child is cranky and irritable and not wanting to eat and not wanting to drink. And when that fever goes on for a few days, they start to look worse and worse and worse. And that's what's bringing parents into the emerge when they can't see another doctor. So if we talk about the Tylenol issue first, I think there's a couple of things that are really important to know. The first thing is that fever on its own is not necessarily a sign that you need to seek medical attention. And a lot of times with these viruses, the fever will go away on its own. The most important thing is how your child looks during the fever.

If they're still playing and drinking and eating, it's not an emergency. The only exception is a newborn. So any newborn under a month of age that has a fever must be seen right away in the emergency. Other kids can wait if they're eating well and they're drinking. Usually by day three of fever, we do want them to be seen by a doctor to make sure there's no ear infection or pneumonia or something more serious. But again, if they look well, but in general, we have up until at least three days before needing to see by a doctor in a clinic just to give them a proper checkup.

Now, if parents are looking for Tylenol, the stuff on the shelves is bare. And I was walking by yesterday. Yes, it's absolutely bare, but there are things that they can do. The first thing is some of the pharmacists are keeping some supplies behind the counter. So I really encourage parents to speak to pharmacists. And then there's different formulations. So young infants, for example, we do have a Tylenol suppository so they can be given without very much discomfort and that can quickly bring down the fever. And then there's adult doses of Tylenol that either some children are actually able to swallow depending on their age and if their weight is enough. Or there's even some pharmacies that can compound the adult

Tylenol into liquid for children. So there are options. And I think any parent who is desperate for Tylenol, trying to bring down the fever, I really urge them to speak to their pharmacist, because I think with all of these solutions, there's something that could be created for their child. Yeah. What about trying to do this at home, like taking half of an adult Tylenol, crushing it up and putting it in a teaspoon of honey? So I just want to be careful with that because the thing with Tylenol in children is we don't want to give too much. And so the smallest adult dose, about 325 milligrams. For that, you have to have a child that's about at least 20 kilos, ideally 25 kilos. And so it's really important that I think before parents do this at home, they definitely know their child's weight. Below 25 kilos, you really have to be careful because

it might be too much. So I would ask that they just consult with the pharmacist to see if they can help them cut the tablets through specific pill cutters as well, or even help them crush it. That was a really, really helpful piece of advice. And just before we move on, we didn't get to amoxicillin yet, how that's affecting children. Just briefly, what kind of effects are you seeing? So this is an issue because it's a very popular antibiotic and a very good antibiotic for things like ear infections and for common pneumonia. And so we're working on the exact same thing as we're doing for Tylenol right now is coming

up with alternatives. So there are some chewable tablets right now in the pharmacy. So we're trying to convert all prescriptions to chewables. And for infants, we'll be able to crush those chewables into a little bit of milk or a little bit of their formula. And if we get to a point where we're out of the chewables, we're going to look at trying to formulate either the adult capsules that the pharmacist will open and mix or come up with an alternative antibiotic. And I want people to be sure there are other antibiotics there on the market that we can use and can give. So we're just within our infectious diseases department coming up with solutions and alternatives to the most common infections.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization, empowering Canada's entrepreneurs through angel investment and industry connections. to hear, you may have seen my money show on Netflix. I've been talking about money for 20 years. I've talked to millions of people and I have some startling numbers to share with you. Did you know that of the people I speak to, 50% of them do not know their own household income? That's not a typo. 50%. That's because money is confusing. In my new book and podcast, Money for Couples, I help you and your partner create a financial vision together. To listen to this podcast, just search for Money for Couples.

It's good news, of course, that you're talking about so many potential solutions here. I just, I can't help but kind of pause listening to you because it's just kind of crazy that this is what's happening right now, that pharmacists are basically trying to create children's Tylenol. It is. We were just talking about this on rounds today. I think there are systems issues that after the fact we're going to have to look at. It's definitely unheard of that we wouldn't have access to these medications. Is this going to get worse, in your opinion, as we head into the winter months? Like, are the next several months going to be worse?

So they could be, I think, if we don't take certain precautions. So the first thing I'm thinking of is influenza. Influenza is just knocking at the door and there's cases rising across country. So if influenza takes hold in pediatrics as well, and on the adult side, we're just going to be running out of hospital capacity to deal with all of these inpatients. And of course, COVID, if that continues to surge and continues to drive a new wave of hospitalizations, especially in adults, it's going to have consequences because during the first two years of the pandemic, both parts of the system, pediatrics and adult medicine were able to help each other out. So there was overflow, there were patients coming to pediatric

hospitals, there was manpower, there was an exchange of nurses. But if RSV, influenza and COVID all surge at the same time, there's very little they're sick, staying home, wearing masks, keeping their distance from some fragile people that will hopefully mitigate some of that worst case scenario. I guess it's worth us mentioning here that there are downstream effects to all of this too, right? I would imagine if you have all of these kids coming into the hospital, you have to redirect staff to care for them, which means maybe surgeries or other procedures that these kids needed would be canceled or postponed? Oh, absolutely. And that's what's happening across the country right now is that because, you know, if you want to run a surgery, you need the ORs, you need the nurses, the anesthetists, the respiratory therapists.

But if you have to cover the emergency department with the respiratory therapists and the nurses, you just can't keep a full roster of operating rooms going. And so there are cancellations and this is on top of the last two years worth of cancellation. So there's really going to be a much bigger backlog of elective surgeries and even non-elective surgeries waiting. And so we're at a point where we thought we caught up a little bit post COVID, but we're on pause again. And a lot of people can't wait that much longer to have their tests and their screening and just their care. So it could really affect more people downstream. Okay. Fatima, thank you so much for this.

We're very appreciative. Thank you. You're welcome. All right, that is all for today. I'm Jamie Poisson. Thanks so much for listening. Talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.