The Hospital for Sick Children in Toronto on Jan. 21, 2021.Fred Lum/The Globe and Mail
Hospitals across the country are seeing a record number of children visiting emergency departments, and the reason has everything to do with the particular moment we are in during the pandemic, health experts say.
“What we’re seeing now is completely unprecedented patient volumes for this time of year, and unprecedented patient volumes almost ever. Normally these types of numbers are reserved for the Christmas holidays when family doctors’ offices are shut down,” said Dr. Daniel Rosenfield, staff physician in the division of emergency medicine at the Hospital for Sick Children in Toronto.
“All these viruses that were basically dormant for two years in kids are now just exploding,” he said, referring to viruses that typically afflict children in the winter, such as influenza, rhinovirus and respiratory syncytial virus.
They had been held at bay by pandemic measures such as masking and physical distancing. Now that more people are interacting in larger numbers and not wearing masks, these viruses are “back with a vengeance,” Dr. Rosenfield said.
It comes at a time when emergency departments typically see a spike in childhood injuries: As more children get out on their bikes or climb trees, there are higher numbers of sprains, fractures and other trauma that send them to emergency rooms. Add to that the fact that many families don’t have a primary care physician, or may not be able to see their family doctor right away, and it is no wonder emergency departments are being overwhelmed.
“What’s happening here is the displaced viral season. The viral mountain has moved on top of the natural seasonal injury and accident mountain and they’re happening at the same time,” said Alex Munter, chief executive of CHEO, a pediatric hospital and research centre in Ottawa. As well, many people are unable to access care elsewhere, he said. “It just feels like a bit of a perfect storm.”
Last month, CHEO reported its busiest May in the hospital’s 48-year history, with an average of 228 emergency department visits a day. Some days that number climbed as high as 300, Mr. Munter said. It was the second-busiest month ever for the hospital, behind the record of 248 visits a day to the emergency department on average set in December, 2019.
The Hospital for Sick Children saw a 12-per-cent increase in in-person visits to its emergency room last month compared to May, 2019. When factoring in visits to the hospital’s Virtual Urgent Care platform, an online tool to get medical advice remotely, that number jumped to 38 per cent.
McMaster Children’s Hospital in Hamilton averaged 140 patient visits a day in May, 2019; that number was up to 185 visits a day last month and shows no signs of slowing down, said Dr. Christopher Sulowksi, chief of the pediatric emergency department.
A spokesperson for B.C. Children’s Hospital said its emergency department is also experiencing high volumes, but did not provide further data.
McMaster Children’s Hospital is seeing higher than usual numbers of children coming to the emergency department with sprains, fractures and other injuries, and Dr. Sulowski wondered whether some children are more eager to be playing outside and might have lost some skills in the past two years. Both CHEO and the Hospital for Sick Children say the visits for injuries typical of this time of year are not higher than previous years.
It’s the viruses spreading among children that are unusual, Dr. Sulowksi said.
“It’s shocking for us when we look at some of the test results we get back and we’re seeing influenza,” he said. “That’s something that just in the Northern Hemisphere in Ontario here at McMaster is unheard of for the month of June.”
The reason is likely because of pandemic measures and our changing behaviours, Dr. Sulowski said.
“We had universal masking and for the most part everyone was masking and schools were requiring masking and so everything just kind of got pushed back. We didn’t eradicate the viruses, I think we just kind of held them at bay with masks,” he said.
The viruses currently circulating have symptoms very similar to COVID-19, and so it’s no wonder worried parents head to the hospital, Dr. Rosenfield said.
“They’re the ones that cause runny nose, coughs, colds, vomiting, diarrhea, all the stuff that would send a parent to the emergency department in the middle of the night,” he said.
Worried parents should know that while a fever is a sign of infection, most can be dealt with at home, and that it is a fever’s duration that is of most concern, Dr. Sulowski said.
“Once you get in to three, five, six days of fever, that’s when we start to worry a lot more,” he said.
To help ease the burden on emergency room visits, several hospitals have created online portals to help guide parents’ decision making, such as McMaster’s www.needadoc.ca and the Hospital for Sick Children’s Virtual Urgent Care platform.
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