Triple the usual number of kids are coming to Ontario ERs with respiratory illnesses. Here's why

Respiratory illnesses are running rampant among children, resulting in hospital visits and admissions at far higher rates than normal for this time of year, according to fresh data from hospitals across Ontario. 

Similar surges are being reported at hospitals across Canada. Although no other province makes public as much data on respiratory illnesses, experts say Ontario's figures help give a clearer picture of the extent of the problem nationwide. 

The number of kids aged five to 17 who came to hospital emergency rooms with respiratory complaints over the past week was more than triple the seasonal average, according to Ontario's Acute Care Enhanced Surveillance (ACES) database. 

For kids up to four years old, daily ER visits for respiratory illnesses during the same period stood at more than double the usual number, ACES showed Wednesday. 

Combining the two age groups, it means some 2,160 children visited ERs for respiratory illnesses each day in the province over the past week, a time of year when that figure historically averages about 800. 

The trend is happening at comparable rates across all regions of Ontario and, in some cases, is putting hospitals under such pressure they've had to cancel surgeries or redirect patients.

Medical experts link the surge in illnesses among children to the withdrawal of preventive public health measures such as mask-wearing that had been in place since the start of the COVID-19 pandemic. 

'Immunity isn't quite where it was'

Without distancing and mask mandates, children are getting exposed to more germs. And because of the public health measures, those germs are ones that kids' immune systems have had little recent exposure to, such as rhinovirus, enterovirus and respiratory syncytial virus (RSV).

It means viruses that typically give kids a common cold are instead driving an autumn surge of ER visits and hospitalizations. 

"Part of the complexity right now is there's just a lot more illness spread out of the changes in our public health mandates," said Dr. Charmaine van Schaik, a pediatrician and chief of staff at Southlake Regional Health Centre in Newmarket, Ont. 

"At the same time, we've come through two years of relatively protected environments for young children, so their immunity isn't quite where it was." 

Another contributing factor cited by some doctors: lower-than-normal availability of children's acetaminophen and ibuprofen. The intermittent shortages of children's Tylenol and Advil mean that a greater number of parents are unable to control their kids' fevers at home, prompting more to make a trip to the ER. 

Admissions putting hospitals under pressure

Dr. David Carr, an emergency physician who works in ERs in downtown Toronto and the suburban cities of Vaughan, Ont. and Richmond Hill, Ont., says he is seeing and admitting a disproportionate number of children. 

"This is something that I'm not used to," Carr said.

"Pediatric patients rarely require admission, at least compared to our adult patients," he said. "Usually you see a child, they have an ear infection or a sore throat, they go home."

The ACES database confirms that hospitals across Ontario are admitting an unusually high number of children for respiratory illnesses: 2.5 times the pre-pandemic average for this time of year. 

Dr. Joe Wiley, chief of pediatrics at Oak Valley Health in Markham, Ont., describes the numbers of children coming to hospital with respiratory illnesses as unprecedented. 

"It's much higher volumes and much earlier in the typical cough and cold season than I've ever experienced," said Wiley in an interview at Markham Stouffville Hospital. 

"We're definitely seeing increased numbers of admissions," Wiley said. "We're under pressure here and in speaking to colleagues at other hospitals, I know they're experiencing similar pressures." 

The surge in ill children is affecting hospital operations around Ontario. 

• McMaster Children's Hospital in Hamilton is preparing to transfer teens to adult hospitals and reduce scheduled surgeries because of "extreme challenges" in its emergency department, critical care and inpatient wards, according to a memo from hospital leadership last Friday. 

• The University Health Network in Toronto alerted staff last Thursday that the emergency department at Toronto General Hospital was at capacity and urged doctors to direct patients to other emergency rooms and specialty clinics. 

• CHEO, the children's hospital in Ottawa, began cancelling some scheduled surgeries and redeployed staff last week amid what its chief executive described as "an unprecedented surge in demand" in its emergency room.

ERs already stretched thin

The wave of illness among children this autumn comes at a time when hospitals have been struggling for months with staffing challenges. Meanwhile, many in the system expect to see a rise in influenza and COVID-19 cases in the coming weeks as colder weather keeps people indoors, making it easier for infectious disease to spread. 

WATCH | Respiratory illnesses among children is on the rise: 

New data reveals extent of children's hospital ER surge

2 years ago

Duration 3:31

Children's hospitals in parts of Canada are still facing an unprecedented surge in ER visits and intakes, due to a huge spike in respiratory illness among kids. In Ontario, kids five to 17 are going to ERs with respiratory complaints at more than triple the seasonal average.

Emergency departments have been under sustained pressure for months, with high numbers of admitted patients stuck in the ER because there are no beds available for them on hospital wards, said Anthony Dale, chief executive of the Ontario Hospital Association.

That is translating into longer than normal ER wait times for people whose cases are less urgent and ambulance shortages as paramedics spend hours waiting to offload their patients. 

"This is still a very, very difficult and ongoing challenging situation within Ontario's hospitals," Dale said in an interview. 

In other provinces: 

• Montreal Children's Hospital had more than double the number of patients than beds occupying its emergency room on Wednesday morning, according to publicly posted wait-time data. The hospital is seeing "an unprecedented amount of children coming to the emergency department and higher volumes of sicker children, many with respiratory illnesses," its medical director Dr. Laurie Plotnick said in an interview last week.

• Total emergency room visits to B.C. Children's Hospital in Vancouver are running at 20 per cent above normal for this time of year, a spokesperson for the Provincial Health Services Authority said in an email. 

• The main children's hospital for Atlantic Canada, the IWK Health Centre in Halifax, is seeing a sharp increase in the number of children coming to the emergency room and getting admitted for respiratory infections, its chief of pediatrics told CBC Nova Scotia Monday. 

• Winnipeg's Children's Hospital is seeing a spike in the number of children being admitted to hospital with respiratory issues