Inside an Ontario hospital bracing for a surge in adult patients — while overflowing with sick kids

Lying with a stuffed monkey in his hospital bed, with oxygen tubes attached to his tiny nose, four-year-old Wolfgang lets out a few scratchy chest coughs.

On this afternoon in early December, the little boy with big eyes and tousled brown hair is one of the youngest patients at Markham Stouffville Hospital, north of Toronto. He was admitted a couple of days earlier to the facility's over-capacity pediatric unit for pneumonia — his third bout since starting kindergarten in September.

As a child with severe asthma, Wolfgang — who usually goes by "Wolfy" — is particularly vulnerable during this "brutal" viral season, says his mother, Mary Doering.

"It's hard to see your little guy struggle," she says.

This fall, the explosive return of respiratory viruses started putting immense pressure on a health-care system that's long been under strain — a quiet crisis, playing out behind closed doors. 

While sweeping pandemic measures kept a variety of pathogens at bay for months on end, they've all roared back, from influenza to RSV, with COVID-19 now firmly in the mix. 

It's no secret that kids like Wolfgang are currently bearing the brunt. But that could be just the tip of the iceberg of infections in the months ahead.

Hospitals like Markham Stouffville are now bracing for a potential surge of adult patients as well, and expecting pressure from both ends of the age spectrum at a time when resources are already tight and staff shortages are a constant battle.

"Our real concern is the severity of illness that we are seeing in the kids, and we are expecting to see more adult cases; usually they come two to three weeks after the kids cases peak," says Dr. Jeya Nadarajah, an infectious diseases physician with Oak Valley Health, who works at Markham Stouffville. 

"We are also predicting a more severe set of adult influenza, too."

Staff hold regular briefings during virus surge

Inside the office of Oak Valley Health chief executive officer Jo-anne Marr, she logs into a virtual call with staff from across the hospital. What was once a daily COVID-19 briefing is now a weekly check-in for the return of a broader, if rather unusual, respiratory virus season.

Speaking first, for the infection prevention and control team, Nadarajah raises questions over how long the peak of this year's influenza season will last, and says local pediatric hospitals are still seeing high levels of patient admissions.

"The bottom line with modelling when you're looking at a season with co-infections of COVID and influenza, is that our best weapon is still vaccination," she says on the video call. 

"That seems to be the only thing in the modelling that will slow the peak and keep it [lower] so hospital capacity can keep up."

After the briefing, Marr tells us that the hospital is doing all it can to manage patient loads. 

"It is a challenge, there's no question," she says.

Across the country, children's hospitals have similarly raised alarms about their units being over-capacity, while emergency departments have reported lengthy wait times. A hospice in Calgary temporarily paused its services and discharged its young patients to redeploy staff to the Alberta Children's Hospital; a pediatric hospital in Ottawa was forced to bring in the Red Cross for staffing support. 

At Markham Stouffville, the kids' unit is now regularly overflowing. 

Pediatric unit regularly over-capacity

On this day, the pediatric department is running at around 220 per cent capacity — while staff are taking on extra shifts and trying to find additional beds for the high number of sick children still being admitted. 

Walking through the hallways, you can hear the faint cries and coughs of kids coping with all kinds of respiratory bugs behind the closed doors of their hospital rooms.

Behind the main desk, chief of pediatrics Dr. Joe Wiley debriefs with Silva Nercessian, clinical director of the childbirth and children's program at Oak Valley Health. 

Staff are tired, Wiley tells us. The space is funded for five beds, but lately, the team has been caring for a dozen or more children on any given day — still small numbers, but it all adds up.

This week alone, Wiley has taken on three extra shifts to help keep the team afloat.

"We are ready for 300 per cent-plus capacity here," adds Nercessian. "But if we want to go higher than that, we have to start creeping into our adult spaces."

That's where things get tricky.

From her office elsewhere in the hospital, Nadarajah tells us Markham Stouffville is bracing for at least 20 per cent more adult admissions in the next couple of months than during a typical flu season.

"The worst case scenario," she said, "is anything above that."

The projection likely applies to hospitals elsewhere, since it's based on a few factors, including a careful watching of the earlier flu season in the southern hemisphere — which started early, like Canada's did this year — coupled with Canada's flu vaccination rates, which have long been stubbornly low.

During the last three flu seasons, the number of Canadian adults signing up for an annual flu shot hovered around 40 per cent. Even seniors, a group at higher risk of serious illness, didn't hit the federal government's goal of 80 per cent coverage; only around 70 per cent of Canadians aged 65 and up got the shot between 2019 and 2022.

If this year's season follows that trend, Nadarajah says plenty of older individuals will wind up hospitalized — which would force the hospital to shuffle resources and add beds in unorthodox areas, like ultrasound clinics.

But that's no easy task, particularly if more staff start catching the flu as well, forcing them to take time off.

"Because of the steep climb, we just haven't had a chance to expand our bed capacity, and after two years of a lot of staffing shortages in the health-care system, it's just really compounded," Nadarajah said.

3,000+ visits to new COVID-19, cold, flu clinic

To keep people from needing a bed in the first place — and to take pressure off other teams — the hospital is banking on a new clinic to help treat people on an out-patient basis.

It's been dubbed the COVID-19, Cold, and Flu Care Clinic, or CCFCC, and just opened a few weeks ago, transitioning from the hospital's previous COVID-19 assessment centre.

As Dr. Cristina Popa, the CCFCC's physician lead, walks our crew through the clinic's hallways, she explains how the space keeps patients with respiratory symptoms safely separated from other patients, while providing private isolation rooms for families where multiple members are battling similar bugs.

It's also appointment-based, she says, so people aren't stuck waiting — and coughing — in the busy nearby emergency department.

In just a few weeks, the clinic has seen more than 3,000 patients.

"It is really good for the emergency department because we can take all this volume away," Popa says. "We allow the ED to take care of sicker patients."

Given all the efforts to boost capacity and transition to a new clinic model, teams here are hopeful they'll weather the storm ahead. But as Nadarajah says, it could be a long journey.

"We are essentially preparing for the worst, which is a high peak of [influenza], a sustained peak and then coming down … that way if we're pleasantly surprised that it's not as bad, then you know what, we over-prepared — but it's for good cause," she says.