COVID deaths and ICU admissions are low while flu and RSV are rising. Some experts are predicting a 'more intense' virus season than normal

Get the latest from Sharon Kirkey straight to your inbox

Article content

It’s difficult to know how any respiratory virus season is going to shake out, “but if I had to bet the house,” Matthew Miller sees a somewhat more intense season than what we’re used to, pre-pandemic.

The situation now isn’t what it was a year ago, when lineups at children’s emergency departments snaked out the doors and parents resorted to furtive cross-border trips to stock up on children’s Tylenol during a months-long shortage of kids’ fever relievers.

Advertisement 2

Article content

Article content

Last year’s RSV (respiratory syncytial virus) season peaked unusually early, with infections shooting up beginning in September, after a near total disappearance during the earlier days of the pandemic, when measures in place to curb COVID’s spread also led to relatively little circulating RSV activity.

RSV is currently on the “high end of normal,” said Miller, and, despite an earlier spike last year, “those lines are starting to meet now.”

“It wouldn’t be crazy to think that we’re going to have a more intense respiratory season than usual,” said Miller, director of McMaster University’s Michael G. DeGroote Institute for Infectious Disease Research.

To get a sense of what winter might bring in the form of any viral onslaught, experts look to the southern hemisphere, which experiences their respiratory seasons over our summers. Australia has some of the best data for monitoring the “triple-demic” of RSV, influenzas, and COVID-19.

Australia saw an earlier-than-normal start to its flu season, and higher than pre-pandemic levels of infection, Miller said, as well as above seasonal norms for RSV.

Advertisement 3

Article content

One recent study suggested COVID-19 infections may have been a driving force for the 2022 surge in RSV infections among children five and under, possibly because of the effects of SARS-CoV-2 on a child’s immune and respiratory systems.

In Canada, flu is increasing, but is within expected levels for this time of year, according to the Public Health Agency of Canada’s latest respiratory disease surveillance report.

Nationally, the COVID-19 per cent positivity — of those tested, the proportion that test positive — has remained stable over the past five surveillance weeks. There are signs weekly COVID-19 deaths are decreasing, and the number in ICU remained low for the week ending Nov. 21.

“We’re not getting a lot of serious, life-threatening cases that need admission to hospital or are overrunning ICUs like we were,” said Dr. Mike Howlett, president of the Canadian Association of Emergency Physicians.

Influenza looks like it’s on a “pre-pandemic trajectory,” and is just beginning to rise, said McMaster University immunologist Dawn Bowdish. Flu season usually peaks between December and February.

Advertisement 4

Article content

“We’re not in the same absolute disaster as we were last year’s cold and flu season,” Bowdish said. “But we’re still experiencing so much health-care strain that even fewer hospitalizations are still really problematic,” Bowdish said.

Emergency departments are still overcrowded. People who need to be admitted are being “boarded” in hallways on stretchers. “I know some hospitals where the waiting time for admission has gone up from 20, 30 hours on average to 50, 60 hours on average,” Fowlet said.

In many ways, hospital crowding is worse now than previous years because underlying conditions haven’t been addressed, Fowlet said, including hiring enough emergency physicians and nurses to manage caseloads. As the National Post has reported, Canadian hospital capacity has been limping along for decades while governments and policy makers, Howlet said, have been “playing around the edges.”

“There’s not a health system in Canada that isn’t understaffed and struggling to deal with emergency admissions as it is,” Bowdish said.

The concern is post-Christmas, when viruses traditionally spread from kids to parents and grandparents, and adult hospitalizations become a problem, she said.

Advertisement 5

Article content

Doctors are seeing some increase in childhood pneumonias. RSV is a common cause of pneumonia and bronchiolitis in young kids, “and I’m seeing more RSV than COVID right now,” said Howlett, who was recovering from what he suspected was an RSV infection he caught from his six-month-old grandchild.

Symptoms of RSV are broad, including common cold-like ones — runny nose, cough, sore throat, muscle aches and pains, and nausea, vomiting or occasional bit of diarrhea sometimes.

The more worrisome symptoms are a worsening cough and shortness of breath. The airways in the lungs of babies and infants are narrower. If a virus gets into the lungs, and secretions start to accumulate in the airways, they can run into difficulty with breathing.

It’s the younger ones, children between three months and 18 months of age, who tend to run into trouble. “They can start having significant wheezing, shortness of breath, rapid breathing,” Howlett said. “Their ribs are sucking in between their chest and under their chest, there’s some tugging around their neck from the muscles because they’re trying to get the air in.” Some need to be admitted to hospital for extra oxygen.

Advertisement 6

Article content

Nationally, COVID activity has stabilized, though trends vary across the country. “Weekly deaths and the number in ICU remain low,” according to the federal government’s update for the week ending Nov. 21.

The COVID test positivity rate is around 19 per cent. “There’s no doubt that it’s circulating,” said Dr. Catherine Hankins, former co-chair of the Canadian Immunity Task Force.

“People have a certain amount of immunity. But it’s not like measles where you get the infection and you get the vaccination and you’re pretty much protected for life,” Hankins said.

Most of what’s circulating now are the XBB lineages, which the updated boosters were tailored to target.

“I think we’re at a point with COVID where we’re sort of equilibrating,” Miller said. There are going to be year-to-year variations, he said. “I know it’s felt like an eternity, but really, it’s only been four-ish years since COVID’s been around. It’s not yet clear what the average level will be.”

For COVID, the high-risk groups haven’t changed. Older adults and those with underlying medical conditions are at highest risk of severe infections.

Advertisement 7

Article content

“There are some pieces of good news, though,” Miller said. This year’s flu vaccines appear a good match for viruses expected to circulate this winter. “If people get vaccinated now, they’ll generate immunity over the next two weeks” when cases are expected to begin rising, he said.

In August, Health Canada approved an RSV vaccine for adults aged 60 and older. However, the shots, which cost about $230 per dose, are not publicly covered by most provinces, even though RSV is one of the “big, underappreciated health burdens in older adults,” Miller said.

Human behavior can shape the spread of seasonal viruses, said Hankins, a professor in the School of Population and Global Health at McGill University.

“How many people get their flu vaccine? Get their COVID booster?”

Governments should make the RSV vaccine free to people 60 and older, she said.

She visited a Christmas market twice this weekend. “I saw one other person wearing a mask — these are tents where the air is kind of steamy and it’s packed with people.”

“We’re not going back to the old lockdown mentality,” Hankins said. “We have to go back to figuring out what is your risk tolerance, and how much risk are you prepared to take for yourself and the people around you.”

National Post

Related Stories

Our website is the place for the latest breaking news, exclusive scoops, longreads and provocative commentary. Please bookmark and sign up for our daily newsletter, Posted, here.

Article content

Get the latest from Sharon Kirkey straight to your inbox
  1. Advertisement 2

Source link