The work of respiratory therapists (RTs), and the essential care they provide to people living with chronic conditions like asthma or COPD as well as those with acute respiratory illness like influenza, is widely recognized by both the people they care for and the colleagues they work alongside. But for the general public, the specialized skills and support that RTs provide for patients who are struggling to breathe, was thrust into the spotlight largely due to the COVID-19 pandemic.
As experts in airway management, RTs provide breathing treatments and support for people with chronic and acute lung diseases but also manage airways for anyone in need of mechanical ventilation. They are a critical support within all health care environments – in hospital, long term care facilities, community settings and as part of interprofessional emergency critical care and transport teams. In the response to COVID-19, the expertise of RTs has been in high demand.
“Unless you were there, it’s hard to describe the experience of the past few years,” said Perry Komonko, an Advanced Practice RT and founding member of the Adult Patient Transport team who has been involved in the safe transport of patients requiring breathing support for more than 22 years.
“Wearing full PPE, sweat running down our backs, transferring very challenging and critically ill patients, and constantly worrying about the COVID patients whose condition could take a turn, often without any warning.”
COVID is not the first time that RTs have been asked to commit their skills to a pandemic response. RTs are highly trained to conduct respiratory tests, monitor oxygen levels and support patients in need of specialized equipment and are regularly called upon during respiratory virus outbreaks – whether influenza, SARS, H1N1, and now COVID-19 –to help people breathe.
It’s a role that does not have a “typical” day, with treatments and tasks largely determined by the care environment and patient population being supported.
“In our heads, we are constantly running through every scenario of what might lie ahead, what might happen and then what we would do, how we would react and intervene,” said Komonko. “Anticipating and reacting are key skills that RTs develop over time. Regular skill days in the simulation lab are so important to an RT’s ability to anticipate and react, while keeping up and evolving our practice.”
Komonko supports the continuous education of a number of colleagues in his role as a Clinical Services Lead, supporting RTs in practicing scenarios with conditions they may not often encounter, allowing them to refresh their training on equipment and with skills they may require when caring for a patient.
“I hope that my experience and my history can support the team and offer a voice of reason or guidance that will help them as they manage their patients,” added Komonko.
It’s this supportive environment, where experiences are shared and ongoing learning is prioritized, that has kept Todd Mortimer, an Advanced Practice RT and Clinical Services Lead with the Child Health Transport Team, energized and invested in his work as a RT for more than 33 years.
“It’s a bit more of an obscure allied health profession but it’s a fascinating field with broad opportunities to work in so many different areas, whether acute, critical care, long-term, chronic,” said Mortimer. “No matter what area you work in, however, you need to be nimble, a problem-solver, able to adapt and able to collaborate. We work with so many other members of different health professions.”
COVID-19 isn’t Mortimer’s first pandemic. In 2009, he worked on the front-lines of Manitoba’s response to H1N1, supporting the care of children admitted to the pediatric intensive care unit at HSC Winnipeg’s Children’s Hospital. His experience – and the role of respiratory therapists in “Helping Kids Breathe Easier” helped to inspire the next generation of RTs, including John Huynh.
“I became an RT approximately nine years ago after seeing a feature about the role of RTs at HSC Children’s during the H1N1 virus,” said Huynh, an RT and member of the Shared Health Inter-Facility Patient Transport Team. “RTs were obviously making a big difference for all of those kids, supporting their breathing. I investigated the role further and I’m so glad to this day that I kind of stumbled onto this profession.”
“Respiratory therapy is the perfect profession for anyone who wants to work in a career that involves close human connections and has a commitment to lifelong learning. Every single day you will make a difference and learn something new,” added Huynh.
The next generation of RTs includes new graduates like Hannah Chale, who has been on the job for only a few months since completing her education at the University of Manitoba Rady Faculty of Health Sciences.
“I finished my schooling but I have my entire life to learn about the role of RT and how we can improve the quality of care for our patients,” said Chale who works as a member of the Adult RT team at HSC. “I can’t say enough about how much I love that this profession will continue to evolve, grow my skills and change over time. The learning doesn’t stop when you finish school.”
“RTs play a critical role in the hospital and in the community helping with the treatment of respiratory conditions as well as improving the quality of life for the large population of people who suffer from breathing problems,” added Chale. “Being able to contribute your skills and knowledge and then seeing how much your work can improve someone’s outcome and quality of life is very rewarding.”
This week, as we celebrate the contributions of respiratory therapists not only this year, but every year, we invite RTs, their health care colleagues and patients from across the province to reflect upon the difference this group of professionals make every day in the lives of Manitobans. Send us your stories to email@example.com or tag @sharedhealthmb in your posts on social.
October 24 to 28 is Respiratory Therapy Week. For more information, visit Canadian Society of Respiratory Therapists website.
Most B.C. residents under 60 have been infected with COVID-19 or vaccinated: study – Prince Rupert Northern View – The Northern View
A large study that chronicles the trajectory of COVID-19 over the first 2-1/2 years of the pandemic suggests most British Columbia children and adults younger than age 60 developed antibodies to slash their risk of severe illness — either through vaccination, infection or both.
Lead author Dr. Danuta Skowronski, an epidemiologist at the BC Centre for Disease Control, said the findings can be generalized to the rest of Canada due in part to a push to deliver first doses of vaccine and the “beast” of Omicron, which drove wave after wave of infections.
Antibodies to SARS-CoV-2, the virus that causes COVID-19, can be detected in the blood of people who have recovered from the disease and among those who have been vaccinated.
Researchers looked for antibodies in the leftover blood of a total of 14,000 people who had lab tests in British Columbia between March 2020, before the World Health Organization declared a pandemic, and August 2022, as the fast-spreading Omicron variant was evading vaccine protection.
They did eight analyses, amounting to snapshots of the virus’s presence in the population over the research period.
The study, published Monday in the Canadian Medical Association Journal, found that by January 2021, less than five per cent of people had been exposed to the virus.
But the proportion of those with COVID-19 antibodies rose to 56 per cent in June 2021 as vaccines were rolled out. It shot to 95 per cent in August of this year through a combination of vaccination and infection as Omicron became the dominant variant.
“The highest infection rates were in children and in parental-age adults. That likely reflects their greater interconnectedness, socially,” Skowronski said, adding that while data from other provinces is limited, similar findings have been reported in the United States.
The lowest infection rates were in the very old, as seen elsewhere in the world. She said that was possibly due to social isolation, and a high rate of vaccination and boosters among this age group, which is also at greatest risk of severe illness.
That points to the need for older adults to be prioritized for vaccination, Skowronski said.
The BC Centre for Disease Control launched similar seroprevalence surveys, which measure the attack rates of a particular illness in a population over time, during the 2009 swine flu pandemic caused by the H1N1 influenza virus.
It has completed several surveys during the COVID-19 pandemic, including one published in September that suggested at least 70 to 80 per cent of children and youth in Greater Vancouver and the Fraser Valley of B.C. had been infected. Another seroprevalence study is set to begin later this month to continue monitoring the virus’s tracks, Skowronski said.
The data can inform real-time policy decisions because without antibodies, a vast proportion of the population is susceptible to infection in a pandemic and that would crush the capacity of the health-care system, she said.
“As (the research) was unfolding, there were several points that I thought were really quite remarkable and in some ways a testament to the decisions that had been made in B.C., but not only in B.C., in Canada, because I think our findings are generalizable to other areas.”
Quick vaccine rollouts helped prevent further spread, she said.
“Canada went from being in a precarious position in January of 2021 in terms of vaccine supply to by June of 2021 being the world leader in vaccine coverage — outstripping the United Kingdom, even Israel, in terms of the proportion that had been vaccinated. And we show that in our seroprevalence survey, that swift uptake in vaccine coverage.”
Caroline Quach-Thanh, a professor in microbiology, infectious diseases and pediatrics at the University of Montreal, will co-lead a study surveying antibodies in children up to age 17 to detect the presence of past COVID-19 infection and/or vaccination.
The research team wants to obtain 36,000 samples of leftover blood from emergency departments in 14 children’s hospitals over five testing periods starting in January 2023.
The yearlong study will involve all provinces except Manitoba. New Brunswick and Newfoundland and Labrador will be excluded because they do not have children’s hospitals.
The hope is to gain more data on how COVID-19 has impacted youth across various provinces, and to be on the front lines of whatever the pandemic may bring next, Quach-Thanh said.
“The question is: Are we able to pick up something new that might be coming?”
—Camille Bains, The Canadian Press
'Intense' flu season hits Canadian kids hard, landing more in hospital – CBC News
Flu infections are raging among children and hospitalizing them across Canada, say pediatricians who are calling for urgent and longer-term solutions.
On the weekend, hospitals across the country were forced to scale back regular service to deal with a surge in influenza illnesses:
- CHEO in Ottawa said the Red Cross will be deployed to help out with its surge of cases.
- A respite care facility in Calgary closed to redeploy staff to a children’s hospital.
- BC Children’s Hospital declared an emergency for 30 minutes on Saturday to quickly boost capacity and resources.
- Newfoundland and Labrador’s children’s hospital cancelled some scheduled surgeries and appointments.
Doctors say the moves reflect a surge in influenza on top of long-standing pressures on both pediatric hospitals and care providers in the community. Cases of respiratory syncytial virus (RSV) have, in the meantime, stabilized after spiking earlier this season.
For the week ending Nov. 26, the Public Health Agency of Canada’s FluWatch reported 223 influenza-associated hospitalizations among children 16 and under.
That’s up from an average of 11, with a maximum of 35, at pediatric hospitals from 2014-15 to 2019-20, says Dr. Jesse Papenburg, a pediatric infectious-disease specialist at Montreal Children’s Hospital.
“This shows that we have had an early and intense influenza season so far this year, hitting the pediatric population particularly hard,” he said in an email.
Similarly in the U.S., Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Monday that flu is at its highest level the U.S. has seen for a decade. So far this season, 14 youth in the U.S. have died.
Federal health officials haven’t released the exact number of influenza deaths among those aged 16 and under so far this season but say it’s fewer than five. The number of deaths for that age group were in the single digits annually before the COVID-19 pandemic.
Bend the curve with flu shots
Influenza is “overwhelmingly … causing a lot of problems,” particularly for children under five, said Dr. Fatima Kakkar, a pediatric infectious diseases specialist at Ste. Justine’s Hospital in Montreal.
But it’s not necessarily the flu, alone, that’s the problem, she says.
Rather, kids catch the flu, which leaves them prone to “really significant bacterial infections,” like pneumonia — and that’s when they land in hospital.
Kakkar says she’d like to see an emphasis on influenza vaccination for children, including publicity campaigns.
“I say this because I think it’s not too late and especially in parts of the country where influenza hasn’t taken hold, I would really like to see people encouraging and making it easier for parents and their children to be vaccinated.”
Whitehorse-based pediatrician Dr. Katharine Smart called it “immensely concerning” that children who are acutely ill and need attention quickly are having trouble receiving it.
But there are other, bigger-picture problems throughout the pediatric health-care system that deserve attention, she says.
Smart, past president of the Canadian Medical Association, cites wait-times for surgery for young people with scoliosis, or curvature of the spine, as an example.
“I’ve had patients that had to put off their post-secondary school planning because they don’t know when they’re going to get the operation and the recovery,” Smart said. “They say, ‘Well, how do I go off to college if I don’t know that I’m going to now have to have a massive spine surgery and be out of commission for weeks or months?'” she said. “Some of these [teens] have been waiting three to four years for this operation.”
Other health-care needs for children are provided outside of the hospital, which is especially important in the first years of life, such as autism services. Some kids aren’t able to access services to improve their speech, social skills and cognition. Once a child is in kindergarten, they may no longer be eligible for certain help because the developmental window to intervene has closed.
“These are problems that we’re seeing across the country,” Smart said. She suggests bolstering nurse staffing and retention.
She also wants to see more uptake of the flu vaccine among children and adults, to “bend the curve” for overwhelmed health-care systems.
The good news, Papenburg says, is that the influenza A H3N2 strain that is mainly circulating in Canada now is genetically the same as the strain in this year’s influenza vaccine. “That bodes well for good vaccine effectiveness, although that needs to be assessed in field studies now underway.”
In the long term, researchers are evaluating newer vaccine technologies for better, longer-lasting flu immunization, he said.
Like Smart, Papenburg suggested governments “invest in our child health care systems capacity, so that we can better handle these types of unpredictable surges of infections in our pediatric population.”
“When you look at Canada, we rank 30th out of 38 countries for childhood well-being,” Smart said. “It’s really shocking to think a country, as wealthy as ours, is doing that poorly for our kids, but it’s because we do not have a strategy for children.”
Health officials also recommend that people mask in indoor public places, screen daily for respiratory symptoms, stay home when sick, practice hand hygiene and keep surfaces clean to reduce the spread of respiratory illnesses such as RSV and flu.
Health officials in B.C. urge flu vaccination for young children as hospitalization rates surge – The Globe and Mail
Prime Minister Justin Trudeau is urging parents to get their children vaccinated against the flu, as provincial governments across the country scramble to deal with hospitals overflowing with sick children.
Hospitalizations of children with flu have skyrocketed across the country, with more children admitted with influenza than at any other time in at least a decade, according to surveillance data.
Mr. Trudeau said Monday he is alarmed about the rise in respiratory illnesses, and called on Canadians to “step up again” to get vaccinated against both COVID-19 and the flu to keep their families and communities safe.
“I’m extremely worried about what Canadian kids are facing right now. Families are really worried about whether they are going to be able to get their kids to hospital,” he told reporters at an unrelated news conference.
British Columbia is heading to a record year for flu vaccines, but a push to protect seniors has left the most vulnerable group – children under the age of 5 – behind. This weekend, public-health officials are launching an influenza vaccination blitz for young children who are most at-risk of severe illness.
More than half of B.C.’s seniors have been vaccinated for the flu this year, but only 20 per cent of children between the ages of six months and 4 years have had a flu shot. With the holiday season approaching, health officials are hoping to boost that rate in the coming week.
Dr. Bonnie Henry, Provincial Health Officer, told a news conference on Monday that the annual flu season arrived early, in mid-November. At that time, BC Children’s Hospital was already cancelling dozens of surgeries owing to staff shortages and a surge in respiratory infections. It is influenza, not COVID-19, that is driving the patient load, and the virus has not yet peaked, according to Dr. Henry.
“We’re still early on in this trajectory of influenza. We’re starting to see the impact of a large number of children who haven’t been exposed to influenza for a few years, and a small proportion of them are getting severely ill,” she said. “But we still have time to blunt the impact.”
Pediatric emergency services at major hospitals have already been reorganized to deal with the surge in cases in the province, however, BC Children’s Hospital briefly activated a “Code Orange” alert on Saturday morning because it did not have the resources to manage demand.
B.C. Health Minister Adrian Dix told reporters the province has taken a number of steps to mitigate the pressure, such as bringing in pediatricians to treat patients in the emergency department at Victoria General Hospital, and creating an emergency satellite clinic at BC Children’s. Starting next week, Surrey Memorial Hospital will place emergency room physicians at the Surrey Urgent and Primary Care Centre so that it can redirect some patients, and Peace Arch Hospital will offer pediatric services at its rapid care clinic.
In Ontario, the government of Premier Doug Ford faced questions on Monday over how it could have allowed a surge in patients to force one of its premiere pediatric institutions, the Children’s Hospital of Eastern Ontario in Ottawa, to call in the Red Cross to help.
The local MPP for CHEO in the riding of Ottawa South, Liberal interim leader John Fraser, said this shows the government had failed to plan properly for the fall surge in illness.
“It is absolutely incredible to me that we’re calling in an organization that deals in humanitarian disasters to help out,” Mr. Fraser said.
In Question Period, Ontario Opposition NDP Leader Peter Tabuns said the move shows the government was caught flat-footed by the situation in children’s hospitals. Progressive Conservative MPP Robin Martin, the parliamentary assistant to the province’s Health Minister, responded by saying that bringing in the Red Cross “was certainly part of our planning to make sure we had the care we need for pediatric patients at CHEO and other pediatric hospitals.” However, Hannah Jensen, a spokesperson for Ontario Health Minister Sylvia Jones, later said that calling in the Red Cross to help hospitals was not part of the government’s surge plan.
Mr. Ford, alongside the Prime Minister for an unrelated announcement at a GM plant in Ingersoll, Ont., praised the chief executive officer of CHEO, Alex Munter, for “thinking outside the box” in dealing with the situation at his hospital. But he did not answer a question about whether using the Red Cross was part of the government’s plans, instead listing its pledges to increase health care funding and the number of nurses.
In Alberta, 65 staff have been redeployed from the Rotary Flames House and five outpatient clinics to help with the surge in respiratory illnesses. Some medical staff have also stepped down from corporate positions to work the front lines, said Margaret Fullerton, senior operating officer of the Alberta Children’s Hospital.
At the affected clinics, Ms. Fullerton said there is a 30-to-50-per-cent reduction in services related to orthopedics, nephrology, gastrointestinal, pulmonary and surgical services. She said patients with urgent needs will continue to be prioritized in those clinics, but other appointments will be postponed.
Ms. Fullerton said there are contingency plans in place at the hospital should respiratory care needs grow, but she did not provide details. Kerry Williamson, a spokesperson for Alberta Health Services, said there are no plans at this time to bring in support from outside agencies, such as the Red Cross in Ottawa.
Alberta Health Minister Jason Copping said Monday there are indications that a spike in flu cases may subside soon but acknowledged that there are likely to be future bouts of respiratory infections in the coming months. He said the government is finding ways to move people through the system quicker, but in the long-term is focused on building capacity.
Most B.C. residents under 60 have been infected with COVID-19 or vaccinated: study – Prince Rupert Northern View – The Northern View
Bedard, Fantilli headline Canada’s selection camp roster for 2023 World Juniors – Sportsnet.ca
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