Reassigning staff and postponing surgeries are just some of the steps being taken at HSC Children’s Hospital to deal with a spike in critically ill pediatric patients.
Dr. Shawn Young, the chief operating officer of HSC Winnipeg, said in a 48-hour period that ended Monday, 10 infants and children were admitted to the pediatric intensive care unit (PICU) and the neonatal intensive care unit (NICU).
Each patient was dealing with severe respiratory symptoms linked to influenza A and RSV bronchiolitis.
Those admissions pushed the number of critically ill children to 21, which is far above the baseline of the PICU, which is nine. There are also 48 patients in the NICU, which has a pre-pandemic baseline of 50.
Young said more beds have been opened in the PICU and 10 to 15 staff have been reassigned in the last couple of months, but he said more help is needed.
“In the last day, and earlier today, we have put out a call for nurses with pediatric critical care experience, who may be working in other positions, to see if they can pick up shifts in the PICU,” said Young.
That call for help isn’t just at HSC but has been put out across the health-care system.
Young said there isn’t a specific number of nurses that they are looking for.
“The demands are shifting by the hour, if not, certainly by the day. So the absolute number is not going to be a fixed number, it’s going to change almost continuously.”
Another step being taken to provide additional support is reducing the pediatric surgical slate. Young said they will continue to focus on life-saving surgeries, but any non-urgent surgeries will be postponed starting Thursday.
“Clinical leadership will assess and review each surgical case with postponements focused on patients who are able to safely remain at home until their surgery and where a short stay will not result in negative medical outcomes.”
The postponements will mean 4.7 full-time equivalent surgical nurses will be assigned to the PICU, there will be less pressure on the unit with fewer surgical stays and it will prevent kids from having to travel or stay at the hospital before their surgery, therefore decreasing their chances of also getting sick, according to Young.
At the moment, Young noted there is no impact on adult surgeries, but it is always a possibility depending on what happens in the coming days and weeks.
The postponement of surgeries is scheduled to last into the new year.
Even though there is a current spike in PICU patients, there appears to be some slightly good news coming from the emergency department.
For the first 10 days of December, there have been 142.7 patients per day in the emergency department, compared to 170.3 patients per day in November.
Dr. Elisabete Doyle, the section head of pediatric emergency medicine at HSC Children’s, said despite lower numbers there are still high admission numbers – 18 on Tuesday.
“So normally, we see between 10 and 12 admissions a day and we’re up to 18 and the acuity of the patients that we’re seeing is much higher,” said Doyle.
She said the majority of cases being seen right now are RSV and influenza, but there are some cases of COVID-19 as well.
“In November of this year, we saw 196 cases of influenza in emergency. This is about four times the number that we were seeing in pre-pandemic times in 2019. And in December, we have already seen 87 cases of influenza. So currently at this pace, we’re set to see about 245 cases, which would be higher than any flu season in the past five years.”
She said nearly half of all patients are being treated for an influenza-like illness.
Doyle was asked why this year is such a strong virus season compared to pre-pandemic years.
She said there are multiple factors for this.
“Through the pandemic, because of isolation, the viruses were not replicating and spreading, we had a lot of restrictions during the pandemic,” she said. “We also have this young group of children who didn’t get exposed to the virus and now are getting affected by the virus and it’s coming with a vengeance. It’s also disrupted our seasonal variation in viruses. So instead of the viruses respecting their seasons, they’re all coming at the same time.”
These reasons are why Doyle said parents and households should be doing everything possible to prevent their young ones from getting sick, including getting the flu shot.
“Taking preventative steps is also going to help, making sure to wash your hands frequently, stay home when you’re sick, masking indoors and in large crowds. So judicious use of masking and cleaning high-touch areas like doorknobs and counter surfaces. Doing these things are going to help protect your health and most importantly, the newborns who are not able to get vaccinated.”
Bird flu keeps spreading beyond birds. Scientists worry it signals a growing threat to humans, too
As a deadly form of avian influenza continues ravaging bird populations around much of the world, scientists are tracking infections among other animals — including various types of mammals more closely related to humans.
Throughout the last year, Canadian and U.S. officials detected highly pathogenic H5N1 avian flu in a range of species, from bears to foxes. In January, France’s national reference laboratory announced that a cat suffered severe neurological symptoms from an infection in late 2022, with the virus showing genetic characteristics of adaptation to mammals.
Most concerning, multiple researchers said, was a large, recent outbreak on a Spanish mink farm.
Last October, farm workers began noticing a spike in deaths among the animals, with sick minks experiencing an array of dire symptoms like loss of appetite, excessive saliva, bloody snouts, tremors, and a lack of muscle control.
The culprit wound up being H5N1, marking the first known instance of this kind of avian influenza infection among farmed minks in Europe, notes a study published in Eurosurveillance this month.
“Our findings also indicate that an onward transmission of the virus to other minks may have taken place in the affected farm,” the researchers wrote.
Eventually, the entire population of minks was either killed or culled — more than 50,000 animals in total.
That’s a major shift, after only sporadic cases among humans and other mammals over the last decade, according to Michelle Wille, a researcher at the University of Sydney who focuses on the dynamics of wild bird viruses.
“This outbreak signals the very real potential for the emergence of mammal-to-mammal transmission,” she said in email correspondence with CBC News.
It’s only one farm, and notably, none of the workers — who all wore face shields, masks, and disposable overalls — got infected.
But the concern now, said Toronto-based infectious disease specialist Dr. Isaac Bogoch, is if this virus mutates in a way that allows it to become increasingly transmissible between mammals, including humans, “it could have deadly consequences.”
“This is an infection that has epidemic and pandemic potential,” he said. “I don’t know if people recognize how big a deal this is.”
H5N1 has high mortality rate
Among birds, the mortality rate of this strain of highly pathogenic avian influenza can be close to 100 per cent, causing devastation to both wild bird populations and poultry farms.
It’s also often deadly for other mammals, humans included.
The World Health Organization (WHO) has documented 240 cases of H5N1 avian influenza within four Western Pacific countries — including China, Cambodia, Laos, and Vietnam — over the last two decades. More than half of the infected individuals died.
Global WHO figures show more than 870 human cases were reported from 2003 to 2022, along with at least 450 deaths — a fatality rate of more than 50 per cent.
Bogoch said the reported death toll may be an overestimate, since not all infections may be detected, though it’s clear people can “get very, very sick from these infections.”
Most human infections also appeared to involve people having direct contact with infected birds. Real-world mink-to-mink transmission now firmly suggests H5N1 is now “poised to emerge in mammals,” Wille said — and while the outbreak in Spain may be the first reported instance of mammalian spread, it may not be the last.
“A virus which has evolved on a mink farm and subsequently infects farm workers exposed to infected animals is a highly plausible route for the emergence of a virus capable of human-to-human transmission to emerge,” she warned.
Louise Moncla, an assistant professor of pathobiology at the University of Pennsylvania school of veterinary medicine, explained that having an “intermediary host” is a common mechanism through which viruses adapt to new host species.
“And so what’s concerning about this is that this is exactly the kind of scenario you would expect to see that could lead to this type of adaptation, that could allow these viruses to replicate better in other mammals — like us.”
Surveillance, vaccines both needed
What’s more reassuring is the ongoing development of influenza vaccines, giving humanity a head start on the well-known threat posed by bird flu.
Wille noted the earlier spread of H7N9, another avian influenza strain which caused hundreds of human cases in the early 2010s, prompted similar concern that the virus would acquire the mutations needed for ongoing human-to-human transmission.
“However, a very aggressive and successful poultry vaccination campaign ultimately stopped all human cases,” she added.
But while several H5N1 avian influenza vaccines have been produced, including one manufactured in Canada, there’s no option approved for public use in this country.
To ward off the potential threat this strain poses to human health, Bogoch said ongoing surveillance and vaccine production needs to remain top-of-mind for both policy makers and vaccine manufacturers.
Dr. Jan Hajek, an infectious diseases physician at Vancouver General Hospital, also questioned whether it’s time to wind down global mink farming, given the spread of various viruses, from avian influenza to SARS-CoV-2, the virus behind COVID-19.
“We’re closely related to minks and ferrets, in terms of influenza risks … if it’s propagating to minks, and killing minks, it’s worrisome to us,” he said.
In 2021, B.C. officials announced an end to mink farming across the province, saying the farms can be reservoirs for viruses and represent an ongoing danger to public health. All mink farm operations must be shut down, with all of the pelts sold, by April 2025.
However, other provinces — and plenty of countries — do intend to keep their mink farms operating.
“Is it responsible to have these kinds of farming conditions where these types of events can occur?” questioned Moncla. “If we’re going to keep having these types of farms, what can we do to make this safer?”
6,654 students facing suspension due to out-of-date immunization records
The Windsor-Essex County Health Unit (WECHU) has issued about 6,654 suspension orders to students who do not meet immunization requirements.
WECHU completed a review of all elementary student immunization records in December and more than 12,000 students received a notice.
These students were either overdue for one or more vaccines required to attend school, or their immunization records were not updated with the health unit.
“While many of these vaccines are normally administered by primary health care providers, parents and guardians of children who received their vaccines from their health care provider still need to report this information to the health unit,” said a WECHU news release.
The Immunization of School Pupils Act (ISPA) (1990), Section 11, Subsections (1) and (2) requires public health units to maintain and review vaccine records for every student attending school and to enforce a school suspension for incomplete immunization information. As the next step of the ISPA enforcement process, orders were mailed out to students that do not meet this requirement.
WECHU said this is the final notice.
The suspension order notifies parents and guardians that immunization records must be updated to the WECHU by Thursday, March 16, at 6 p.m. or their child will be suspended for up to 20 days from school, starting Monday, March 20, 2023. Once parents and guardians provide the missing immunization information to the WECHU, the student is removed from the suspension list and can attend school again.
Under the ISPA , children can be exempted from immunization for medical reasons or due to conscience or religious belief.
Families can book immunization appointments with their health care provider and are reminded to update their child’s immunization records online at immune.wechu.org.
Catch-up immunization clinics are also being offered at the WECHU Windsor and Leamington offices and will continue until the end of March. Families can book an appointment at a WECHU clinic by visiting wechu.org/getimmunized or by calling the WECHU at 519-960-0231.
Another COVID-19 outbreak at Elliot Lake hospital
St. Joseph’s General Hospital in Elliot Lake is facing yet another COVID-19 outbreak.
Jeremy Stevenson, the hospital CEO, says Algoma Public Health declared the outbreak on the third floor in acute care yesterday afternoon.
He says visitor restrictions remain in place allowing only essential caregivers and consideration of compassionate circumstances.
Stevenson adds he would like to remind everyone there are several things that can be done to protect themselves and others from respiratory viruses from washing hands to observing social distancing and respiratory etiquette.
For more information on respiratory viruses, please contact Algoma Public Health at: (705) 942- 4646 ext. 5404 or contact your family health care provider. SJGHEL will update information on the Hospital outbreak as our information changes or more information becomes available.
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