It’s hard to know how a respiratory virus season will play out, “but if I had to bet on the house,” Miller sees a slightly more intense season than we were used to, before the 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.
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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 would be crazy to think that we’re going to have a heavier-than-usual breathing season,” said Miller, director of the Michael G. DeGroote Infectious Diseases Research Institute at McMaster University.
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 has noted an earlier-than-usual start to the flu season and infection levels above pre-pandemic levels, Miller said, as well as above seasonal norms for RSV.
A recent study suggests that COVID-19 infections could have been one of the drivers of the increase in RSV infections among children aged five and older in 2022, most likely due to the effects of SARS-CoV-2 on the child’s immune and respiratory systems.
In Canada, influenza is on the rise, but it’s within expected degrees for this time of year, according to the Public Health Agency’s most recent respiratory surveillance report.
Nationally, the percent positivity for COVID-19 (among people tested, the proportion of others who tested positive) has remained strong over the past five weeks of surveillance. There are signs that weekly COVID-19 deaths are declining and ICU numbers remained low during the week ending Nov. 21.
“We’re seeing a lot of severe, life-threatening cases that require hospitalization or overwhelming, extensive care packages like ours,” 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.
“We’re not in the same absolute crisis as last year’s flu season and no blood,” Bowdish said. “But we still face so much pressure on health care that even fewer hospitalizations are still problematic,” Bowdish said.
Emergency departments are still overwhelmed. People who want to be admitted are “carried” through the aisles on stretchers. “I know some hospitals where the wait time for admission is 20 to 30 hours on average to 50 to 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 a physical care formula in Canada that is understaffed and struggles to manage emergency admissions like it does now,” Bowdish said.
The fear is after Christmas, when viruses historically spread from young people to parents and grandparents, and adult hospitalizations are a problem, he said.
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.
The symptoms of RSV are varied, adding those that are similar to those of a cold: runny nose, cough, sore throat, muscle pain, and occasional nausea, vomiting, or diarrhea.
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 little ones, children between 3 and 18 months, who tend to get into trouble. “They may start to have heavy wheezing, shortness of breath and immediate breathing,” Howlett said. “Their ribs sink in between and under their chests, and the muscles tighten around their necks because they’re trying to get air in. “Some want to be admitted to the hospital for extra oxygen.
Nationally, COVID-19 activity has stabilized and trends vary across the country. “Weekly deaths and the number of other people in intensive care remain low,” according to the federal government’s update for the week ending Nov. 21.
The positivity rate for COVID tests is around 19 percent. “There’s no question it’s circulating,” said Dr. Harris. Catherine Hankins, former co-chair of the Canadian Task Force on Immunity.
“People have safe immunity. But it’s not like measles, where you get the infection, you’re vaccinated and you’re pretty much 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 in some of a balance,” Miller said. There will be diversifications from year to year, he said. I know it feels like an eternity, but in reality, COVID has only been around for 4 years. It is not yet known what the average point will be.
For COVID, the high-risk groups haven’t changed. The elderly and those with underlying physical conditions are at higher risk for serious infections.
“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 in all provinces, even though RSV is one of the “important and underappreciated fitness burdens among older people,” Miller said. .
Human behavior can shape seasonal viruses, said Hankins, a professor at McGill University’s School of Population and Global Health.
“How many more people get a flu shot?Get your COVID booster?
Governments offer the RSV vaccine for free to people 60 and older, he said.
He visited a Christmas market twice this weekend. “I saw another user wearing a mask. They are tents where the air is humid and there are a lot of 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.”
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