Letter to the Community – November 18, 2022

The community is experiencing an unprecedented surge in pediatric cases of respiratory illness. As a regional pediatric center we are seeing higher volumes in the emergency department and more infants and children requiring admission to hospital for supplemental oxygen, intravenous fluids and monitoring.

There are many viruses circulating, but most prominently we are seeing RSV (respiratory syncytial virus) and Influenza (“the flu”) (in addition to occasional cases of COVID-19).  All or most children are getting sick.  We have been making changes to help with the higher acuity and increased need and are operating consistently at or above 120% capacity. Within the hospital, we are using all available spaces to provide care which includes moving kids in to our obstetrical ward where appropriate.

Children at highest risk of severe illness are those with a chronic disease (such as asthma and diabetes), those under 6 months of age and patients who are medically fragile.

Prevention:

A note on prevention: Children should be up-to-date on their vaccinations, which includes the yearly flu shot (for those over 6 months). COVID-19 vaccination can help prevent severe disease in children. Pregnant mothers should also be vaccinated against COVID-19 and the flu to provide some protection to their baby in the newborn period. Good hand hygiene is important as most virus are transmitted by droplet contact. And children should avoid daycare and school when sick. Provincial health officials are now recommending masks in public places to help reduce the spread of respiratory viruses and this can be considered.

What can be done at home:

The treatment for RSV and other respiratory viruses is supportive care. This includes regular hydration and age-appropriate doses of Tylenol, as needed. Importantly there are no safe and effective cough and cold medications for children under the age of 6 years. For congestion, you could try saline nasal spray, humidifiers, and bulb suction. For cough, children over 1 year of age can be given honey. Hydration is key and pedialyte, popsicles, gingerale and soups are all good ways to get the fluids into children.

When to seek care:

The majority of children can be managed at home, with supportive care during illness. What I typically tell parents is to seek care for their child when they are worried. Objective features include; increased work of breathing, lethargy, not drinking, and dehydration (which can present with decreased wet diapers, or dry lips and mouth). Other considerations include fever in a baby less than 3 months of age, and if the fever is prolonged, longer than several days. Children with cough, who are well, typically do not require assessment but can be watched at home.

Looking forward, there is more to be done on a community, regional and provincial level to coordinate efforts for the safe care of every child. We have already made changes to increase our capacity, above the level of our usual bed capacity, to address the surge in admissions. This is important to reduce the pressure on the system, including our partners at SickKids and other local community emergency departments.   We will continue to work as One Community as we provide excellent compassionate care to kids across our region.

Ryan W Smith BSc, MSc, MB BCh BAO, FRCPC
Chief of Paediatrics, Paediatric and Neonatal Medicine, Orillia Soldiers’ Memorial Hospital, Orillia Ontario Assistant Professor, Faculty of Medicine, Department of Paediatrics, University of Toronto