The annual flu season is here, respiratory virus outbreaks among kids are on the rise, and there are still severe shortages of children’s painkillers in Canada.
RSV infections and flu are higher than anticipated for this time of year nationwide and are continuing to rise, according to official data. Earlier than normal, influenza is also rapidly spreading.
The fact that some Canadian clinics are already cancelling surgeries and moving patients to make room shows how pressed for time medical professionals are to care for “unprecedented” numbers of ailing young children.
Why there are so many ill children at once is not clear!
Even while they claim it’s challenging to know the whole truth, scientists do have a few hypotheses.
There may be a spillover impact from the early stages of the COVID-19 pandemic when it comes to the pressure from RSV, an infection that is so pervasive that the majority of individuals contract it by the time they are toddlers.
RSV cases decreased to extremely low levels in 2020, according to immunologist Deepta Bhattacharya, a professor at the University of Arizona. She attributed this to COVID mitigations, a set of measures that included social isolation, mask use, and widespread lockdowns during which a sizable portion of the workforce started working from home.
He said that since the immune system’s generation of antibodies after an RSV infection declines rather fast, missing a year of infections has an effect on the entire population.
Bhattacharya noted that this means more individuals are at risk for infection in the first place, those who do contract the virus have less antibodies to slow it down, and moms who haven’t been exposed recently aren’t passing on as many antibodies to their kids through breast milk.
In an editorial on RSV that was published back in July 2021 in the Canadian Medical Association Journal, numerous Canadian scientists issued this warning.
A resurgence in cases could strain resources in paediatric intensive care units across the nation, the group wrote. “Canada has seen virtually no cases of RSV infection for many months, which may mean that pregnant women and infants have had lower exposure and therefore paediatric immunity levels may be low.”
In early 2021, Canada ultimately saw a mid-pandemic rise in RSV infections, although it was unrelated to the present level of hospital demand. Notably, by that time, influenza had just partially returned and was still fairly late in the regular flu season.
Co-infections may potentially have a role in the prevalence of severe illness now that COVID and the flu are both firmly back in the picture, according to Dawn Bowdish, an immunologist at McMaster University in Hamilton, Ontario.
Each virus behaves slightly differently and has a varied effect on the body. According to research on adults, those who simultaneously contract numerous viruses, as those causing COVID, the flu, or RSV, may experience worse results, according to Bowdish.
RSV is often known to only cause minor symptoms in most kids and healthy adults, but it can also cause significant sickness in newborns, elderly individuals, and those with weakened immune systems.
According to Dr. Amesh Adalja, an infectious diseases specialist with the Johns Hopkins University Center for Health Security, “RSV was the main cause of newborn hospitalizations long before anyone had even found COVID-19.” Similarly to influenza, RSV caused serious harm to adults.
Along with the flu and other temporarily suppressed infections, it was also always going to return, he continued.
Because of COVID, Adalja said, “it wasn’t like we’d never have respiratory viruses.” Additionally, there are kids who were born around the time of the pandemic but haven’t yet contracted RSV.
An investigation by a group of Canadian scientists into more than ten years’ worth of respiratory virus seasons, as well as mathematical simulations of potential future seasons, revealed “striking regularity” in the way that various viruses alternated between mild and severe winter peaks, year after year.
Dr. Lynora Saxinger, an infectious disease expert at the University of Alberta, said their 2021 study, which was published in the academic journal JAMA, demonstrates a certain degree of predictability.
Due to the loss of immunity throughout a whole society, years of lower transmission are often followed by a period of more aggressive transmission, she explained. That might help to partially explain this year’s RSV outbreak as well as the swiftly approaching virulent flu season.
If most children are exposed this year, Bowdish said, “next year we would expect a smaller wave.”
COVID-19’s Role in this scenario
Other theories attempting to explain the ongoing paediatric health-care crisis involve possible immune system effects from prior cases of COVID-19, possibly in line with already-documented post-COVID health issues. In the meantime, as scientists are frantically trying to understand the current viral landscape.
Some kids who contract the SARS-CoV-2 virus develop the deadly illness known as MIS-C, or multisystem inflammatory syndrome. Though the exact reason is still unknown, an excessive immune reaction is one theory.
Other children — and more frequently adults — may experience protracted, occasionally incapacitating COVID symptoms years after an infection, which may also be related to the virus’ effects on the immune system.
In all instances, scientists point out that the underlying processes are still poorly understood.
But does this imply that children’s immune systems start to malfunction when they contract COVID, increasing their likelihood of developing life-threatening infections from other bugs? That’s unlikely, CBC News was informed by many medical professionals.
While Bhattacharya emphasised that there is no evidence to support the idea that COVID causes long-lasting immune suppression against other illnesses, Bowdish described the idea as “unproven but not implausible.”
Your blood’s T-cells, a component of the human immune system that specifically targets foreign invaders, do decline in quantity during the acute phase of COVID-19. But after you get better, they return to normal straight away, Bhattacharya added.
If you get COVID and RSV close together, Bhattacharya said, “I do believe it’s plausible that additive inflammation may make you pretty unwell.” But that differs greatly from COVID, which can cause immunodeficiency that lasts for a long time after recovery.
The “plausible” function of COVID in the present paediatric epidemic is as a co-factor, interfering with immune responses and amplifying the effects of all those initial viral exposures, according to Dr. David Naylor, co-chair of Canada’s COVID-19 Immunity Task Force.
He said that while there is currently little evidence to support that theory, “this terrible virus is full of unpleasant surprises.”
In a time when hospitals are overcrowded and drug shelves are bare, both parents and healthcare professionals are having difficulty caring for children.
Federal officials claim they have finally managed to import children’s fever and pain medications to ease a months-long shortage, hopefully allowing parents to treat sick children at home. In recent weeks, numerous paediatric healthcare facilities across the nation have reported being significantly over capacity and staff short.
Leading public health authorities in a number of locations are urging the public to cover up this autumn and winter as discussions over the use of masks to reduce viral transmission are also picking up steam.
Along with other preventative measures, Saxinger emphasised the importance of widespread flu and COVID immunisation efforts.
Adalja, on the other hand, advocated for improved virus monitoring. RSV testing has to be made more commonplace since it has been a “serious paediatric burden for decade after decade after decade,” he added.
Recent epidemiological surveillance data in Ontario do indicate some early, encouraging signs that the burden of respiratory viruses on hospitals may start to lessen. If clinical trials are successful, there may eventually be vaccines against not only the flu and COVID, but also RSV, in the years to come.
Alyson Kelvin, a virologist and researcher at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, cautioned that children will always be more susceptible to these diseases, including those who are too young to get vaccinations.
We are aware that they represent one of the largest groups requiring hospitalisation due to respiratory infections, she added. “And we want to make sure we’re always protecting them,”
