It’s hard to know how the coming months will play out, including the strain level severe flu infections will cause in overburdened hospitals, and how this year’s array of viruses will interact now that SARS-CoV-2 is firmly in the mix. However, what is clear is that there is already a sharp increase in recent infections and a “tidal wave” of cases is likely on the way, said Dr. Sameer Elsayed, an infectious disease pathologist and medical microbiologist in London, Ont., and a professor with Western University. “We’re going to have a long flu season, I expect, this year.” In national level, flu activity is “skyrocketing” and exceeded the seasonal limit of five percent of samples that came back positive by the end of October. If these trends continue, the federal government will declare the start of a flu epidemic in Canada at its next update, scheduled for November 14. Ontario has already surpassed that benchmark, with about 10% of tests recently testing positive for this year’s dominant strain of influenza A. In the latest update from Public Health Ontario on November 4ththe province said the flu season started “more than a month earlier than typically seen in pre-pandemic periods.” This early start comes as the province’s children’s hospitals are already overflowing with children sick with illnesses including respiratory syncytial virus, or RSV, and as positive test results for COVID-19 rise again. more recently reaching 17 percent. “In the coming months, Ontario will likely face the triple threat of respiratory disease,” warned Dr. Rose Zacharias, president of the Ontario Medical Association, a physician advocacy group. during a press conference on Wednesday. Alberta also began to see an uptick in influenza A cases until the end of Octoberalong with the circulation of other pathogens, and BC public health officials are also watching for a continued increase in positive samples. “Right now we’re seeing the flu pick up and samples are coming in from long-term care facilities, children’s hospitals, adult hospitals,” said medical microbiologist Dr. Linda Hoang, associate director and program leader of the bacteriology and mycology laboratory at the BC Center for Disease Control.
Evidence from the Southern Hemisphere
How Canada’s flu season plays out from here could mirror, to some extent, what countries in the southern hemisphere experienced earlier this year. In Chile, where the 2022 flu season has come and gone, influenza A began circulating “months earlier” than pre-pandemic flu seasons. according to a recent report released by the US Centers for Disease Control. (The US is now experiencing an early start as well, with southern states seeing the largest increases.) Chilean officials reported more than 1,000 hospitalizations during the season. That’s higher than during the COVID pandemic, when public health restrictions and other factors kept the flu at bay for more than a year, but lower than during recent flu seasons before the pandemic. The country’s flu shots also nearly halved the risk of hospitalization. Data on laboratory-confirmed influenza cases in Australia this year they also show that the country experienced an early and early end to the flu season and a level of infections much higher than in any of the previous five years. However, the clinical severity of the 2022 flu season – referring to the total number of deaths and the proportion of patients admitted to intensive care – was rated “low” by the Australian government. WATCHES | Ontario doctors warn of ‘triple threat’ of breathing season:
Concerns are growing over the triple threat of rising respiratory diseases
The Ontario Medical Association is urging people to wear masks indoors and get their flu and COVID-19 shots, as it worries a surge in flu cases could overwhelm a health care system already seeing an influx of patients with RSV and COVID-19. So what do these trends portend for Canada in the coming months? Alison Kelvin, a virologist and researcher at the Vaccine and Infectious Diseases Agency at the University of Saskatchewan, said it’s possible our flu season will “peak and wane” earlier. However, he stressed that the combination of influenza and other respiratory viruses, including the first time of COVID circulating in the winter months without public health restrictions, makes it particularly difficult to predict the extent of what lies ahead. It is possible that the early start of the flu season in the southern hemisphere, which is now affecting countries further north, suggests that the virus is moving into circulation after other waves of infection. “We could see a later spike in COVID-19 cases, maybe in early January,” Kelvin said. “But it could also just be the backlash of not having the flu in the last couple of years. I really don’t know. And I’ll be watching the numbers to see a clearer pattern over the next couple of years.”
Time for masks again?
Hospital groups worry that waves of different viral infections will mean months of strain on Canada’s health care system, regardless of whether flu cases alone equate to high levels of hospitalizations this season. “It’s only November,” said Dr. Fahad Razak, an internist at St. Michael’s in Toronto, during an interview with CBC News Network. “Typically the respiratory virus season, including flu and RSV, but of course COVID, is expected to peak in the coming months. So we haven’t seen, probably, how bad this is going to get.” The coming months could be “very, very difficult,” he added, given the already long wait times to access care in many overworked and understaffed hospitals across the country. Given these concerns, a growing chorus of doctors they are now asking for a return to mask use indoors to mitigate the spread of viral infections. WATCHES | Toronto doctor calls for return of mask orders:
Time to bring back the mask mandate, says Toronto doctor
Dr. Fahad Razak, an internist at St. Michael’s Hospital, says the triple threat posed by COVID-19, RSV and influenza should be addressed through public health measures such as mask mandates. “If it’s added to the other layers of protection, including vaccination, then it can make a difference in terms of cushioning the increase so that hospitals can cope a little bit better,” Canada’s chief public health officer Dr. Theresa Tam he said at a press conference on Thursday. A study was published this week in the New England Journal of Medicine offered more evidence to suggest that masks can help moderate the transmission of the virus. The peer-reviewed study, which focused on school districts in Boston, found that lifting coverage requirements was associated with about 45 additional cases of COVID per 1,000 students and staff in the months following the end of a state policy. Masks are a blunt, imperfect tool, Razak said, but one that has also helped keep the flu at bay in Canada for much of the pandemic. The 2020 flu season ended abruptly after a series of public health restrictions were put into place to combat COVID, and there were no signs of community flu circulation next season, either. Usually, the flu is thought to kill thousands of Canadians each year while COVID is currently killing hundreds every week.
Canadians encouraged to get flu, COVID vaccines
Getting a vaccine to protect against both is of the utmost importance this fall, many doctors stressed in recent interviews with CBC News. It is still safe to take both a COVID booster shot and an annual flu shot at the same appointment, according to the National Immunization Advisory Committee of Canada. Kelvin, who has long studied influenza, said Canadians should always take the threat of influenza seriously. The added fear now, he said, is that it’s roaring back while there’s another respiratory virus — SARS-CoV-2 — now in the mix. “This will add to increased cases of serious illness,” he said. “And that’s what I want to be careful about — that we’re doing the best we can to reduce the transmission of the respiratory virus in the community.”
