Across Canada, children are getting sick.
And it’s not just COVID. The Public Health Agency of Canada’s data show that influenza and respiratory syncytial virus (RSV) are circulating in the population at higher than expected rates this fall.
It’s led to long wait times at emergency rooms. The Children’s Hospital of Eastern Ontario has opened a second pediatric ICU. SickKids hospital has cancelled non-urgent surgeries. Thousands of kids are missing school — 20,000 in Edmonton alone, about 10 per cent of all elementary and high school students.
In some provinces, it has politicians and public-health officials grappling with a question that many hoped wouldn’t come up again: Do mask mandates need to come back?
Alberta Premier Danielle Smith has given an unequivocal no. Dr. Kieran Moore, Ontario’s top doctor and B.C. health officer Dr. Bonnie Henry, both recommended masks in some settings, but stopped short of a mandate. The Quebec College of Physicians recommended everyone wear masks in public, but the province said it is still analyzing the situation.
More than two years of pandemic health measures not only prevented the spread of COVID-19, but the flu and other respiratory viruses as well. Now that children have returned to school and day care without masks, there is an unusually large cohort of children getting these infections, all at the same time, after two years of protection from viruses, said Colin Furness, an epidemiologist at the University of Toronto.
In response, doctors and experts are calling for mask mandates to reduce the spread. But this raises the question: If more kids are getting sick now because public-health measures delayed their exposure to these viruses, would re-instituting mask mandates just ensure the problem is sustained over a longer period of time? The National Post spoke to Furness and other experts about what is happening with sick children, and the best way to protect them.
Why are so many people sick right now?
Respiratory viruses tend to be seasonal in Canada, said Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta.
“After you have a light year of a respiratory virus, there’s fewer people that have partial immunity because it just wasn’t transmitting as much, and then you tend to have a heavier year after that,” said Saxinger. “We kind of have a layering problem going on right now where we have, influenza coming back with less partial population immunity. RSV is coming back, same thing, all of the viruses are coming back.”
Children tend to get exposed to plenty of viruses in their early years. Unless, of course, they were young at the start of the pandemic and missed those rounds of viral infections because of COVID-19 measures meant to protect people during the pandemic.
There are also socioeconomic factors at play, said Dawn Bowdish, the Canada Research Chair in aging and immunity at McMaster University.
“If parents have to go to work because they can’t afford not to, they’re going to send their kids with a fever suppressant medication to school, they’re gonna get other kids sick, and on and on and on it goes,” Bowdish said.
Why are kids getting so sick now if they were less effected by COVID?
The simple answer is, different viruses work differently.
“COVID is definitely the outlier,” said Bowdish, and even then, it has changed a lot over the course of the pandemic. Kids do better with viruses in the lungs, but do worse with those that infect the upper respiratory tract, Bowdish said.
“RSV, influenza and omicron stay up high, so they can trigger asthma exacerbations.”
Also getting, say, influenza and COVID simultaneously may be more dangerous for kids than just one of the viruses.
“So part of the severity is probably due to the fact that there are these co-infections, as well as sometimes bacterial infections have to happen after an even mild infection,” Bowdish explained.
Are kids suffering from an ‘immunity debt’?
Furness said “immunity debt” is not a term that he likes. He prefers “immunity deferment.” Which means that the immunity kids would have gotten during the pandemic has now been deferred, and that’s why so many are falling ill.
There’s a common misunderstanding of how the immune system works.
It’s not like a muscle that you need to exercise. Or like your brain, which might enjoy the challenge of a crossword puzzle. Rather, explained Furness, it’s like a series of photos — it snaps a picture of a virus and remembers it. But it doesn’t need to be practiced.
The misunderstanding, basically, is the idea that kids went two years without getting sick and now their immune systems are weak and unable to cope with the viruses they haven’t been exposed to before.
“This idea that everyone’s more susceptible, because they’re wearing masks, this is just pure fiction,” said Furness.
It’s an appealing explanation because that’s how “common sense” helps us understand it, given that’s how other parts of our bodies work.
“It seems like kind of a bent version of the hygiene hypothesis, where if kids don’t eat enough dirt when they’re little, they might be more prone to allergic diseases. Like it seems like a riff off of that, but I think it’s a different scenario,” said Saxinger.
However, the immune system’s memory is more developed in an adult or a vaccinated child — they can see a new virus and figure out how to respond. A kid who hasn’t been sick repeatedly, or hasn’t had his or her vaccines, is going to be less able to respond appropriately to a new virus. For kids, the first infection, Bowdish said, tends to be the worst, which helps explain the severity right now.
“Kids just don’t have that memory yet. So what we try to do is we give it to them through vaccination, we give their immune systems a little template, to say, ‘Hey, if you see something that looks like this, use this, see what you can do,’” Bowdish said.
Could masks prolong the pandemic?
No, said Furness. “We’re not talking about shutting down restaurants and locking people in their houses.”
Rather, what masks would do is “take the edge off” the current infection rate. “Frankly, taking the edge off is exactly what we need,” Furness said.
Given the way masks have been so heavily politicized, there is going to be a proportion of the population who refuse to comply, and people are still going to be gathering and kissing babies, and doing other things that spread viruses. Even among those who wear their masks, they aren’t 100 per cent effective.
So viral transmission is still going to happen, kids will still get these diseases — it’s just not going to happen in one fell swoop that swamps the health-care system, Furness said.
“It’s catastrophizing, in a sense — that worry that a temporary mask mandate is going to make the problem worse. I don’t think that’s a good characterization,” Furness said.
It’s clear now that schools and daycares are major sources of spread. This means that, for example, masking in schools could help break the chain of infection. It’s not clear how long this would take, said Bowdish, and it depends on a province’s objectives. If the goal is simply to alleviate hospital pressure, it might not need as much time as if the goal is a far healthier child population.
“It’s entirely possible if everyone adhered right away, we’d see such a steep decline that we’d be able to lift (the mandate) quickly,” said Bowdish. “The length of time is inversely proportionate to the amount of people who adhere to it.”
However, there could still be a rough few years ahead, Bowdish said, although that could ease as new vaccines — such as an RSV vaccine — become available.
Any child who ends up ventilated in hospital is likely going to have lifelong health issues, Bowdish said.
“Any serious infection leaves a scar and, for example, one of the things RSV is associated with is asthma, wheezing, chronic lung health issues,” Bowdish said. “Each province has to make a decision about how healthy they want their kids to be — do they accept the fact that lots of kids are going to be impacted and some fraction of them are going to have lifelong health challenges? Is that OK, as long as the hospitals still run? Or is that not OK?”
Saxinger said some are suggesting that, when it comes to viruses, sooner or later, “kids are going to have to get it, so we may as will not do anything.” They don’t — vaccines, which are available for the flu, can be given, and kids don’t need to get these viruses when they’re super young, either.
“Inevitably, kids end up getting exposed to lots of respiratory viruses time and time again,” said Saxinger. “But we don’t have to set it up so that they get them all right now.”
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