McMaster Children’s Hospital prepares for possible COVID surge as kids make up more of Hamilton’s cases

McMaster Children's Hospital is preparing to expand its intensive-care unit if there is a surge of hospitalizations as kids make up more of Hamilton's active COVID cases.

We remain alert to the possibility that a continued significant growth in the number of children or youth with COVID-related illness could stretch our hospital capacity," said Dr. Angelo Mikrogianakis, chief of pediatrics at the children's hospital. Fortunately, at this point, we've not seen a significant increase in hospitalizations. There are a limited number of pediatric critical-care beds in the province, so there is less capacity to absorb any significant growth."

Meanwhile, an outbreak has been declared at Hamilton General Hospital on the Burn Trauma Unit, where six staff and one patient have tested positive since Sept. 27. The vaccination status of the infected is unknown.

The outbreak on the vulnerable unit comes as Hamilton Health Sciences (HHS) rolls out a bare-minimum vaccine policy for its staff.

Education and test kits have been made available to all individuals who have not yet reported or have reported that they are not fully vaccinated," HHS said in a statement.

Hamilton is in the midst of a tense waiting game as the fourth wave was predicted by Scarsin Forecasting to peak in mid-October.

We're at a fragile phase in the pandemic," Hamilton's medical officer of health, Dr. Elizabeth Richardson, said at a briefing Monday. Our rates have just been fluctuating ... They go up for a short period, they come down for a short period - so no real trend."

Average daily new cases hit a fourth-wave high of 80 on Aug. 31 before dropping to 37 on Sept. 21. It started climbing again, hitting 44 by Sept. 28 before falling to 36 on Oct. 2.

Scarsin predicted between 100 and 200 new cases a day by mid-October, with the most likely scenario being a peak of 120. The modelling has been accurate in the past.

Hamilton currently has the fifth-highest COVID rate in the province, shows analysis by epidemiologist Ahmed Al-Jaishi.

At the same time, the city has among the lowest vaccination rate, with 78 per cent of eligible residents fully vaccinated.

Following the proof-of-vaccination policy that came out, we did see an encouraging boost," said Richardson. It's now declined again."

The average doses administered per day increased by nearly 25 per cent between Sept. 21 and Sept. 27 - to 1,739 shots a day from 1,404. The vaccine passport was implemented on Sept. 22.

But it has since gone back down to about 1,400 doses a day.

Richardson added her support Monday to calls from the Registered Nurses' Association of Ontario and the Ontario Hospital Association for the province to make COVID shots mandatory for all health-care workers and not just those in long-term care.

It's definitely something we're interested in and continue to pursue," said Richardson. I think that provincial approach is really key so that there is a level playing field across the whole province rather than doing it area by area."

Hamilton's hospitals have implemented the minimum requirements for staff vaccine mandates - in contrast to some of its peers with stricter policies.

Education and regular testing rules started Monday for staff who haven't had two shots or won't report their status.

A plan for achieving full compliance is in development and will roll out in the coming weeks," said HHS.

The impact of vaccines can be seen as kids - mostly too young for COVID shots - make up more of Hamilton's recent infections.

Children age nine and under have the most active cases followed by those age 10 to 19 - those born in 2009 or earlier can get a shot.

Together, these two age groups account for 101 of Hamilton's 295 active COVID cases, which is more than one-third.

Of Hamilton's 20 ongoing outbreaks, more than half are in schools or child-care centres.

The shift in terms of more kids being positive for COVID than in previous waves is not unexpected," Mikrogianakis said, pointing to vaccination as well as a return to in-person learning, sports and extracurriculars.

So far the increase has hit the emergency room the hardest.

Every fever, every cough, every vomit requires a need for medical assessment and COVID testing in order for kids and families to be able to get back to normal, go to school, go to daycare or to go about their activities," said Mikrogianakis.

The children's hospital is trying to get out the message that family doctors or the city's assessment centres are the appropriate place to go instead of the ER when kids aren't significantly ill.

So far, COVID hospitalizations have remained low for children - fewer than five at any one time at McMaster. There were no kids with COVID in the intensive-care unit (ICU) on Monday.

But the children's hospital is planning for surge capacity in the ICU as well as working with community hospitals to expand ward space for kids with COVID just in case it's needed.

In short notice, it's not an easy thing to accomplish," Mikrogianakis said, particularly about expanding the ICU. You need the physical space but, more importantly, you need the doctors, nurses, respiratory therapists with the skill set to be able to to care for those patients. Unfortunately, the recent challenges with respect to health human resources has made this a challenge to be able to find the necessary staffing to create that capacity. But we are working on it."

Adding to the potential strain is an increase in other respiratory viruses that were mostly absent during lockdowns.

What we're seeing is a re-emergence of normal seasonal viruses," said Mikrogianakis. How busy we get remains to be seen."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com