Inside an Ontario hospital bracing for a surge in adult patients — while overflowing with sick kids

Lying with a stuffed monkey in his hospital bed, with oxygen tubes attached to his tiny nose, four-year-old Wolfgang lets out a few scratchy chest coughs.

On this afternoon in early December, the little boy with big eyes and tousled brown hair is one of the youngest patients at Markham Stouffville Hospital, north of Toronto. He was admitted a couple of days earlier to the facility's over-capacity pediatric unit for pneumonia — his third bout since starting kindergarten in September.

As a child with severe asthma, Wolfgang — who usually goes by "Wolfy" — is particularly vulnerable during this "brutal" viral season, says his mother, Mary Doering.

"It's hard to see your little guy struggle," she says.

This fall, the explosive return of respiratory viruses started putting immense pressure on a health-care system that's long been under strain — a quiet crisis, playing out behind closed doors. 

While sweeping pandemic measures kept a variety of pathogens at bay for months on end, they've all roared back, from influenza to RSV, with COVID-19 now firmly in the mix. 

It's no secret that kids like Wolfgang are currently bearing the brunt. But that could be just the tip of the iceberg of infections in the months ahead.

Hospitals like Markham Stouffville are now bracing for a potential surge of adult patients as well, and expecting pressure from both ends of the age spectrum at a time when resources are already tight and staff shortages are a constant battle.

"Our real concern is the severity of illness that we are seeing in the kids, and we are expecting to see more adult cases; usually they come two to three weeks after the kids cases peak," says Dr. Jeya Nadarajah, an infectious diseases physician with Oak Valley Health, who works at Markham Stouffville. 

"We are also predicting a more severe set of adult influenza, too."

Inside the office of Oak Valley Health chief executive officer Jo-anne Marr, she logs into a virtual call with staff from across the hospital. What was once a daily COVID-19 briefing is now a weekly check-in for the return of a broader, if rather unusual, respiratory virus season.

Speaking first, for the infection prevention and control team, Nadarajah raises questions over how long the peak of this year's influenza season will last, and says local pediatric hospitals are still seeing high levels of patient admissions.

"The bottom line with modelling when you're looking at a season with co-infections of COVID and influenza, is that our best weapon is still vaccination," she says on the video call. 

"That seems to be the only thing in the modelling that will slow the peak and keep it [lower] so hospital capacity can keep up."