Paediatrician expresses concern for kids as flu cases rise

The rising number of flu cases across the country is set to put further pressure on our healthcare system, which is already thought to be close to breaking point.

Data from the Australian Department of Health shows an increase in early cases of influenza compared to the previous three years — with the number of cases expected to continue rising as the flu season approaches.

What do these numbers mean, and how can we be prepared for influenza this year? Throughout the pandemic, lockdowns and other restrictions (like social distancing and mask-wearing), not only reduced your risk of catching COVID-19 but they also reduced the spread of other airborne diseases, like the flu.

Due to these measures, flu cases in 2020 and 2021 were artificially suppressed. Last year influenza returned, but case numbers in the early months remained suppressed due to restrictions. With minimal restrictions now in place, a significant increase in cases is expected in 2023, with circulation trends aligning to pre-pandemic patterns. As influenza increases in the community, Dr Daryl Cheng, paediatrician at The Royal Children’s Hospital in Melbourne, is concerned about the potential impacts on hospital flow, workloads and our ability to provide timely care for all cases.

Even though the 2022 flu season was considered low in terms of clinical severity according to the Department of Health and Aged Care, Dr Cheng said the increase in reported flu cases, from just 600 in 2021 during the COVID-19 pandemic to more than 225,000 in 2022, combined with other respiratory illness such as COVID-19, overwhelmed already overloaded staff in hospitals, medical centres and GP clinics.

“As a paediatrician, I saw both patients and the healthcare workforce hit hard last year. Respiratory diseases that we hadn’t seen since the arrival of COVID came back with a vengeance, including influenza.

“While influenza is unpredictable, the most recent numbers for 2023 may indicate an earlier start to the flu season, and we have real concerns about the consequences for the healthcare system and patients if this year’s influenza season really takes off in the context of an already overstretched health system,” Dr Cheng said.

Concerns in Australia have been heightened by the flu season experienced in the Northern Hemisphere. The Centers for Disease Control and Prevention has reported more than 25 million illnesses, 280,000 hospitalisations and 17,000 deaths from flu in the US this season, including 111 paediatric deaths.

“What really worries me is the impact on younger children,” Dr Cheng said.

“Children aged five to 15 made up about half of all patients admitted to hospital due to the flu last year. Many of these kids, whose immune systems are still developing, are susceptible not only to more severe influenza, but complications such as bacterial pneumonia, influenza encephalitis and even multi-organ failure. A lower rate of flu immunisation across the community may compound some of these challenges.”

Dr Cheng said that large numbers of children getting sick created a cascading effect, with growing queues in emergency departments, pressure to cancel or postpone elective surgery and the risk of understaffed hospitals being overrun.

He said the surge of respiratory disease was predictable following increased population movement and fewer COVID restrictions.

“During the acute phase of the COVID pandemic, fewer children were exposed to the flu and other respiratory viruses. Reduced exposure meant less opportunity to build their natural immunity, as well as population level immunity.”

According to Dr Cheng, increasing vaccination rates is the most effective way of reducing the case burden and severity of influenza, but it is challenging due to vaccine fatigue in the community.

“On the one hand, we have many families with a higher awareness of the benefits of immunisation thanks to COVID. This gives healthcare workers a platform to initiate discussions around the importance of flu vaccine in preventing ICU admission and severe disease, particularly for children and other vulnerable groups.

“On the other hand, trying to engage parents who have switched off due to fatigue, ambivalence or who have been sucked in by misinformation through social media is a far bigger challenge. We need a sophisticated public health campaign to get the message across.”

Dr Cheng said a measure healthcare workers could take was to get immunised as soon as vaccines become available. For those working in ICU, Dr Cheng has some tips on how to interact with children who are acutely unwell and their concerned parents.

“While it can be challenging to holistically engage the family in these situations, it is important to keep talking calmly and reassuringly with the child and parents.

“Young patients are often terrified of the unusual things in an ICU, such as alarms and other strange noises, lights, intravenous lines and foreign faces. Slowly, calmly and repeatedly explaining things can help put them at ease.

“You should also check in on how the parents and caregivers are doing as a child with a critical illness can have a significant physical and mental toll on them as well.”

Getting through flu season is as much about protecting yourself as it is about being confident with your approach to the vulnerable young patients you will be helping in ICU.

^{Reference
Australian Bureau of Statistics, Overseas Arrivals and Departures. Released 15 March 2023 Overseas Arrivals and Departures, Australia, January 2023 | Australian Bureau of Statistics (abs.gov.au). Accessed March 2023}

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