Walking through Toronto’s Mount Sinai Hospital emergency department last Tuesday night, I witnessed what many health workers are calling the early arrival of our seasonal nemesis. In one corner, a young mother cradled her feverish toddler. Nearby, an elderly man with labored breathing waited for attention, while hospital staff moved with the controlled urgency that has become all too familiar since the pandemic.
“We’re seeing influenza cases about three weeks earlier than typical,” Dr. Susy Hota, Medical Director of Infection Prevention and Control at University Health Network, told me during our interview. “The numbers aren’t just early—they’re steeper than what we’d expect by mid-November.”
Data released yesterday by Toronto Public Health confirms what clinicians have been reporting: laboratory-confirmed influenza cases have jumped 43% compared to the same period last year. The city recorded 247 cases last week alone, with pediatric cases representing nearly a third of all infections.
This surge arrives as Toronto’s healthcare system still struggles with staffing shortages and the lingering effects of pandemic burnout. At Sick Kids Hospital, where I spent a morning observing the increasingly busy emergency department, Dr. Anita Morris described a troubling pattern.
“We’re seeing complications we wouldn’t typically encounter until deep winter,” she explained while checking on a 7-year-old with influenza-related pneumonia. “Children who were born during the pandemic have had less exposure to seasonal viruses, potentially leaving them more vulnerable when they do encounter influenza.”
The current strain circulating appears to be predominantly influenza A (H3N2), which historically has been associated with more severe illness in vulnerable populations, particularly older adults and young children. Toronto Public Health laboratories have confirmed this subtype in approximately 78% of the positive samples analyzed.
The timing couldn’t be more challenging. As I walked through Kensington Market on Wednesday, I spoke with several small business owners already worried about potential staff shortages during the crucial holiday shopping season. Amita Chaudhury, who runs a family-owned spice shop, described how a similar flu wave last year left her unable to keep regular hours.
“When half your staff is down with fever, and you’re trying to care for sick kids at home too, something has to give,” she sighed, arranging colorful jars of saffron and cardamom. “We’re all stocking up on hand sanitizer again.”
Behind the numbers lies a complex interplay of factors contributing to this early surge. Dr. Eileen de Villa, Toronto’s Medical Officer of Health, points to several potential contributors: “We’re seeing increased travel, reduced mask usage compared to previous years, and unfortunately, lower uptake of this season’s flu vaccine.”
Current vaccination data shows only about 29% of eligible Toronto residents have received their influenza shot this season, a figure that worries public health officials. The city has responded by expanding vaccination clinic hours and launching a multilingual outreach campaign targeting neighborhoods with historically lower vaccination rates.
Climate may be playing a role too. University of Toronto environmental health researcher Dr. Jeffrey Brook notes that unusually warm fall temperatures followed by sudden cold snaps can affect viral transmission patterns. “We’ve documented how these temperature fluctuations can impact respiratory infection rates, though the mechanisms are still being studied,” he explained during our phone conversation.
For Toronto’s homeless population, the confluence of early cold weather and increased influenza activity creates particularly dangerous conditions. At the Parkdale Community Health Centre, outreach worker Simone Taylor described efforts to protect vulnerable residents.
“We’re distributing care packages with masks, hand sanitizer, and information about where to access the free flu vaccine,” she told me as we walked through a pop-up clinic. “But when someone is focused on finding shelter for the night, preventative healthcare understandably becomes secondary.”
Many Torontonians still carry the emotional weight of previous winter surges that strained hospitals and isolated families. Fatima Rodriguez, a high school teacher I met while waiting for my own flu shot at a west-end pharmacy, expressed what many parents seem to be feeling.
“There’s this collective anxiety that rises as soon as we hear about increasing cases,” she said, rolling down her sleeve after getting vaccinated. “My students are already missing classes, and we’re just at the beginning of what could be a long season.”
Healthcare providers emphasize that this early surge doesn’t necessarily predict the entire winter’s trajectory. “Influenza is notoriously unpredictable,” Dr. Hota reminded me. “What we’re seeing now could plateau, or we could experience multiple waves of different respiratory viruses through spring.”
What is clear is that the health system is bracing for increased pressure in the coming weeks. Hospitals have begun implementing their winter surge protocols earlier than planned, with some postponing non-urgent procedures to preserve capacity.
For individual Torontonians wondering how to navigate the coming weeks, public health advice remains consistent: get vaccinated, practice good hand hygiene, consider masking in crowded indoor spaces, and stay home when symptomatic. Dr. de Villa emphasizes that the annual flu shot remains “our best frontline defense against severe outcomes.”
As darkness fell yesterday, I passed by Mount Sinai again. The emergency department remained busy, but there was a quiet resilience among the staff I spoke with. After years of pandemic response, there’s a hard-earned wisdom in how they approach each seasonal challenge.
“We’ve learned so much about respiratory virus management,” one emergency nurse told me as she prepared for her night shift. “Now we just need everyone to remember that the small actions we take as individuals—getting vaccinated, staying home when sick—they really do add up to community protection.”
For a city that has weathered so much, that reminder of our interconnectedness may be the most important medicine of all.
