As COVID-19 hospital admissions in Ontario hit pandemic heights, hospitals are running to take care of an influx of sick patients with a wider range of symptoms and conditions, making this increase different from previous waves and putting additional strain on a system, who are already struggling to make ends meet.
While patients are still hospitalized with declining oxygen levels that require respiratory support – the typical COVID presentation seen in previous waves – a wider range of patients with the virus also need care.
Hospital executives report that COVID now makes a greater number of elderly patients ill, people who are immunocompromised, those considered medically fragile, and patients for whom the virus has exacerbated an underlying medical condition, such as heart failure, chronic obstructive pulmonary disease (COPD), or insulin-dependent diabetes.
In many cases, this type of patient is vaccinated, which prevents serious illness. But doctors say the virus still makes them sick enough to need hospital treatment.
“We see COVID’s other impacts,” said Dr. Vikram Kapoor, a hospitalist and ward manager at Brampton Civic Hospital.
“For some older people, it affects their mobility; they generally feel weak and tired. Many come in dehydrated; they are unable to take care of themselves at home alone … Some are fainting.
“We see a wide range of complaints and concerns that bring people into the hospital who are not just focused on breathing difficulties. And much of this is in patients who have a high number of comorbidities and other health conditions, or if they are unvaccinated. “
Data suggest that the Omicron variant causes less serious illness than Delta. But the rapid spread variant means the large number of infected people in Ontario has led to a recent near-vertical increase in hospitalizations.
“Although a smaller percentage of people require hospitalization (with Omicron), given the large number of patients infected in the community, the absolute number requiring hospitalization is still quite high,” Kapoor said, noting , that hospitals also face staff. deficiency due to health professionals isolating at home due to the virus.
On January 7, the province registered 2,472 COVID admissions, which is a marked increase over the previous week. And on Monday, Critical Care Services Ontario reported 427 adult patients with COVID-related critical illness in provincial intensive care units – surpassing the second wave height of 420 recorded in January 2021 – after 54 new patients were admitted since the previous day.
“I think it would be wrong for people to think that Omicron only causes mild illness,” said Dr. Damon Scales, Head of Critical Care at Sunnybrook Health Sciences Center. “For most people, it’s like a cold or the flu. But we’re still seeing people on COVID fans.
“We expect that the largest flow of patients will still come in the coming weeks, reflecting the large case numbers we saw in the New Year period.”
On December 29, the province instructed hospitals to collect data on COVID patients to distinguish between those who are hospitalized because they are sick with the virus and those who test positive when they are hospitalized for other reasons.
In an email to Star, a spokesman said the health ministry was asking hospitals to update their daily reporting “to be transparent and give the public as much context as we can,” adding that “changes in public reporting will be made in the coming days. “
But hospital executives told Star that while tracking such data could help the province plan the health care system, it does not necessarily affect day-to-day operations, which are under extreme pressure from the rise in COVID patients combined with severe staff shortages.
“From a nursing perspective, it does not make much of a difference because it is patients who are ill and contagious,” said Mary-Agnes Wilson, senior nurse at Mackenzie Health, which includes Richmond Hill Hospital and Cortellucci. Vaughan Hospital.
“The nurse needs the right PPE, the patient needs to be placed in a private room, all the things we do to take care of patients who have an infectious disease.”
Patients who test positive for COVID while receiving treatment for another injury or disease may not have the same length of stay as a patient who is seriously ill with the virus, said Agnes, Mackenzie Health’s executive vice president and chief operating officer. “But they may have other problems and they still require resources.”
Mackenzie Health began to experience an increase in the number of COVID patients during the first week of January. On January 7, it had 104 confirmed and 71 suspected COVID patients.
Some had COVID pneumonia and needed oxygen support and may eventually require mechanical ventilation, Wilson said, noting that a majority of these patients are unvaccinated.
Others are medically fragile, for whom the virus “tends to be their turning point in needing hospitalization,” she said. Patients who test positive during their course of treatment for other illnesses and injuries, including stroke or a broken hip after a fall, tend to be asymptomatic or have very mild symptoms, she said.
“We’re starting to tease it out and capture that data.”
A spokesman for Mackenzie Health told Star that they are not ready to share the data, but “at the moment we are seeing more and more patients coming to us because of COVID-19 as opposed to with COVID-19.”
At Sunnybrook, the picture is different. A spokesman for the hospital said that of the 91 COVID-positive patients at the hospital on January 7, 21 had a primary diagnosis of COVID, nine of whom were in the intensive care unit.
Scales said there is a slow but steady increase in the number of COVID patients in need of intensive care. On January 7, the ICU took care of 14 COVID patients, about twice as many as the week before. On Monday, the ICU had 16 COVID patients.
‘There are patients in the cohort who have been vaccinated and who have comorbidities. But critical illness caused by COVID is still really being experienced by those who are unprotected and unvaccinated. “
Scales said an important difference in the Omicron wave is that many hospitals across the province are facing the double pressure of critical staff shortages and the rise in COVID cases, limiting the system’s ability to relieve patients from severely affected hospitals, as it did in the third wave.
“I do not think that solution will work right now just because everyone is suffering,” he said. “Every hospital deals with these human resources and workforce issues, so the amount of help we can offer each other is more limited.”
At the Brampton Civic, part of the William Osler Health System, the COVID situation is changing rapidly. According to a spokesman for Osler, on January 7, the hospital had 67 COVID-positive patients, 13 of whom tested positive after being admitted for other conditions. On Monday, the hospital took care of 89 COVID-positive patients, seven of whom tested positive while being treated for other conditions.
Kapoor said the majority of COVID patients on the Brampton Civic are being treated in the medical wards.
“The hope would be that since we do not see as much COVID pneumonia, we can see fewer cases in the intensive care unit. But it is too early to say for now.”
At Trillium Health Partners in Mississauga, COVID also plays out differently than at other points in the pandemic, said infection doctor Dr. Gabriel Rebick. In previous waves, it was primarily unvaccinated patients with COVID pneumonia who came to the hospital and needed breathing support after being ill at home for about a week.
While unvaccinated patients are still hospitalized – albeit in smaller numbers than at other peaks – they appear to need hospitalization a little faster after the onset of symptoms, he said, noting that observation has not yet been described in the literature.
Likewise, there are several COVID patients in this wave arriving with symptoms of severe viral illness, including high fever, soreness and pain, and a poor appetite leading to dehydration, Rebick said.
“These patients fall into two main categories: elderly people with multiple medical problems who do not need much illness to turn them into hospitalization, and immunocompromised patients who have been vaccinated but nevertheless become moderately ill, not seriously ill. , with the virus. “
According to a THP spokesman, its hospitals took 284 COVID-positive patients on Monday, of which 114 are in the hospital with a primary diagnosis of COVID.