Care team members attend to an ICU patient at Brampton Civic Hospital last year.Fred Lum/the Globe and Mail
In early December, emergency room staff at Bluewater Health in Sarnia, Ont., began seeing a troubling change in patients coming to the hospital with serious COVID-19 symptoms. Unlike during earlier waves, multiple people were showing up at once. Sometimes entire families came in, all sick, likely with the newly identified Omicron variant of the virus.
Now, the hospital’s intensive-care unit is at capacity, with 70 per cent of patients there as a result of COVID-19 infections. About 90 per cent of the COVID-19 patients in the ICU are unvaccinated, chief of staff Michel Haddad said in an interview this week. Among the hospital’s entire population of COVID-19 patients, both inside and outside the ICU, two-thirds are unvaccinated.
In the past two weeks, the number of COVID-19 patients admitted to Bluewater has quadrupled. Meanwhile, a significant chunk of the staff – nearly five times the typical number – is on sick leave, in many cases because of Omicron. This has forced others to work double shifts and postpone holidays.
The situation is so urgent the hospital sent an open letter this week in which it urged community members to get vaccinated and limit social contacts.
Versions of this are playing out at hospitals around the country. On Friday, Ontario said 2,472 people were hospitalized as a result of COVID-19, a new provincial record. The same day, Quebec officials said more than 2,100 patients were in the hospital as a result of the disease, also a new record. The Quebec government expects that figure to reach 3,000 by mid-January.
But this new flood of COVID-19 hospitalizations is different from those in previous waves. High vaccination rates, combined with a variant that appears to cause less severe disease than previous versions of the virus, have led to a situation where patients being admitted are often unvaccinated, and many are vaccinated but suffering from chronic health conditions that make them more vulnerable.
COVID-19 hospitalization rates for
selected provinces
As of Jan. 6*; per 100,000 population;
seven-day moving average
Non-ICU hospitalizations
ICU hospitalizations
British Columbia
30
25
20
15
9.6
10
4.9
5
0
Feb. 2020
2021
2022
Alberta
30
25
24.6
20
15
9.2
10
5
0
Feb. 2020
2021
2022
Saskatchewan
30
29.3
25
20
15
10
7.5
5
0
Feb. 2020
2021
2022
Manitoba
30
25.2
25
20
13.1
15
10
5
0
Feb. 2020
2021
2022
Ontario
30
25
20
15.3
15
11.3
10
5
0
Feb. 2020
2021
2022
Quebec
30
25
21.3
18.6
20
15
10
5
0
Feb. 2020
2021
2022
New Brunswick
30
25
20
15
8.0
10
6.5
5
0
Feb. 2020
2021
2022
Nova Scotia
30
25
20
15
9.5
10
3.9
5
0
Feb. 2020
2021
2022
*Data for Manitoba, Ontario and Quebec are as of Jan. 7.
MAHIMA SINGH, CHEN WANG AND MURAT
YÜKSELIR / THE GLOBE AND MAIL, SOURCE:
PROVINCIAL GOVERNMENTS
COVID-19 hospitalization rates for
selected provinces
As of Jan. 6*; per 100,000 population; seven-day
moving average
Non-ICU hospitalizations
ICU hospitalizations
British Columbia
30
25
20
15
9.6
10
4.9
5
0
Feb. 2020
2021
2022
Alberta
30
25
24.6
20
15
9.2
10
5
0
Feb. 2020
2021
2022
Saskatchewan
30
29.3
25
20
15
10
7.5
5
0
Feb. 2020
2021
2022
Manitoba
30
25.2
25
20
13.1
15
10
5
0
Feb. 2020
2021
2022
Ontario
30
25
20
15.3
15
11.3
10
5
0
Feb. 2020
2021
2022
Quebec
30
25
21.3
18.6
20
15
10
5
0
Feb. 2020
2021
2022
New Brunswick
30
25
20
15
8.0
10
6.5
5
0
Feb. 2020
2021
2022
Nova Scotia
30
25
20
15
9.5
10
3.9
5
0
Feb. 2020
2021
2022
*Data for Manitoba, Ontario and Quebec are as of Jan. 7.
MAHIMA SINGH, CHEN WANG AND MURAT
YÜKSELIR / THE GLOBE AND MAIL, SOURCE:
PROVINCIAL GOVERNMENTS
COVID-19 hospitalization rates for selected provinces
As of Jan. 6*; per 100,000 population; seven-day moving average
Non-ICU hospitalizations
ICU hospitalizations
British Columbia
Alberta
30
30
25
25
24.6
20
20
15
15
9.6
9.2
10
10
4.9
5
5
0
0
Feb. 2020
2021
2022
Feb. 2020
2021
2022
Manitoba
Saskatchewan
30
30
29.3
25.2
25
25
20
20
13.1
15
15
10
10
7.5
5
5
0
0
Feb. 2020
2021
2022
Feb. 2020
2021
2022
Ontario
Quebec
30
30
25
25
21.3
18.6
20
20
15.3
15
15
11.3
10
10
5
5
0
0
Feb. 2020
2021
2022
Feb. 2020
2021
2022
New Brunswick
Nova Scotia
30
30
25
25
20
20
15
15
9.5
8.0
10
10
6.5
3.9
5
5
0
0
Feb. 2020
2021
2022
Feb. 2020
2021
2022
*Data for Manitoba, Ontario and Quebec are as of Jan. 7.
MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS
Despite growing evidence that the Omicron variant is less likely to lead to severe illness requiring hospitalization or mechanical ventilation, its highly contagious nature poses a major threat.
“There’s so many people that are infected out there that a smaller percentage of a larger number is still a big number,” Dr. Haddad said.
Physicians say there’s no typical patient in the Omicron wave. People who are unvaccinated are much more likely to be hospitalized or end up in the ICU and experience severe outcomes. But people with compromised immune systems or other serious health problems are also being admitted.
“What we’re seeing during this wave, I would say, is a wider spectrum of disease,” said Jessica Liu, an internal medicine physician at Toronto’s University Health Network.
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According to the Ontario Science Table’s online dashboard, the hospital occupancy rate for the unvaccinated was 611 per million unvaccinated people in the province’s population as of Jan. 7, compared to 129 per million among those who had received at least two doses of a COVID-19 vaccine. The ICU occupancy rate among the unvaccinated was 153 per million, compared to about 11 per million among those who have received at least two vaccine doses.
How to measure the impact of unvaccinated Ontarians on ICUs
If judged by the raw data (top), the gap between the numbers of unvaccinated and fully vaccinated patients in Ontario ICUs seems to be narrowing. But when the size of the province's fully vaccinated population – now more than four times the size of the unvaccinated population – is taken into account, along with the fact that the unvaccinated population skews young, it's clear that the occupancy rate of unvaccinated people in ICUs is almost 15 times higher than that of fully vaccinated people (bottom).
Daily count of COVID-19 patients in ICU
in Ontario, by vaccination status
As of Jan. 6
Unvaccinated
Fully vaccinated
140
120
100
80
60
40
20
0
Aug.
2021
Sept.
Oct.
Nov.
Dec.
COVID-19 ICU occupancy rate in Ontario,
by vaccination status
As of Jan. 6; per 1 million corresponding population
by vaccination status; age standardized
Unvaccinated
Fully vaccinated
140
120
100
80
60
40
20
0
Aug.
2021
Sept.
Oct.
Nov.
Dec.
Note: Partially vaccinated people are not included in this analysis.
MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: ONTARIO MINISTRY OF HEALTH; THE ONTARIO COVID-19 SCIENCE ADVISORY TABLE
How to measure the impact of unvaccinated Ontarians on ICUs
If judged by the raw data (top), the gap between the numbers of unvaccinated and fully vaccinated patients in Ontario ICUs seems to be narrowing. But when the size of the province's fully vaccinated population – now more than four times the size of the unvaccinated population – is taken into account, along with the fact that the unvaccinated population skews young, it's clear that the occupancy rate of unvaccinated people in ICUs is almost 15 times higher than that of fully vaccinated people (bottom).
Daily count of COVID-19 patients in ICU
in Ontario, by vaccination status
As of Jan. 6
Unvaccinated
Fully vaccinated
140
120
100
80
60
40
20
0
Aug.
2021
Sept.
Oct.
Nov.
Dec.
COVID-19 ICU occupancy rate in Ontario,
by vaccination status
As of Jan. 6; per 1 million corresponding population
by vaccination status; age standardized
Unvaccinated
Fully vaccinated
140
120
100
80
60
40
20
0
Aug.
2021
Sept.
Oct.
Nov.
Dec.
Note: Partially vaccinated people are not included in this analysis.
MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: ONTARIO MINISTRY OF HEALTH; THE ONTARIO COVID-19 SCIENCE ADVISORY TABLE
How to measure the impact of unvaccinated Ontarians on ICUs
If judged by the raw data (left), the gap between the numbers of unvaccinated and fully vaccinated patients in Ontario ICUs seems to be narrowing. But when the size of the province's fully vaccinated population – now more than four times the size of the unvaccinated population – is taken into account, along with the fact that the unvaccinated population skews young, it's clear that the occupancy rate of unvaccinated people in ICUs is almost 15 times higher than that of fully vaccinated people (right).
COVID-19 ICU occupancy rate
in Ontario, by vaccination status
Daily count of COVID-19 patients in ICU in Ontario, by vaccination status
As of Jan. 6; per 1 million corresponding population
by vaccination status; age standardized
As of Jan. 6
Unvaccinated
Fully vaccinated
Unvaccinated
Fully vaccinated
140
140
120
120
100
100
80
80
60
60
40
40
20
20
0
0
Aug.
2021
Sept.
Oct.
Nov.
Dec.
Aug.
2021
Sept.
Oct.
Nov.
Dec.
Note: Partially vaccinated people are not included in this analysis.
MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: ONTARIO MINISTRY OF HEALTH; THE ONTARIO COVID-19 SCIENCE ADVISORY TABLE
It seems as though Omicron infections are leading to fewer cases of severe COVID-19-related pneumonia, compared with infections seen in earlier waves of the pandemic, said Vikram Kapoor, hospitalist and site division head at William Osler Health System’s Brampton Civic Hospital.
“It’s not a uniform pattern. It’s very specific to each individual patient and their own specific risk profile,” Dr. Kapoor said.
For instance, many frail, elderly patients who get infected are coming to the hospital because they can no longer manage to take care of themselves, he said. In other cases, people with chronic illness, such as chronic obstructive pulmonary disease, experience flare-ups of symptoms after a COVID-19 infection, resulting in hospitalization.
Some people are testing positive for COVID-19 despite being admitted for something else. But from a hospital perspective, it doesn’t make much difference, because the same isolation protocols are put in place for everyone who tests positive, Dr. Kapoor said.
At Bluewater, according to Dr. Haddad, unvaccinated ICU patients often range in age from 40 to 60. The hospital’s vaccinated COVID-19 patients include people undergoing chemotherapy and transplant recipients, he said.
While some patients are still experiencing breathing problems and respiratory distress severe enough to require mechanical ventilation, the overall proportion of patients needing this kind of treatment appears to be less during this wave than in previous ones, said Bram Rochwerg, site lead at the Juravinski Hospital ICU in Hamilton.
About 20 to 30 per cent of patients in the hospital’s ICU have classic COVID-19 pneumonia, Dr. Rochwerg said. Others have multiple health problems, along with COVID-19 infections.
The less-severe nature of Omicron appears to be leading to shorter hospital stays. Kieran Moore, Ontario’s Chief Medical Officer of Health, said in a briefing on Thursday that the average length of a stay for a COVID-19 ICU patient has dropped from 13 days in early December to six.
“That, to me, is a very good trend,” Dr. Moore said. He added that shorter stays will give the province more flexibility to treat higher numbers of patients.
The stress on the hospital system is being exacerbated by the fact that many health workers are isolating or taking sick leaves because of COVID-19, while many others are off the job because of pandemic fatigue and burnout.
Quebec health minister Christian Dubé said on Thursday that 20,000 health care workers are absent as a result of COVID-19 in the province. That’s on top of 50,000 health care workers who are on longer-term leave because pandemic burnout and other issues, he noted.
“Everyone is exhausted in the health system,” Mr. Dubé said.
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