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A COVID-19 drive-thru testing site in Montreal on Dec. 22.Graham Hughes/The Canadian Press

Canada marked Boxing Day by crossing another COVID-19 milestone, surpassing two million total cases despite many jurisdictions not reporting numbers over the holiday weekend, and as hospitals brace for the still unknown impact on admissions.

Health care staff and governments are on edge as they wait to see whether the sharp rise in case counts will have a domino effect on hospitals and intensive-care units. A steady number of international studies show that the new Omicron variant of COVID-19 leads to fewer severe cases, but with the sheer number of infections, even a smaller ratio of people getting very sick could swamp hospitals.

In Canada’s most populous provinces, hospital admissions have begun to rise, and infectious-diseases physician Andrew Morris said the increases reflect the beginning of exponential growth in Ontario and Quebec. On Sunday, Toronto’s University Health Network announced that it is reopening its COVID-19 unit because of the rise in admissions. However, intensive-care numbers in the province remain relatively stable.

Modelling released by Ontario’s COVID-19 Science Advisory Table on Dec. 16, as the Omicron wave was just taking off, showed that without a “circuit breaker” lockdown, cases would climb to 10,000 a day. While that has already happened, a hopeful indicator is that the intensive-care admissions remain below the best-case scenario forecasted by the same model.

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The steepest rise in hospital admissions has been reported in Quebec, where the latest data show a more than 50-per-cent increase in the last week. On Sunday, new restrictions took effect there, limiting private gatherings to six people, and restaurants are also now limited to six people a table.

While Omicron is leading to many more breakthrough infections in vaccinated people, doctors on the frontlines this weekend reported the same thing that the data show: Vaccinations are still protecting against severe illness.

“If you believe that Omicron is a milder variant, that seems to be true only for the vaccinated,” David Jacobs, a radiologist at Humber River Hospital, posted on Twitter Sunday. “For the unvaccinated, let me tell you that from an imaging point of view, it still results in a severe pneumonia.”

“Don’t take any chances. Again, get vaccinated and get boosted.”

Many provinces either didn’t report new COVID-19 data over the Christmas long weekend or reported pared-down information. But even with that patchwork of data, and no updates from provinces such as B.C., Canada passed the two-million case count.

Officials across the country have also warned that recent case counts are an underestimate because testing systems are overwhelmed and people are being asked to forgo lab testing all together if they are young and have mild symptoms.

In Manitoba for example, officials predict that there are more positive COVID-19 cases in the backlog of tests than in the most recent daily report of confirmed cases.

Ontario marked a record 10,412 new cases of COVID-19 on Saturday, and 9,826 on Sunday. In Nova Scotia, 569 new cases were recorded on Saturday and 578 on Sunday; the numbers mark three days now with lower case counts.

Quebec did not release any official counts over the weekend but media there reported that the province recorded more than 9,000 cases on Saturday and more than 7,000 on Sunday. Alberta also did not release official numbers, but Lynora Saxinger, an infectious-diseases professor at the University of Alberta, said based on laboratory data, the province added about 6,300 cases since Dec. 22.

Prince Edward Island, Newfoundland and Labrador, New Brunswick, Manitoba, and Saskatchewan also did not report updated data.

Governments across the country have imposed new restrictions as they try to protect the health care system. That key goal of pandemic management is more difficult to navigate in this Omicron-driven fifth wave because Canada is experiencing the wave at the same time as other countries instead of several weeks after it hits other countries.

That means the data on Omicron and how it affects different demographics isn’t yet clear. Dr. Morris, who works at Toronto’s Sinai Health and University Health Network, said hospitals are in a “waiting game” to see how the thousands of new cases impact intensive-care units, but it will become clear within the next week.

“The next six to seven days are going to be really key to understanding this,” he said. Hospital and intensive-care admissions are lagging indicators and don’t yet reflect the tens of thousands of more people who got sick in the past week, Dr. Morris said.

“The issue is can the health care system handle it? And you know, we probably will, but I’m pretty nervous,” he said, noting that staff shortages are already stretching the system and outbreaks are increasing in long-term care homes.

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Since Dec. 16, Ontario’s seven-day rolling average of critically ill COVID-19 patients in intensive care has gone from 156 to 165. “Hospitalizations are starting to accelerate,” Ontario Hospital Association CEO Anthony Dale said in a statement to The Globe and Mail.

Dr. Saxinger said on Christmas Day that Calgary’s positivity rate topped 30 per cent and across the province, the rate was about 24 per cent. The impact on hospitals is what she is also watching.

Alberta’s decision to stop widespread lab testing for suspected COVID-19 cases last week means health care systems will have less information to work with. Even so, Dr. Saxinger said the testing numbers don’t capture the full picture of COVID-19 in the province and hospital numbers will be more meaningful.

Complicating the country’s understanding of Omicron are factors such as vaccination rates and previous infection rates, which vary between regions and provinces and make comparisons difficult, she said. But both those factors will play a key role in the fifth wave’s impact on hospitals.

“It really is a hard thing to predict,” Dr. Saxinger said. “We know there’s a huge amount of transmissions going on. We just don’t know what that’s going to mean in the next two to three weeks.”

She added: “I don’t think that this is a guaranteed disaster. But there’s certainly a very, very significant risk of a real challenging time ahead.”

Dr. Saxinger noted that while areas with low vaccination rates would appear to be at risk, they may also be spots where the infection rate – whether recorded or otherwise – may have been high. Previous infections could help mute the severity of new infections.

Neeja Bakshi, an internal-medicine and COVD-19 physician at Edmonton’s Royal Alexandra Hospital, said given Canada’s relatively small population, crossing the two-million mark is a notable milestone.

“That is quite significant,” Dr. Bakshi said, noting that the official tally does not capture the breadth of the spread. “Probably more people than not have been now infected at some point.”

Alberta’s hospitals are not yet flooded with Omicron patients, she said, but the anticipation is weighing on health care workers. Alberta’s decision to dial back PCR tests will also make it harder for hospital officials to plan for a potential wave, Dr. Bakshi said.

“We are flying a little blind.”

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