Does it matter if patients are admitted to hospital specifically for treatment of COVID-19, or if they are admitted for another reason and found to be infected with the virus?
The “for” or “with” debate is an intriguing one.
It reminds us that data are important but so, too, is the context in which data are reported, and their interpretation.
On Jan. 1, Ontario changed its COVID-19 reporting system and, last week, it publicly issued the first data making the “for” and “with” distinction. (A number of other provinces have also done so.)
It showed that of the 3,220 COVID-19 patients hospitalized in the province, 1,739 were admitted because of their COVID-19 symptoms, and 1,481 were admitted for other reasons but also infected. That’s 54 per cent “for” and 46 per cent “with.”
There are a couple of ways to interpret these numbers.
The “it’s-just-a-cold” crowd will see the data as proof that hospitalization numbers are greatly inflated – that almost half of COVID-19 patients are not really COVID-19 patients.
The “lock-it-down” proponents will view the distinction between “real” and “incidental” infections as a phoney, politically motivated one, designed to play down the severity of the pandemic.
The reality, as is often the case, is somewhere in the middle.
In earlier waves of the pandemic, virtually every COVID-19 hospitalization was unambiguous because patients were admitted specifically because of symptoms related to the virus.
With the arrival of the highly infectious Omicron strain, a lot more people are infected, but there are more mild cases. Vaccination also means people have more mild symptoms and don’t require hospitalization unless they have an unrelated health problem such as a broken hip or a heart attack.
There’s now a lot more background noise. Collecting more nuanced data can help avoid both exaggerating the toll of the pandemic and dismissing its true impact.
That Omicron is milder for individuals doesn’t mean the impact is milder for the health system. The proportion of very sick may be small, but hospitalizations are way up.
Practically, it doesn’t matter if COVID-19 infections are incidental or not. Hospitals are full to bursting. Many have “ANB status,” meaning patients can be admitted but there are no beds. They lie in ER corridors.
Everyone who is infected with the coronavirus requires not only a bed, but special accommodation, and extra work for an already overworked staff. The collateral damage of everything, from cancelled surgeries to delayed screening, is real.
More importantly, the “for” and “with” categories are not black and white.
Just because a COVID-19 patient is not admitted for typical symptoms such as trouble breathing or COVID-19 pneumonia doesn’t mean the virus is not affecting their health.
If an older person with an infection has a fever, dizziness and falls, breaking a hip, is that related to COVID-19? Knowing that a COVID-19 infection can cause blood clots, did it contribute to a heart attack that sent a patient to hospital?
One of the intriguing bits of data published in Ontario was that 83 per cent of patients in intensive care (the sickest of the sick) were admitted “for” COVID-19. We know, too, that the large majority of ICU patients are unvaccinated.
There are also a lot of unanswered questions about the “incidental” cases. Most appear to be new infections – meaning they are highly infectious and at greater risk of infecting staff and other patients. We don’t know where they are contracting the virus; it could well be in hospital.
We also don’t know how their infections are progressing, or to what extent the virus exacerbates underlying conditions such as cancer, diabetes, heart disease or chronic ailments. We do know that even incidental infections can lead to treatment delays such as cancellation of surgery or blocking transfers; for example, keeping a psychiatric patient in the COVID-19 ward instead of a transfer to the psych ward.
Often, it is assumed that the “with” patients are less sick, or less affected, and that’s not necessarily true. We have systematically played down the deaths of people with underlying health conditions, failing to acknowledge how the virus hastened their demise.
Data have guided our response to the pandemic, but we must adapt data collection and interpretation to changing circumstances.
Case counts matter much less now because we have dramatically cut back PCR testing, and many cases are mild. Hospitalizations are a better indicator of where the pandemic is headed, so we need those numbers to be more complete.
So let’s keep tracking the “for” and “with” but let’s also understand that what ultimately matters is: 1) reducing infections so we reduce hospitalizations and; 2) that we are able to treat all patients who need hospital care, regardless of their viral status.
And these days that’s a struggle – one that should not be dismissed as incidental.
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