Hospitalizations rising right across Canada as Omicron threatens to overrun the health system

Hospitalizations rising right across Canada as
               Omicron threatens to overrun the health system

By Jeff Gray, Andrea Woo and Eric Andrew-Gee (Toronto), Globe and Mail, Jan 4, 2021

The Omicron variant is driving a rapid rise in hospitalizations in much of Canada, prompting
provinces to find ways to maintain staffing levels in health care systems already pushed to the
brink.

In Ontario, William Osler Health System, a hospital network in Peel Region, initiated a “Code
Orange (Stage 2)” alert this week as it redeploys staff and prioritizes the most urgent cases to
deal with a surge in patients and a shortage of personnel. British Columbia and Quebec have
developed protocols that would allow asymptomatic health care workers to remain on the job
should the public-health situations continue to deteriorate. Scheduled surgeries are again being
postponed across the country to free up resources for Covid patients.

Anthony Dale, head of the Ontario Hospital Association, said the province’s directive to ramp
down other surgeries will have a “significant long-term impact on thousands of patients,”
including those awaiting lifesaving procedures. “These are not trade-offs any of us wanted to
make, but they are necessary now to protect hospital system capacity and health human
resources,” Mr. Dale said in an e-mailed statement.

Ontario reported 1,290 Covid-19 patients in its hospitals on Tuesday, an increase of 58 in just
one day and a total that has shot up from 491 a week ago. ICU numbers were also on the rise,
with 266 patients in intensive care units, up 18 from the day before. A week ago, there were 187
Covid-19 patients in Ontario’s ICUs.

At the peak of the pandemic’s third wave, the province had just over 2,400 patients in its
hospitals with the virus, and more than 900 in its ICUs. The Ontario government’s website said
Tuesday it had more than 600 ICU beds still available.

Premier Doug Ford this week announced new restrictions that include the closing of indoor
dining and schools for two weeks and the suspension of non-emergency surgeries, saying they
were needed to protect the province’s health system from being overwhelmed as it faces a
“tsunami” of new patients and staff shortages caused by the virus.

Dr. Michael Warner, clinical director of critical care at Michael Garron Hospital in Toronto, said
many hospitals will face serious staffing challenges, even if Omicron’s effects are less likely to
put as many patients on ventilators as the previous Delta variant. Some in the bulging wave of
new patients may need just oxygen or intravenous fluids, rather than a full-blown intensive-care
bed, but a lack of qualified staff could still compromise even their care, he said.

“I think that many hospitals will face that for a period of time and it’s difficult to predict how
long each hospital, each province, each region will experience that supply-and-demand
mismatch,” Dr. Warner said.

Ontario’s Progressive Conservative government has faced criticism for not acting earlier on
warnings from the province’s Covid-19 Science Advisory Table on Dec. 16. Modelling from the
table’s scientists projected more than 10,000 new cases a day and said a stricter “circuit breaker”
was needed to keep Covid-19 ICU admissions at or below the 300 mark by Dec. 31. (Ontario
limited restaurants to 50-per-cent capacity Dec. 19, before ordering indoor dining closed on
Monday.)

In an e-mailed statement on Tuesday, Alexandra Hilkene, a spokeswoman for Health Minister
Christine Elliott, said the science table’s projections assumed that Omicron was as deadly as the
Delta variant, which has turned out not to be the case. ICU occupancy in the province has not
grown exponentially as predicted and has instead “continued to trend below or within the
margins of the best-case scenario projected by the Science Table,” she said.

But since the modelling was released, she said, Omicron’s higher transmissibility has resulted in
“explosive growth in hospitalizations,” rather than ICU numbers, as well as staffing shortages.
This prompted the government to take more action as it did this week to “help blunt transmission
and prevent hospitals from becoming overwhelmed.”

In British Columbia, which is beginning to see a climb in hospitalizations, Provincial Health
Officer Bonnie Henry said some public-health activities have been paused to free up resources
for pandemic response, and that the province continues to plan for potential shortages of health
care workers. Protocols are in place to allow asymptomatic health care workers to remain on the
job as a last resort, she said.

“We’d only want them to work with Covid patients, for example, so that we wouldn’t increase
risk anywhere else in a facility,” Dr. Henry said. “But the protocols for how that would happen,
what we would call fitness-to-work protocols, those are all developed as well.”

There were 298 people hospitalized with the coronavirus in B.C. on Tuesday, a 35-per-cent
increase from Friday. Of those, 86 people are in critical care. In the past two weeks,
unvaccinated people were hospitalized at a rate of 22.3 per 100,000 people, compared to 2.2 and
1.7 per 100,000 for partially and fully vaccinated people, respectively.

Alberta counted 436 patients with Covid-19 in hospital, up 26 per cent from 346 a week prior. In
each week, 61 of these Covid-19 patients were in ICU, according to provincial data.

Unvaccinated people make up 47 per cent of Alberta’s hospitalized Covid-19 patients, even
though all but 20 per cent of people in the province have received at least one dose of vaccine.
Only 10 per cent of Albertans over 12 years old have yet to receive a single shot, according to
provincial data.

Premier Jason Kenney, when asked about the growth in hospital admissions, noted the ICU
census remained low compared to the rest of the pandemic. “That has been the key pressure
point in our system,” he told reporters Tuesday, adding that other jurisdictions battling Omicron
have experienced a “modest” impact on ICUs.

Meanwhile, Saskatchewan on Tuesday said it was caring for 95 people with Covid-19 in its
hospitals, 11 of whom were in ICU. A week ago, the province had 87 Covid-19 patients in
hospital, with 29 ICU patients. The province reported a total of 3,602 new cases of Covid-19
between Dec. 29 and Jan. 4, with the seven-day average of new daily infections reaching 515,
according to a statement the government released Tuesday.

Premier Scott Moe declined to implement tighter restrictions over the holidays and, unlike his
counterparts across the country, refused to delay the return to in-person learning for children.
Before and after Christmas, Mr. Moe touted how the number of Covid-19 patients in
Saskatchewan’s hospitals and ICUs were dropping, despite an onslaught of new cases. Hospital
admissions, however, are a lagging indicator.

The Quebec health care system continues to show strain under the unprecedented load of cases
caused by the Omicron variant, with 1,592 hospitalizations linked to Covid-19 on Tuesday, an
increase of almost 200 and the most since the early days of the pandemic in the spring of 2020.
The province also recorded 14,494 new cases, in keeping with the recent trend of roughly 15,000
per day, five times its pre-Omicron high.

The province announced on Tuesday that most people will no longer be eligible for a PCR test at
a government clinic, as it rations supplies. The tests will now only be offered to certain priority
groups including patients, staff, and visitors in hospitals and communal living facilities; health
care workers in contact with patients; some outpatients; homeless people and those with
precarious housing; and Indigenous people and those working in Indigenous communities.

The province also shortened the recommended isolation period for vaccinated people with
Covid-19 symptoms from 10 to five days, or seven days for health care workers in contact with
at-risk people, provided their symptoms are improving and they have been without a fever for 24
hours. The altered guidance comes days after the U.S. Centers for Disease Control and
Prevention issues a similar directive, recently adopted by the government of Ontario.

The Atlantic provinces continued to report low hospitalization rates, despite soaring numbers of
infections in recent weeks. In Nova Scotia, there are 40 people in hospital with Covid-19, with
five in intensive-care units. One person is hospitalized in Newfoundland and Labrador. In PEI,
three people are in hospital with the virus, one in intensive care.

In New Brunswick, where 571 health care staff are isolating at home because of Covid-19, 56
people are hospitalized with the virus, 16 in ICU and 11 of them on ventilators. Two-thirds of
those in hospital are over 60, while no one under 19 is in hospital.

New Brunswick’s Health Minister Dorothy Shephard said people need to change the way they’re
thinking about an Omicron variant that appears to be most dangerous to older Canadians and
those with vulnerable immune systems.

“We need to assume, just like the common cold, it is everywhere, and it’s not common to us to
have this kind of mindset with Covid-19, but the fact is, is that, you know, we’re looking at
transitioning to a different mindset and a different perspective with regards to how we live with
Covid,” she told reporters Tuesday.

“And so I’m not saying that we don’t need to be concerned because we do. We need to protect
our over-50 population. We need to keep in mind, always, our vulnerable communities and those
who are at risk. And I think that that’s the kind of the pivot that we’re going to need to make in
the near future.”

With reports from Carrie Tait in Calgary and Greg Mercer in Saint John.