Some patients come in for COVID-19, others get infected alongside another problem. In hospitals these lines are fading
In a busy intensive care unit in east Toronto, Dr. Martin Betts often sees patients struggling with a dual diagnosis: a serious health condition associated with – or caused by – COVID-19.
As chief of critical care for the Scarborough Health Network, Betts treated several patients with diabetic ketoacidosis, a buildup of acids in the blood that is a life-threatening complication of diabetes, which can be triggered by viral infections.
Others have been admitted for heart inflammation, heart attacks and even cardiac arrest caused by SARS-CoV-2 infection – yet COVID-19 is often listed as a secondary diagnosis, a situation Betts describes as “misleading”.
“Accidental COVID patients actually have potentially longer length of stay and higher mortality…they should actually be seen as a greater burden on the system than being portrayed as accidental cases,” he said. he declares.
“I think it’s a story that really needs to be told.”
“For” versus “with”
As an Omicron training surge continues to send more COVID-19 patients to hospitals, some jurisdictions – including Ontario earlier this month, following the example of various American hospitals — break down hospital data differently.
They now distinguish between those admitted directly for COVID-19 and those admitted for other health conditions who also test positive because the variant infects such a wide range of patients.
In other words, you’re either in the hospital for COVID-19, or with COVID-19[FEMALE[FEMININE
Distinguishing the data could make it easier to rule out accidental infections, minimize the strain on hospitals, or assume that the crisis phase of this pandemic has already passed.
But Betts and other clinicians say the reality on the ground is more complicated, and these binary buckets don’t capture all the nuances of patient experiences and care in a system under strain during a pandemic.
More than a “little player”
“I think the impression in the community is that these COVID infections are really not a big deal, that it’s just kind of a small player in this patient’s illness,” Betts said. “This is not the case.”
Over the past few weeks, extremely high infection rates have begun to cloud the COVID-19 data in several ways. Record case spikes have proven too difficult to track, and many parts of the country have scaled back testing, leave canada in the dark how many people are infected each day.
The same time, this variant works differently, often causing less severe illnesses than its predecessor, Delta. This is partly thanks to Omicron’s wide range of mutations, and partly because millions of Canadians are now largely protected from adverse health effects, thanks to vaccinations.
This means that while unprecedented numbers of people have been infected in just weeks, many are not presenting to hospitals with classic COVID-19 pneumonia, but rather a wider range of symptoms, or all in facing another health problem.
Betts says dividing hospitalized patients into those admitted with COVID-19 and those infected after being admitted with another condition, can be helpful in planning health system capacity, given the specialized care and treatment required for patients with the condition. of COVID-19 in its own right. .
“But for me,” he said, “it’s the end.”
Worse outcomes for infected patients
Many patients who test positive while hospitalized for another condition end up having worse outcomes than those who aren’t battling a coronavirus infection, Betts said.
Several studies from various countries suggest higher death rates for patients being treated for hip fractures who also tested positive for coronavirus, compared to those who tested negative, for example. Having a coronavirus infection also makes it more risky to undergo various types of surgery and increases the chances that someone will be pregnant. having a premature birth, stillbirth, or other complications.
Then, of course, there is the ripple effect on the health and well-being of people who are not infected with COVID-19 at all, including thousands of canceled and delayed surgeries.
Hospitals under pressure
At a recent press conference to highlight the pressure being felt by hospitals in Hamilton, Dr. Zain Chagla, Co-Medical Director of Infection Control for St. Joseph’s Healthcare Hamilton, explained how the current increase in admissions to Omicron strains the health system. as a whole, regardless of how patients are classified.
Such a high number of infected patients admitted at the same time means people have “repeated exposures”, he said. Even negative test results cannot completely rule out an infection, which can then trigger transmission of the virus in hospitals.
And it’s really more like three buckets of patients that hospital teams see, Chagla added: the seriously ill with classic COVID-19 pneumonia, those battling another major health issue alongside a COVID-19 infection. and those with cases that are really incidental, like someone who tests positive after being admitted for a scheduled procedure.
“The hospital pressures are quite similar in all three cases,” he said.
More COVID-19 patients of all kinds inside a hospital is a logistical struggle, echoed Calgary emergency physician Dr. Joe Vipond.
“Even if you are inadvertently diagnosed with COVID when you arrive at the hospital with another problem, it still makes things difficult,” he said. “You can’t just throw a COVID-positive patient in a four-bedroom room.”
Weeks of impact from Omicron’s “massive” surge
Dr. Alex Wong, an infectious disease specialist in Regina, said the pressure cooker situation that many Canadian hospitals will face in the coming weeks is largely related to COVID-19, regardless of how the jurisdictions break down the data.
“Massive surges cannot simply be explained by people being hospitalized for other reasons who are found out ‘by chance’ to have COVID,” he said.
“It’s going to be this perfect storm of understaffing, plus the lack of beds, plus a huge wave of patients, that’s really going to put the system on edge.”
LOOK | Federal modeling suggests a “very intense” surge of Omicron within weeks:
Federal modeling released Friday suggested that Omicron infections will increase hospital admissions in the coming weeks, with “several weeks of very intense activity expected”.
During this briefing, public health officials discussed the shift in many jurisdictions to reporting patients with COVID-19 and accidental infections, Chief Public Health Officer Dr. Teresa Tam, noting that the breakdown will prove useful to study the impact of this last variant.
“But for the hospitals themselves, they are quite full, and the hospitals have always been very busy in the winter months anyway,” she said.
“So it really doesn’t help at all to have a massive push from Omicron.”