'it’s making people really sick in a different way': how omicron affects hospital patients

some canadian emergency rooms are being walloped by “ridiculous” numbers of people with suspected or confirmed covid, with symptoms ranging from what essentially resembles a mild cold to, in the unvaccinated and vulnerable, severe covid pneumonias, frontline doctors are reporting.some are arriving in hospital with minimal symptoms, driven there instead by anxiety or a desire to confirm their covid status, and with having had no clearly communicated advice on what to do if they do get covid.got omicron? these covid-19 symptoms are a sign you should get to a hospital plus, here’s how to recover from mild illness at home“we are still catastrophizing covid,” said dr. martha fulford, an infectious diseases specialist and chief of medicine at the mcmaster university medical center. “we have somehow made when you have a positive result equal disaster in a lot of people’s minds.”“the emotion and fear are so overwhelming. it’s very difficult to try to break through this,” fulford said.omicron is propagating rapidly, prime minister justin trudeau said wednesday. in ontario, the contagious variant has led to “explosive growth in hospitalizations,” though not icu admissions, a spokeswoman for the province’s health minister said in an emailed statement tuesday. the province has directed its hospitals to call-off non-emergency surgeries and brace for a potential “tsunami” of infections in the coming days and weeks.but doctors stress this isn’t march 2020, when people arrived in hospital extremely sick with gastro symptoms like vomiting or diarrhea, or dangerously short of breath. in new york city, where doctors and healthcare workers served as trailblazers in the first wave of sars-cov-2 and where hospitalizations surpassed 10,000 this week for the first time in 20 months, “we aren’t seeing as many patients gasping for air,” dr. craig spencer, a nyc emergency doctor tweeted this week. “thankfully the covid patients aren’t as sick. but there are so many of them.”unlike march 2020, when there were no vaccines, “we’re not seeing a lot of admissions for respiratory failure, we’re not seeing a lot of patients being put on high-flow oxygen, being intubated” and ventilated, or put on bipap machines that deliver oxygen under pressure through a mask, said dr. eric legome, who runs two mount sinai health system emergency sites in new york city. “what we are seeing is people who are being admitted because they are extremely weak, dizzy, a fall risk.” severe lung inflammation was a major issue in wave one, with people suffering respiratory distress and respiratory failure. “that’s not so much an issue this time,” legome said. “we’re not seeing a huge number of covid pneumonia and people requiring intensive respiratory support. we’re not seeing that very much at all.”the unvaccinated make up a disproportionate share of the sickest covid patients, spencer said. like earlier waves, some people are short of breath and require supplemental oxygen. “but for most, covid seemed to topple a delicate balance of an underlying illness,”  he said — diabetics in whom a covid infection triggered ketoacidosis, a potentially fatal complication.“it’s making people really sick in a different way,” spencer said.emerging research suggests omicron infects and lodges in the bronchi, and less so deep in the lungs, like delta does, which could explain why it’s spreading so quickly but causing less severe disease.“of all the patients we have with omicron, the vast, vast majority are going home,” legome said. of those hospitalized, “it tends to be the patients who would be admitted otherwise: you’re 90 years old, you have underlying pulmonary disease, heart failure, you have a hip replacement, you don’t get along well at baseline and then you have omicron on top of that and you just can’t get out of bed. it’s that type that we’re seeing more of,” he said.“it does clearly feel like the ones that seem to be more symptomatic tend to be the ones that are not fully vaccinated or boosted, or vaccinated at all.”canadian doctors are also seeing lots of covid in emergency departments. “and it’s all omicron,” radiologist dr. david jacobs tweeted wednesday morning in the final hours of a long overnight shift at humber river hospital in toronto.“the cases coming to the emergency room are basically all comers,” jacobs said in an interview. they range from those with mild symptoms and no shortness of breath, but who are worried and want to be tested, up to those with seriously “robust” pneumonias.of those sick enough to get a chest x-ray or ct scan of the chest, “those patients, for the most part, don’t have a lot of findings,” said jacobs, president of the ontario association of radiologists. most of them are also vaccinated. “they’ll either be completely normal chest x-rays or they’ll be very subtle, very mild pneumonia.”

a very small number of x-rays, however, are “downright horrible,” he said. the horrible ones, where the lungs are whited out, with more fluid in the air spaces than air, are seen in the unvaccinated, as well as the immune compromised — people with kidney failure, cancer patients on chemotherapy, organ transplant recipients — and the frail elderly with waning immunity and so many underlying health problems they simply can’t cope with even a mild case of covid pneumonia.the severe cases look the same as the cases seen during the height of delta and the first wave, jacobs said. “why that scares me is that it tells me that this virus is as bad a player as any other before it. it can be a milder virus, but it can also be quite severe,” and the only real differentiators are vaccination status, immune status and age.“you don’t want to spread panic, but you also don’t want to be blasé about what can be a very dangerous virus,” jacobs said.of the approximately 90 covid-positive people in humber river’s 744-bed hospital wednesday afternoon, 29 per cent are 60 to 79, and 41 per cent 80 or older. among the hospitalized, 50 are in hospital because of covid, and 40 with covid as an incidental diagnosis, meaning they were admitted for appendicitis, for example, or a broken leg or delivering a child, “and they happen to have covid,” jacobs said. “that kind of distribution has held relatively stable.” seven people were in the icu, “much, much lower than we’ve had with previous waves.”still, humber and other hospitals are seeing a constant stream of covid patients that need sorting out to find out which ones are truly sick and which ones can go home, the same time staffing levels are being depleted, with hundreds testing positive or in isolation because of a covid exposure.“most people are coming (to emergency) because they feel very unwell,” jacobs said. “most are using emergency services appropriately. we want to continue to get the message out there, if you have mild symptoms, you should stay home to decrease the risk of exposure to other people, particularly our emergency room staff. but of course, if you are ever concerned, you come right into emergency, and we’ll always be here. not just humber, but any hospital.”the challenge is that, because it’s covid, people are looking for clear guidance. “and it’s very hard for them to know and access reliable information,” said dr. andrew morris, a professor of medicine at the university of toronto and an infectious diseases specialist at toronto’s sinai health system. “they want treatment, they don’t know what’s available for treatment and there is very little public guidance around this.”in montreal, “the unvaccinated continue to populate the icu,” said dr. peter goldberg, former director of critical care medicine at the mcgill university health centre. “they can be very ill, indeed.” their chest x-rays are indistinguishable from what goldberg saw with the sickest patients in previous waves.thankfully, however, “we’re not seeing the same voraciousness of the virus as we did in the first waves, otherwise, given the prevalence in the community, there would be people getting tended to on the street,” goldberg said.in ottawa, while hospitalizations and icu admissions are growing, “it’s nothing on the level of what we were seeing in previous waves,” said critical care doctor james downar. “people are coming to the critical care unit, but are generally recovering relatively quickly.”fulford, of mcmaster, said for the young and otherwise healthy infected with covid who have no risk factors, “it’s the equivalent of any other viral infection: stay home, take lots of fluids.”for the mildly ill, budesonide, a steroid that can be inhaled from a “puffer” may make people feel better a few days earlier, according to guidelines produced by ontario’s covid-19 science table. the anti-depressant fluvoxamine can reduce the risk of hospitalization by about 30 percent if started early. in high-risk people, including those 50 and older with obesity, kidney disease or other underlying conditions, the monoclonal antibody sotrovimab may keep covid from progressing to severe disease, though it has to be administered intravenously or via injections.if people can get their hands on one, fulford recommends using oxygen saturation monitors to monitor oxygen levels. if your oxygen levels go down, that’s a sign for seeking medical attention. “people at higher risk should be referred for early treatment,” she said.• email: skirkey@postmedia.com | twitter: sharon_kirkey

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