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Why are Canadian ICUs filling up faster than other countries?

News

The rapid spread of the Omicron variant and early research showing it is much less likely to cause severe outcomes than previous incarnations of the COVID-19 virus has left people around the world nervously eyeing the situation in nearby intensive care units, hoping for the best and fearing the worst.

Although Omicron may be less likely to send people to the ICU, some experts have warned that the highly transmissible virus could infect so many people that hospitals struggle to cope with the deluge of patients.

So far, the most sinister projections haven’t come to pass. In mid-December the Ontario COVID-19 Science Advisory Table predicted the province’s ICUs would see more than 600 occupants by the end of the year and, by mid-January, the hospitals still haven’t reported that many occupants.

In the United Kingdom, the ICU numbers have barely budged, with 11.4 people in ICU per million residents, even as Omicron cases reach dizzying heights. In Australia, they are at 15.2 per million people. In Canada? A spike starting in early January left the ICU occupancy rate at 27 occupants per million people on Jan. 13, the last day that all three countries reported reliable data.

The United States, which has always been in a league of its own on ICU occupancies, is at 76.7 per million.

The disparity between the United Kingdom and Canada stands out because until late December, the two countries were following an identical trendline. Australia has always been low and continues to be low, while the United States is high and continues to be high. The worst projections may not have panned out in Canada, but we are still seeing an ICU occupancy rate higher than countries with vaccination rates lower than us.

What’s causing the divergence? It’s almost impossible to say for sure, but there are a few theories that have been proposed.

Natural immunity levels

One stark difference between the U.K. and Canada over the two-year pandemic is the rate of infection.

Although officially reported case rates are likely massively underestimated due to the rapid speed of Omicron transmission, with at least nine in 10 cases going uncounted, the data from previous waves shows that about three times as many Britons endured a previous case of COVID-19 compared to Canadians.

That means the U.K. population is benefitting from a much higher level of natural immunity than Canada while the two countries face the Omicron wave. Because natural immunity offers longer lasting and stronger protection against symptomatic disease and hospitalization, it could make the difference in the ICUs.

“I strongly suspect the amount of post-infectious immunity in the unvaccinated cohort, and possibly levels of hybrid immunity is what makes the difference,” said Dr. Sumon Chakrabarti, an infectious diseases physician at Trillium Health Partners.

The Delta variant was still spreading

Another reason for Canada’s higher ICU occupancy rate could be the remnants of the more virulent Delta variant still circulating in late December. Although Omicron is now dominant, hospitalizations and deaths tend to lag infections by several weeks.

Rupa Subramanya, a columnist at the National Post, wrote that between Nov. 22 and Dec. 25, those with the Delta variant accounted for 190 ICU admissions or deaths in Ontario, while only eight were Omicron patients.

In British Columbia last week, many of the people in hospital were suffering from disease caused by the Delta variant, according to Dr. Bonnie Henry, the provincial health officer. Lingering Delta cases have also caused hospitalizations in New Brunswick.

Booster shots

When Omicron descended on the United Kingdom, Prime Minister Boris Johnson immediately called for an all-out blitz on booster shots. In terms of raw numbers, the plan worked: The U.K. has given more than 50 booster shots for every 100 residents.

Canada lags behind the U.K., with about 31 boosters given for every 100 residents and one-third of those shots coming in the last two weeks.

It’s possible that the booster gap made a small difference in the ICU occupancy rate of the two countries. Although Johnson’s booster campaign likely came too late to make much difference, since the shots take about a week or two to take effect, the U.K. had many more residents boosted on Dec. 1 than Canada did. A third shot has been shown to be very effective against symptomatic illness and severe effects from Omicron.

Omicron is not milder

Although there was a litany of evidence coming from South Africa, and other countries, that Omicron was less deadly than Delta it took some time for the world to be sure.

As late as Dec. 12, the director-general of the World Health Organization Tedros Adhanom said that it was “wrong for people to consider Omicron as mild.”

More recent research has definitively found that Omicron causes less severe disease and death than previous variants. A recent study out of California found that Omicron was half as likely to send people to hospital as Delta and that, out of 52,000 Omicron patients studied, not a single one needed a ventilator. This agrees with a handful of other studies from countries battling an Omicron wave.

Although federal modelling released on Friday still included a hypothetical scenario where Omicron turns out to be as severe as Delta — and some news organizations ran with that as the lead story — few believe that scenario is possible.

‘Everybody’s burnt out and tired’: Stories from the front lines of the Omicron wave

News

The Omicron variant of COVID-19 has been conclusively shown to be less severe than the Delta variant, but Omicron’s massively increased transmissibility has allowed it to sweep through the population at an incredible speed. In Alberta alone, the province’s chief medical officer of health estimated there are currently half a million active COVID-19 cases in the province, with only 10 percent of them officially confirmed by a PCR test. Since the end of December, hospitalizations have been gradually rising and ICU admissions have been growing, although slower than was originally feared.

With Omicron likely at its peak, we spoke to a handful of people on the front lines of the new wave crashing across Canada and asked them to tell us their story. Here’s what they told us.

‘Everybody’s burnt out and tired’

Katie Warrington, ICU nurse at the London Health Sciences Centre

I don’t think people realize what a COVID patient in the ICU looks like. I mean, these patients are very, very sick. We have the state of the art ventilators and even they aren’t enough to provide the proper ventilation that the sick patients need. I mean, we’re throwing everything we have at them, and people are still dying, and dying frequently.

I just think it’s sad that people don’t seem to really care unless it affects them and their families. Maybe your family got COVID and they were sick for a week and then they’re fine. But when it’s your loved one in the ICU, I think it’s a much different perspective.

Everybody’s burnt out and tired. And I do think at this point a large source of mental strain is the fact that most of our patients are unvaccinated. And, you know, you think that these admissions were preventable. Back, even in the last wave, when we were completely overrun, our unit was full of COVID, we had beds between the beds, so in a four bed area, we would have six patients all with COVID.

It was different then in the sense that, you know, that was before vaccines were widely available, they weren’t available to everybody yet. Whereas now, everybody’s had that chance. So to think that some people chose not to have it, and now they’re in the situation that they’re in, you know, critically ill and declining in front of our eyes, and there’s nothing we can do about it. It’s mentally taxing.

‘You see a lot of ‘for lease’ signs now’

Paras Baveja, owner of Bohca Bistro & Bar in Edmonton

I think the hardest part is definitely the longevity of the pandemic. Uncertainty would be another one because we don’t know what’s going to happen next. We cannot plan accordingly. And, you know, it doesn’t really matter how much we sit down in the meetings and plan the quarter ahead, because we cannot execute, because we don’t know if we’re going to go into a complete lockdown next week. You know, it’s just that uncertainty, which has affected us the most. We cannot plan anything.

We’re trying to cope. We’re trying to shift our focus and we hired a full kitchen staff. We changed our menu for the third time just because we are back into closing earlier right now due to new restrictions. We signed up on UberEATS and Skip The Dishes so we can shift our focus, again, towards food because we still have bills to pay. The rent doesn’t stop and the landlord knocks on the door every first-of-the-month.

You see a lot of “for lease” signs now. Like even our next door neighbor, they shut down. Their place is for sale. And people are worried, people are scared. But you know, there are people who don’t believe in COVID, you know, they say, ‘hey, we’re tired of it.’ Like, ‘we’re vaccinated now, so we don’t really care, we’ll go out.’ But I have a young family and a kid. We’re still scared, you know? The latest variant, Omicron, it’s spreading. And we’ve seen a few cases in the neighborhood.

‘I’m relieved to be virtual’

Colin MacLellan, teacher at Albert Campbell Collegiate Institute in Toronto

This afternoon in my Grade 10 drama class, my students were rehearsing scenes, so what I did was I just opened nine tabs and I had nine different Google Meets going at the exact same time. So I actually had nine groups of students talking at the exact same time. I know their voices, so I could kind of hear the rehearsal. To communicate with them, since I can’t turn my mic on, I had to actually go through the chat in nine different windows. And the crazy thing is that I actually got choked up after it. Because it was kind of like what it’s like in school for just a moment. This afternoon I had about 20 minutes of it, where I heard this cacophony of voices, and they were all talking at the same time and doing something good.

Well, I have to tell you, I taught for five hours today, and I keep my kids in the class the entire time. I sit at my desk sometimes after my lessons and I fall asleep. And I’m a marathon cyclist, like I do six to eight hours on a bike. So this is not a matter of endurance. It’s just so consuming. The technology is a huge challenge.

There is one end user, and it’s your kid, it’s my kids. And I happen to have, you know, 70 in desks and two at home. They deserve so much more. And I don’t mean throwing money at them. I just mean thoughtful and conscious decisions. I can tell you right now that I’m relieved to be virtual, despite the shift, because my kids, I’m telling you, I talk to them, they talk to me. They are not comfortable being in person.

‘The pandemic has become the new normal for our children’

Chris Murray, father of three in Ottawa

It is easy to underestimate the cumulative effect of the pandemic. We are not the same parents we were when this began, and the feeling of fatigue is very real.

The everyday reality of the pandemic has become the new normal for our children, whether that means virtual school, not seeing family, or missing out on playdates with friends. At the end of the day, no matter how hard we try, we cannot replace their peer groups or give them the same experiences they would be having at school with other kids. 

We can see this impact as we struggle to keep our kids motivated and engaged with learning and online activities. We understand the need to avoid further spread of the virus but the impact of that is very much being felt at home.

At the same time, we see the amount of effort that is being made by our biggest support system as parents: teachers and schools. It’s consistently disheartening to see the opening or closing of schools being framed as a political issue, when in truth for the last two years the only proactive efforts we’ve seen to make this experience somewhat normal for our kids have come from the schools in our communities.

‘I really just miss the actual personal interaction’

Richard Spiegel, Grade 9 and 10 teacher at Thistletown Collegiate Institute in Etobicoke

So far, it’s been it’s been okay for me going back to online schooling. I mean, it’s kind of mind-numbing. I’m kind of bored and I really just miss the actual personal interaction with other people, right? It’s me and my family and we’re the only ones that we see pretty much. It’s really the personal connection you miss because talking to the students online, it’s hard to do. You’ve got a class full of students, you don’t know who’s paying attention, who’s not, you don’t know what the students are doing.

I did talk to some of the students individually today. And I remember one student said that she’s having a really hard time with the online schooling.

Last year, when I switched to online schooling back in April, we started off the semester in person and then we went online, and a couple of students just sort of disappeared. They just sort of fell off a cliff. They were doing okay in person, and then they were just not online.

It’s more of a socio-economic thing. At least that’s what my experiences were last year. Some of the less well-off students they were the ones who seemed to suffer the most. And I can think of a few students who would have passed my class, or who were passing at the time that we were all sent home, and then they ended up not passing the class.