Dr. David Jacobs: Omicron has filled up my hospital, but the panic from the Delta wave is gone

Faced with a constant barrage of hyperbolic headlines, social media posts, and punditry, the public has become inured to bad news, accustomed to low levels of panic, and justifiably suspicious of any predictions, good or bad. The best way to untangle this web of spin and sensationalism is take a peek inside the hospitals to see what’s really happening. Let me be your guide.

As a radiologist at Humber River Hospital, a large urban general hospital in Toronto, I’ve had a bird’s eye view of the entire pandemic seeing the imaging of patients from when they walk through our doors in emergency to when they are unfortunate enough to require critical care. Every picture tells a story, and the story of Omicron has been unlike any of the waves that have come before.

At the beginning of every wave, the emergency department has always taken the brunt of the assault. During the Delta wave, multiple patients would be rushed in requiring immediate intubation. Right from the start of the Omicron wave, things were decidedly different. The volume of patients was enormous, but the panic of Delta was absent. Very few of the large number of patients coming to emergency have been seriously ill. There were those seeking a PCR test because of contact with a case, others with mild upper respiratory tract symptoms, and some with flu-like symptoms. They were of all ages, all vaccinated, and their chest X-rays were all normal. Every dozen or so cases however, there was a jaw droppingly horrible pneumonia in an unvaccinated patient, and it soon became clear that a pattern was emerging.

Most of the patients desperately ill with hypoxia, a lack of oxygen in the blood, were unvaccinated, 60 years and older, obese, diabetic, and hypertensive. Sadly, joining their ranks were the elderly who had two doses of the vaccine almost a year ago, and had not received boosters. The most tragic were the fully vaccinated and boosted immunosuppressed patients. Whether it was due to chemotherapy, autoimmune disease, or renal transplant, Omicron has been cruel. The unvaccinated, under vaccinated, and immunosuppressed are the patients who would be admitted to the wards and then slowly fill the ICU.

Unlike Delta, there are few direct admissions to the ICU, Omicron patients tend to go first to the wards. The largest group of symptomatic COVID patients on the wards are fully vaccinated, of all ages with mild pneumonias. They have brief stays, admitted only until their oxygen saturation improves. Close behind in terms of numbers are unvaccinated patients of all ages. The unvaccinated patients are grossly overrepresented when compared to their small percentage of the general population is considered. They tend to struggle on the wards and stay much longer in hospital than their vaccinated peers. While most inpatients recover, there are the unlucky few whose disease progresses.

• Rupa Subramanya: Ontario unsurprisingly too timid to move to the pandemic endgame
• Randall Denley: State of Ontario’s health care makes it hard to feel optimistic about the future

Many of the frail elderly on the wards choose not to seek care in the ICU and unfortunately succumb to the virus. Among those who do agree to receive care in the ICU, vaccinated patients rarely require intubation and tend to rally with high flow oxygen. The unvaccinated, under vaccinated, and immunosuppressed requiring critical care services regrettably have a much more difficult path. They more often require intubation, and once intubated, they have a vanishingly small chance of survival.

The message is painfully clear. Omicron is a pandemic of the unvaccinated. Please get vaccinated.

Despite the growing numbers of hospitalized patients, and bleak headlines, our current situation is surprisingly good. Wastewater viral signal (no you don’t want to know how that is obtained) has been dropping as has been the positivity rate of PCR tests indicating Omicron has likely peeked. The emergency department has quieted down marking the beginning of a drop in hospitalizations. The wards remain under mild stress due to sheer numbers and staffing shortages due to nurses falling sick from COVID. They are however bolstered by operating room nurses who were redeployed after the mandated cancelation of non-urgent surgeries. Staffing is still stretched thin, but the wards will hold.

The ICUs are another story. They remain in a stubborn logjam, hit by staffing shortages due to illness, but less able to replenish their ranks due to the highly specialized nature of critical care nursing. Anesthetists, and surgeons have stepped in at some hospitals to fill in the gaps, but this is not a long-term solution. There is no doubt that the ICUs will be able to weather this wave now that it seems to have peeked. While estimates range from two to four weeks for our critical care numbers to recede to acceptable levels, what is clear is that we can’t do this again.

Omicron has been a flash flood, and its receding water reveal great weaknesses in our health-care system. We have infrastructure, human resource, and funding deficits that have spanned decades of governments and will not be solved quickly or without great cost.

But perhaps the greatest challenge facing us is not one of infrastructure, but one of perception. As Canada’s chief public health officer Dr. Theresa Tam has said, Omicron marks the shift from pandemic to endemic. We must now begin the difficult task of recalibrating risk and learning to live with a virus that is not going to go away. In the balance are countless delayed diagnoses, cancelled surgeries, economic hardships, and lost educational opportunities. It’s a hard truth, but it’s the truth nonetheless. The time to prepare for tomorrow is today.

Dr. David Jacobs is a radiologist at Humber River Hospital in Toronto and president of the Ontario Association of Radiologists.