Ambulance crew members deliver a patient at Mount Sinai Hospital as officials warned of a 'tsunami' of new COVID-19 cases in the days and weeks ahead due to the Omicron variant in Toronto on Jan. 3.COLE BURSTON/Reuters
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
Sign up for the Coronavirus Update newsletter to read the day’s essential coronavirus news, features and explainers written by Globe reporters and editors.