The number of people with COVID-19 in Canadian hospitals has more than tripled compared with this time last year, although far fewer of these patients require intensive care – a shift that experts say reflects the ubiquity of the virus and advances in treatment.
But after three years of the pandemic, the virus remains deadly. It will kill more than 18,000 people in Canada in 2022, bringing the country’s official death toll to just shy of 50,000, a figure some believe underestimates COVID’s true reach.
While Canada’s hospitals are being spared the surges of critically ill COVID patients that threatened to collapse the system in the first two years of the pandemic, they are now dealing with a higher baseline number of patients.
Further, hospitals may face a lighter burden from COVID in their ICUs, but influenza, respiratory syncytial virus (RSV) and other viruses added to the challenges in 2022. Those viruses were previously contained by the same public-health restrictions governments imposed to manage COVID. The rules were almost universally lifted in early 2022, when vaccines were widely available and public patience thinned.
“We aren’t feeling like it is a tidal wave, but we’re feeling like it is one of those continuous sort of currents that’s pushing,” said Elizabeth MacKay, a general internist at the Peter Lougheed Centre and a professor at the University of Calgary’s medical school.
COVID is extremely prevalent now, meaning more people are likely to be infected compared with a year or two ago. Patients may be admitted to the hospital because they are sick with COVID, or for other reasons, but test positive upon screening and, therefore, get captured in the data, experts say. Meanwhile, vaccines, antibodies acquired through previous infections, and new drugs are helping to keep patients out of the ICU.
Patients with COVID occupied 5,548 hospital beds in Canada on Dec. 19, according to the Public Health Agency of Canada’s most recent information. Of those patients, 248 were in ICUs. By way of comparison, PHAC counted 1,489 COVID-19 patients in Canadian hospitals on the same day in 2021, with 444 of those in ICUs.
Eric Sy, an intensivist and critical-care professor at the University of Saskatchewan, noted that COVID data can be difficult to interpret now that the virus is so widespread. “Many patients may be admitted to hospital for other reasons but may also concurrently have COVID-19, without the development of COVID-19-related respiratory failure [or] illness,” he said. “This is by far the majority of COVID-19 diagnoses, which has been termed incidental COVID.”
He noted that all patients in most hospitals are likely screened for COVID in the emergency department.
Donald Vinh, infectious-disease specialist at McGill University Health Centre, agrees that the virus’s increased prevalence means more cases of incidental COVID, but said the positive tests should not be brushed off.
“It is not that COVID is benign in those instances,” he said. “It is just that the medical determinant of hospitalizations isn’t necessarily COVID upfront.”
The reduced ICU statistic can also be deceptive, he said. Physicians, who now have three years’ experience treating the illness, and access to more advanced treatments, can now better manage the disease on hospital wards, diverting patients away from ICUs in a way that wasn’t available in the pandemic’s earlier waves.
“Our medicine is better,” Dr. Vinh said. “That doesn’t mean, however, that the burden to the health care system has decreased or that the disease has become less severe.”
PHAC noted that the rate of COVID patients admitted to hospitals and ICUs is highest among those aged 80 and older.
The agency said 48,948 people have died of COVID in Canada as of Dec. 17. That translates to 17,997 so far in 2022, compared with 16,489 in all of 2021 and 14,462 in 2020.
It calculated that between the start of the vaccination campaign on Dec. 14, 2020, and Sept. 25, 2022, roughly 48 per cent of those older than five who died of COVID were unvaccinated. Those who completed a primary series, which preferentially consists of two shots of an mRNA vaccine, represented 16.8 per cent of COVID deaths.
Tara Moriarty, an infectious-disease researcher and University of Toronto professor, believes Canada’s COVID death toll is higher than the official count, in light of excess mortality statistics and the rate of infection.
She expects the number of ICU admissions and deaths to climb in January and February because the protection gained from vaccines administered in the autumn booster campaign will begin to wane.
“We will start seeing more deaths and ICU admissions again,” she said.