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COVID-19: Most patients in the Toronto ICU are not vaccinated

This is where the Omicron wave begins to show its worst side: inside the Toronto General’s intensive care unit, which is filling up with critically ill COVID-19 patients, the majority of whom are unvaccinated.

There are twice as many COVID-19 patients here as there were two weeks ago.

“Based on the rate at which we see phone calls and referrals, we think this slope has a very big increase, so we are preparing for an increase in the number of people seeking our support,” Dr. John Granton, Head of pulmonology at University Health Network (UHN) and intensive care specialist at Toronto General, told CTV News.

Some hospitals don’t see such a high percentage of unvaccinated cases, but this is in part because unvaccinated patients are more likely to have severe cases and are therefore more likely to have been transferred to hospitals like the Toronto General that are equipped to handle the worst cases of intensive care.

And the sick patients in this intensive care unit are younger.

“Twenties, thirties, forties, which is the official definition of young, which is younger than me,” said Dr. Niall Ferguson, Chief of Critical Care Medicine at UHN and Senior Scientist at the Toronto General Research Institute. “And often without any significant comorbidities, no other major illnesses.”

Doctors say obesity and diabetes seem to put people at a higher risk for serious illness, but the biggest risk factor is whoever failed to get the shot.

In Canada, the unvaccinated represent less than 13 percent of the population.

In Toronto General, which cares for the sickest COVID-19 patients, 70% of the intensive care unit is unvaccinated.

“In our units, we find that about two-thirds of our patients are relatively young, unvaccinated and have serious illness,” Ferguson said.

It’s frustrating for healthcare teams.

“It’s happening, it’s real and we keep seeing it, and I have to say it’s very disheartening to keep seeing this,” Granton said.

While Omicron is gentler on people with immunity and causes fewer deaths than previous waves, it is still sending more people to hospitals around the world due to its heavy spread.

“It remains a dangerous virus, especially for those who are not vaccinated,” said Dr Tedros Adhanom Ghebreyesus, director general of the World Health Organization.

Ontario is reporting 3,448 people hospitalized with COVID-19 and 505 in intensive care, a number that experts say could increase over time. Currently, partially or fully vaccinated people represent 186 of these hospitalizations in intensive care units, 157 unvaccinated people constituting the other half.

Ferguson explained that with the high levels of cases we’re seeing in Ontario right now, even though more of these cases are mild, there will still be a high number of people in intensive care.

“The absolute number of severe cases is going to be a significant number, even if it is a small proportion,” he said.

“Omicron certainly exceeds two doses of the vaccine and causes many infections. And that allows it to spread and find unvaccinated people and really make them sick enough to be hospitalized and even need intensive care. “

People who end up being hospitalized generally correspond to two profiles: unvaccinated people with little or no comorbidities, and those who benefit from some protection against vaccination, but also other risk factors that make them more at risk. risk.

People who are fully vaccinated are still much less likely to be hospitalized with the virus. According to the Ontario Science Table’s online dashboard, on Tuesday there were 762 hospitalizations per million people among those unvaccinated, compared with 171 hospitalizations per million people among those who received at least two doses of vaccine.

“We consistently see the sickest patients either not getting vaccinated at all or having an underlying immune disease that does not allow them to benefit from the vaccination,” Granton said.

One of Omicron’s main concerns is that in Canada there may be fewer intensive care beds for the most seriously ill people because there are not the necessary nurses and specialist anesthetists to staff them. compared to previous waves.

The high rate of younger, unvaccinated patients at the Toronto General may be in part due to the fact that it is one of the few hospitals that offers a high-intensity resuscitation service called ECMO, which is highly staffed. qualified.

New patients were transferred to hospital just today to undergo ECMO, Granton said.

“We have three or four of those who are on ECMO because of COVID and a few more who are being assessed,” he explained. “It might seem like small numbers, but it is a very resource intensive form of therapy.”

Their capacity is extensive, he said, noting that they had around 35 people on ECMO in total last week, “possibly one of the largest in the world at some point on ECMO.”

Omicron being so prevalent in the community, puts additional pressure on an already shrinking workforce from the pressure of previous waves.

“For the first time, we have to face this wave of patients with a significant part of our staff at home, […] with relatively mild COVID but unwilling to come in and pass it on, ”Ferguson said.

Granton said the stress on staff is higher than ever.

“I think our nurses in particular are under a lot of stress, our respiratory therapists,” he said. “[They] are really on the front lines. We as doctors are very lucky not to be here. 24/7. And it is really these people who are under the incessant onslaught of this pandemic. “

Hospital officials say they are doing their best to prepare for an increase in the number of critically ill patients, pointing out that their intensive care units would be 50 or even 70% less busy treating COVID if more people were getting vaccinated.

Granton said if everyone in Canada were vaccinated their intensive care unit would be “much quieter.”

“We wouldn’t see it near the number of people we see now.”

“They are just scared and not informed or have not received the right advice,” Ferguson said. “So most people ultimately wish they had the vaccine and could go back. ”