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COVID-19: Most patients in Toronto ICU unvaccinated

This is where the Omicron wave begins to show its worst side: inside the ICU at Toronto General, which is filled with critically ill COVID-19 patients, most of whom have not been vaccinated.

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

“Based on the rate at which we see phone calls and referrals, we are looking at that number as a very high increase, so we are preparing for an increase in the number of people searching. our support,” Dr. John Granton, head of respiratory medicine at the University Health Network (UHN) and critical care specialist at Toronto General, told CTV News.

Some hospitals don’t see such high rates of unvaccinated cases – but part of this is that unvaccinated patients are more likely to have severe cases, and therefore more likely. have been transferred to hospitals like Toronto General that are equipped to take care of the worst ICU cases.

And the sick patients in this ICU are younger.

“Twenty, thirty, forty – that is the official definition of young, which is younger than me,” said Dr. Niall Ferguson, chair of the department of critical health care at UHN and senior scientist at the Institute. The Toronto meta-study said. “And usually without any significant comorbidities, any other serious illness.”

Doctors say obesity and diabetes seem to put people at greater risk of severe disease, but the biggest risk factor is people who have skipped vaccinations.

In Canada, the unvaccinated make up less than 13% of the population.

At Toronto General, which takes care of the sickest COVID-19 patients, 70% in the intensive care unit are unvaccinated.

“In our units, we see about two-thirds of the patients who are relatively young, unvaccinated, and critically ill,” says Ferguson.

It’s frustrating for the medical teams.

“This is happening, it’s real and we’re continuing to see it, and I have to say, it’s discouraging to continue to witness this,” Granton said.

While Omicron is milder for those with immunity and has caused fewer deaths than previous waves, it still leaves more people hospitalized around the world due to its high degree of spread.

Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, said: “It remains a dangerous virus, especially for unvaccinated people.

Ontario is reporting 3,448 people hospitalized with COVID-19 and 505 people in the ICU, a number experts fear could grow over time. Currently, people who are partially or fully vaccinated account for 186 of those ICU admissions, with 157 unvaccinated people making up the other half.

Ferguson explained that with the high level of cases we’re seeing in Ontario right now, even if many of the cases are milder, there will still be a large number of people in the ICU.

“The sheer number of severe cases would be a significant number, even if it were a small percentage,” he said.

“Omicron is definitely breaking two doses of the vaccine and causing a lot of infections. And that allows it to spread and find unvaccinated people and make them really sick enough to require hospitalization and even intensive care.”

Those who ended up hospitalized tended to fit two characteristics: those who were unvaccinated with few or no comorbidities, and those who had some protection from vaccination but also had other risk factors. Other risk factors put them at higher risk of developing the disease.

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

“We regularly see the sickest patients either unvaccinated or have an underlying immune condition that doesn’t allow them a chance to benefit from vaccination,” says Granton.

A major worry with Omicron is that in Canada, there may be fewer intensive care beds available for the most severely ill, as there are no specialized nurses and anesthesiologists needed to staff them compared to other intensive care units. previous batch.

The high proportion of younger, unvaccinated patients at Toronto General may be partly due to the fact that it is one of the few hospitals to offer an intense life support service known as ECMO, which requires staff to highly trained staff.

New patients were transferred to the hospital today to participate in ECMO, Granton added.

“We have three or four of those who are in ECMO because of COVID and a few others that are being evaluated,” he explains. “That may sound like small numbers, but it’s a form of therapy that uses a lot of resources.”

Their capacity is being ramped up, he said, noting that they totaled about 35 people on ECMO last week, “probably one of the biggest in the world at any point on ECMO.”

Omicron’s prevalence in the community is adding to the strain on an already thin workforce due to the pressures of previous waves.

“For the first time, we have to deal with a spike in patients with a significant portion of our staff at home, […] with relatively mild COVID but didn’t want to go in and transmit it,” said Ferguson.

Granton says the stress on employees is higher than ever.

“I think our nurses in particular are under a lot of stress, our respiratory therapists,” he said. “[They] really the front line. We’re doctors, we’re lucky we weren’t there. 24/7. And those are really the people who are experiencing the relentless onslaught of this pandemic. “

Hospital officials say they are doing their best to prepare for a surge in critically ill patients, stressing that their ICUs would be less busy treating COVID 50 or even 70% if more people inject them. more strains.

Granton said that if everyone in Canada were vaccinated, their ICU would be “a lot quieter”.

“We’re not going to see it near the number of people we’re seeing right now.”

“They’re just scared and don’t know or don’t have the right advice,” says Ferguson. “So most people, when it comes down to it, wish they had a vaccine and could turn back the clock.”

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