This is what Quebec’s doctors and nurses are seeing in ERs during the Omicron wave

 

The Omicron variant of the coronavirus may be less severe, but it’s still leading to an unprecedented wave of hospitalizations in Quebec.

© Ivanoh Demers/Radio-Canada Dr. Joseph Dahine, an intensive care specialist at Laval’s Cité de la Santé hospital, said two kinds of COVID-19 patients are generally reaching his facility: unvaccinated people between 30 and 60, and vaccinated patients over the age of…

In interviews, doctors and nurses in the province described how the highly transmissible new variant has created new challenges as they try to provide care.

Nathan Friedland, a nurse who worked eight out of the last nine days at the Lakeshore Hospital in Montreal’s West Island, said the ER is “completely overrun.

“We are getting so many COVID patients that we cannot isolate them properly,” he said. “The ER is not built to withstand an outbreak like this.”

On Friday, the province surpassed 3,000 patients in hospitals with the coronavirus. The number of deaths has also climbed back up to its highest levels since last January, with more than 400 in the last two weeks alone.

“People are still getting sick and though they’re not getting sick to the same extent, they’re still ill, and those who have comorbidities will probably die from this,” said Dr. Peter Goldberg, head of critical care at Montreal’s McGill University Health Centre.

But there are also signs of hope, health-care workers say, most notably in the improvements in care and the efficacy of vaccines in preventing serious illness.

COVID-19 hospitalizations in Quebec

Booster gives a boost

Proportionally, those with at least two doses of vaccine are far less likely to end up in hospital in Quebec — as has been the case elsewhere.

In Quebec, only 13 per cent of people aged five and up have not received two doses, but that group currently makes up 32 per cent of hospital admissions and 46 per cent of admissions in intensive care over the last 28 days, according to the province’s Health Ministry. That means a non-vaccinated person was 13 times more likely to end up in the ICU during that period. 

In a statement, the Health Ministry said that “most often (but not always) people who die and are adequately vaccinated are people who have health conditions that make them vulnerable.”

The province doesn’t have a breakdown for those in hospital with three doses, but several health-care workers reported in interviews this week they had seen few or no patients who had gotten a booster.

Dr. Joseph Dahine, an intensive care specialist at Laval’s Cité de la Santé hospital, said COVID-19 patients in his hospital can be divided into two general categories.

The first is unvaccinated individuals, many between 30 and 60, who were previously healthy. The other group of patients is older, mostly over 70, with two doses of vaccine, and who often come in with existing health problems.

Given the advances in care, Dahine said his team is able to get people better more quickly, often without intubation, especially if they are vaccinated. But a few patients, he said, have been in the ICU for several months, prior to the emergence of Omicron.

Like others, Dahine noted some patients who come in for treatment for an illness seemingly unrelated to COVID end up testing positive.

“They usually have an exacerbation of their underlying disease,” he said. 

Even if they don’t require the usual care necessary for a COVID patient, precautions must be taken to ensure they don’t further spread the virus inside the hospital, he said.

Nearly two years into the pandemic, Melanie Jade Boulerice, an ER nurse at a Montreal hospital, said the protocols have improved and so has the understanding of how to care for patients. But she said the workload has taken a toll.

“There’s a high level of burnout. There’s turnover,” she said. Friedman described the “sheer volume of cases” as “overwhelming.”

Hidden cost of delaying crucial care

The INSPQ, the province’s public health research institute, released a report Thursday that projected hospitalizations had reached their peak or would do so in the coming days.

Still, the strain on the health-care system and the shortage of staff has made for major challenges.

Already, many regions have reached the highest level of alert — meaning surgeries and other crucial forms of medical care have been cancelled.

“The people who are supposed to be in the ICU are not,” said Dr. Michel de Marchie, an ICU doctor at Montreal’s Jewish General Hospital.

“The people with cancer are not having their surgery. The people who were supposed to have their cardiac surgery are having it postponed. The people who are supposed to have their hip surgery are suffering at home.”

In the long run, he said, they are “the ones who are going to pay.”

While Quebec’s first wave largely affected elderly people in care, de Marchie said he is now seeing a range of ages in hospital.

“The number of deaths, at least at the Jewish, is not as high as we’ve seen before,” he said.

Benoit Barbeau, a virologist at Université du Québec à Montréal, said the next month will be difficult, even if the projections suggest daily new hospitalizations will gradually go down. 

“Even though the variant is not as pathogenic, by sheer number of infected cases, individuals will be hospitalized and that will translate to more deaths,” he said.

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