While COVID On The Upswing, Severity Reduced

"It seems that many of my colleagues around the world who are seeing many more cases than at my hospital here are seeing lower mortality rates."

"I'm very concerned about the modelling and what it means if we don't change what we're doing."

Dr.Eddy Fan, medical director, Extracorporeal Life Support Program, University Health Network, Toronto

"We're realizing, and the U.K. data is supporting it, that people can tolerate a certain degree of climbing Mount Everest -- getting really hypoxic and not doing poorly."

"We're becoming more vigilant for some of the complications of COVID, particularly the blood clotting, which is a huge issue."

"We're starting to see a mortality that I don't think is in excess of what we would normally see for a sick person with an infection ending up in an ICU bed. But it's the fact that we've got so many more infections out there."

Dr.Alison Fox-Robichaud, critical care specialist, McMaster University/past president, Canadian Critical Care Society

In Canada's hardest-hit provinces, the second wave is well underway with cases soaring across the country. (Evan Mitsui/CBC)

 

It was an anxiety-ridden and stressful period when the medical community faced the first COVID-19 wave in Canada, even though there was the good fortune of being hit by the pandemic later than other countries, a situation that allowed Canadian doctors precious time as they connected with colleagues around the world to ask "What's working? What isn't?" That was then, this is now, and now a second wave has hit, and hit harder than the original, causing equal consternation, even though the medical community does have a better idea of what it's dealing with.

 

 

Fewer people with severe COVID-19 are now dying from the disease, according to emerging reports, offering a patch of brightness to an otherwise grimly dark COVID landscape. Just 58 percent of people sent to the ICU in late March with COVID-19 were still alive 30 days on, one study published in the Journal of Hospital Medicine involving over 21,000 people admitted to British hospitals revealed. Survival, however, reached 80 percent by the end of June. Yet another study with over 5,000 people involved who were admitted to one of three New York City hospitals between March and August saw the death rate drop from 26 percent in March to eight percent by August.

 

Testing backlogs in Ontario reached a record high of more than 90,000 this week, and the province's associate chief medical officer of health, Dr. Barbara Yaffe, said the number of contacts per COVID-19 case is 'much higher' than in the first wave. (Evan Mitsui/CBC)

 

Those who have contracted COVID, who end up in intensive care in the second wave tend to be younger with fewer underlying health conditions than those admitted in the spring wave to ICUs. The median age of those admitted to ICU in March, according to the New York City study, was 63, but by August that median age descended to 49, which may explain in part the declining mortality rate, but certainly not all. The New York City study was one of the first that adjusted for age, co-morbidities (such as diabetes, obesity, heart disease) and vital signs on admission, all suggesting that data risk decline in NYC reflected not only a differing mix of patients.

The hard-won gains in discerning more information about the SARS-CoV-2 virus causing COVID through observation and trial and error reflecting a combination of factors now include better understanding of COVID'S effects on the human body, specifically organ systems and how best to manage it. The use of steroids to ensure the body's immune system doesn't overact; turning people over to the 'prone' position improving oxygenation represent a few advances in handling the disease. "Lower viral load exposure from increased maskwearing and social distancing" is also being attributed with potentially saving lives.

 

 

Early reports out of Italy were that mortality rates soared as high as 62 percent in hospitalized patients. Of 117 people admitted to one of six ICUs in metro Vancouver between February and April saw dramatically lower complications. By May, 85 percent of patients in Vancouver were still alive, with 61 percent having been discharged to return home. "Our experience is consistent" with what others are reporting, Dr.Donald Griesdale, a critical care doctor at Vancouver General Hospital reported. "Our mortality rate is also lower than in the first wave and our thoughts mirror the hypothesis put forth by the other clinicians." 

 

The majority of those infected with COVID-19 experience mild disease, but roughly eight percent of people in Canada must be hospitalized, and of that number 20 percent go on to be admitted to the ICU, but even among those admitted to the ICU, the length of stays are becoming shorter, and the survival rate of those ventilated is higher. "It does seem like there definitely is something inherently different now than there was back in the spring", Dr.James Downar, a critical and palliative care specialist at The Ottawa Hospital remarked.

 

 

"There may be something about the speed with which people present for care, and the speed with which people are getting resuscitated", he elaborated. The use of low-dose steroids can cut the risk of death by 12 percent -- "Anyone who's very sick should get steroids", stressed University of Pittsburgh critical care doctor Derek Angus. And no longer are people being rushed to be placed on ventilators. Additionally, said Dr.Fox-Robichaud, doctors avoid the use of therapies with the potential to harm, such as the malaria drug hydroxychloroquine.

 

But there is the caution that should uncontrolled spread of the virus occur, leading to greater numbers of people in hospital, increased ICU admissions may ultimately result in more deaths. In Edmonton, doctors are warning that the city's hospitals are at a "tipping point". "The system is breaking along with the backs of those who are trying desperately to hold it together", a Winnipeg anesthesiologist warned on Facebook.

 

 

 

 

This week Canada surpassed 300,000 known infections, that is infections that tests have identified; the true picture is without doubt ten times higher. There are currently about 1,840 people in hospital with COVID, 385 of whom are in intensive care. The U.S. Centres for Disease Control chief epidemiologist Dr.Anthony Fauci has warned Canada that it is in the losing-control territory of the disease's maw. 

 

Family clusters where siblings or multiple family members have been admitted to ICU after a family event where no one wore masks are occurring, with no pattern explaining how it is that an entire family will become ill with the virus while others with the same risk exposure come off having escaped infection. Scientists recently reported over ten percent of people developing severe COVID might have 'Autoantibodies' mistakenly targeting and attacking the immune system, not the virus.

 

Others venture the opinion that it's not a mere binary issue -- dead/not dead, but that COVID is capable of causing a wide range of serious lingering problems, including kidney or heart damage. A very high risk of stroke has been identified by studies into the complexities of COVID's aftermath. People surviving an ICU emergency for severe COVID have been known to struggle with physical weakness, anxiety, depression and cognitive and memory issues.

 

(Nathan Denette/The Canadian Press)