Politic?: COVID Variants Driving Rising Numbers of Serious COVID Infections Among the Young

"They were sick at home for a week, sick at another hospital for a week, then intubated and on a ventilator for a week, and then they got bad enough to need to come to us [Extracorporeal Life Support Program]."
"Clearly there is something that is making them both more transmissible and able to replicate more quickly."
Dr.Niall Ferguson, head, critical care medicine, University Health Network, Toronto

"The demographics of COVID-19 infection are clearly changing from the spring [of 2020]."
"[In Canada, new infections are highest among the 20- to 29-year-olds, a more mobile and socially active group, but whether the new variants alone are contributing to more younger people being hospitalized] is hard to know for sure."
"In the end, this is a numbers game -- the more individuals in the younger age group who get infected, the more will have severe disease requiring hospitalization and potentially intensive care support."
Dr.Scott Solomon, professor of Medicine, Harvard Medical School

"These are not simple metrics to analyze because there are multiple parameters that are influencing what we are seeing right now, and we have to be very careful to make these statements that, 'Oh, yes, the younger people we're seeing more of them in hospital'."
"We're seeing more of them because we're not seeing as many elderly in proportion."
"But why the younger adults? Why is it not affecting just everyone in the same way, in the same proportion? There are layers to that complexity that are still poorly understood."
Dr.Marc-Andre Langlois, national Coronavirus Variants Rapid Response Network

An upcoming briefing note from Ontario scientists is expected to suggest that coronavirus variants substantially increase the risk of serious illness when compared to the initial strain of SARS-CoV-2. (Evan Mitsui/CBC)

"Rescue" interventions are being forced on Toronto hospitals for people as young as 22 reflecting a recently-observed phenomenon, that younger people are now becoming more severely ill with the novel coronavirus, and their conditions worsen swiftly, creating desperate situations. At Toronto General Hospital 17 people with COVID were connected to extracorporeal membrane oxygenation (ECMO); aged 22 to 61, with four among them in their 20s or 30s.

"Certainly, we've seen a shift in the kinds of patients that we're seeing coming to the ICU in this wave", medical director of the Extracorporeal Life Support Program Dr.Eddy Fan stated. His unit, the largest in Canada acts as a provincial referral centre. Most patients placed on ECMO in waves one and two were older, in their 50s and 60s, suffering from chronic health conditions. That has changed; they're now younger and most of them were healthy before contracting COVID.

Alarmingly different is the fact that some people progress from sick to mortally ill in no time at all. A typical pattern had emerged in earlier COVID waves, familiar to ICU physicians. That is no longer the case. People now reach a critical stage in the evolution of their COVID sickness in a matter of days, not weeks as previously. What precisely it is driving that shift is unclear, but Dr.Fan and others identify highly contagious variants of the SARS-CoV-2 virus as being behind the phenomenon.

Doctors have taken to social media to describe previously healthy people "in the prime of their lives" on life-support with COVID. "This wave is worse than a year ago. Worse than January. They're younger. They're sicker", Dr.Shankar Sivananthan, a critical care doctor with the William Osler Health System serving Brampton and North Etobicoke tweeted recently. Fast-spreading SARS-CoV-2 "variants of concern" roughly double risk of ICU admission, increasing dying risk by 60 percent, as revealed by Ontario's COVID-19 Science Advisory Table.

The three variants now in circulation have all mutated to make it easier for the virus to clutch receptors on human respiratory cells. Dr.Solomon, senior physician in the cardiovascular division at Brigham and Women's Hospital in Boston and his colleagues, analyzed medical records of 3,222 patients aged 18 to 34 who had been admitted to hospitals in the U.S. with COVID in spring's 2020 wave. Of the total, 21 percent required intensive care, ten percent mechanical ventilation and among them three percent died. They published their report in JAMA Internal Medicine.

While the death rate was lower among this group than reported for older adults with COVID, it was about double that of young adults with a sudden heart attack. The likelihood of severe outcomes from COVID in the young was increased in the presence of severe obesity, high blood pressure and diabetes, and struck males more frequently. That greater numbers of the elderly are being vaccinated reduces their numbers in COVID cases; ergo, rising numbers among the young.

In the final analysis and certainly for the time being -- and particularly in the face of a third wave that is hard-hitting with steadily rising numbers creating alarm in government and health agencies -- continued masking, distancing and gathering-avoidance that help fuel transmission is vital. It remains to be seen how matters will continue to unfold from the current alarm, to a hoped-for gradual reduction in cases as more members of a younger demographic eventually are inoculated with COVID-preventive vaccines.