‘Signs of stabilization’: Milder Omicron wave starting to crest; ICU stays have been much shorter  

On Wednesday, provincial officials including Health Minister Christine Elliott told Ontario residents the worst of the latest pandemic wave is likely behind us.

“Starting to see glimmers of hope,” said Elliott, “signs of stabilization,” as she described the current pandemic situation during a morning press conference.

It can now be stated conclusively, according to data and research from around the world, that Omicron is less virulent than the Delta variant, which is not as transmissible but causes much more severe disease in patients who develop COVID-19. While Omicron can cause dangerous symptoms and death, this type of severity is usually seen in some older patients, those whose immune systems are compromised and the unvaccinated.

For the vast majority of others infected with Omicron, data, research and clinical determinations by physicians show much less severe disease outcomes.

During the first wave of the pandemic in Peel (April to May 2020) COVID patients at Trillium Health Partners’ two Mississauga hospitals remained in intensive care for an average of approximately 18 days. That number dropped to 10 days during the December 2020 to January 2021 wave and again to 6.5 days in the March to July 2021 wave. 

Over the seven days leading up to January 18 the average length of stay for a COVID patient in intensive care was approximately three days, according to a spokesperson for Trillium. That means, on average, patients during the current wave in Mississauga are spending 83 percent less time in the ICU.

Mississauga patients are spending much less time, on average, in critical care with COVID-19.

(Image from Isaac Callan/The Pointer Files)

Dr. Kieran Moore, Ontario’s Chief Medical Officer of Health, related similar data during Wednesday’s provincial update. He said ICU “length of stay was in the 20s, 20 days” at the peak of the pandemic, and now ICU stays in Ontario are at 6 or 7 days. “With Omicron I think we will see less lethality, less severity.” 

The encouraging data out of Mississauga and from across Ontario align with a study into the hospital outcomes for COVID-19 patients in southern California. The research, which is yet to be peer-reviewed and was funded by the United States Centers for Disease Control and Prevention, found more favourable outcomes when comparing Omicron to Delta infections across a range of situations.

It examined information from more than 52,000 Omicron patients and almost 17,000 who were infected with the Delta variant and concluded the risk of mechanical ventilation for patients with Delta was “significantly higher” than patients infected with Omicron, while there was also a “substantially reduced risk of severe clinical outcomes” for patients with Omicron. The median length of stay for patients who were hospitalized with Omicron was around 70 percent shorter than those admitted with Delta.

“Reductions in disease severity associated with Omicron variant infections were evident among both vaccinated and unvaccinated patients, and among those with or without documented prior SARS-CoV-2 infection,” the wide-ranging study reports.

The Pointer requested data from William Osler Health Systems, the hospital network that runs Brampton Civic and Etobicoke General, but was told it could not be provided. 

“Due to current capacity pressures at William Osler Health System (Osler) and the fact that the numbers are dynamic and change very frequently, we are unable to provide the specific breakdown of COVID-19 patient census in our hospitals at this time,” Catalina Guran, senior manager of public relations for William Osler, said. The same statement was also provided in response to other questions this week around Osler’s COVID patient data.

COVID-19 cases have been a feature of intensive care for nearly two years.

(Image from Richard Catabay/Unsplash)

With many Ontarians not even aware of an infection, due to Omicron’s milder impact on most people, and others reporting easily managed symptoms (thanks partly to vaccine protection or natural immunity), overall case numbers no longer provide a relevant picture of the pandemic’s impact. Even broad hospitalization data need to be understood in a different context, as factors such as respiratory function under a less severe viral strain that does not attack the lungs in the same way as Delta, non-COVID disease effects on Omicron patients and the immune benefits of inoculation and natural protection from earlier infection now have to be considered when assessing the hospital situation.  

To get a clearer picture, the clinical expertise of front line physicians observing patients is key.

Doctor David Jacobs, president of the Ontario Association of Radiologists, has used social media to share his handover notes after his shifts at Humber River Regional Hospital in northwest Toronto where he works. On Monday, January 17, he reported that 75 percent of all X-rays (patients) he assessed during his just completed shift were normal, 17.5 percent showed mild pneumonias, 5 percent had moderate pneumonias and 2.5 showed severe pneumonias.

Doctor Jacobs did indicate that volumes are continuing to strain hospitals, many of which across parts of Ontario are still facing capacity pressures partly due to infections among staff.

“Overall volume of non COVID related [imaging] was down significantly,” he tweeted. “Volumes vary day to day, and this is likely of no consequence, but if this becomes a trend like in the first wave, it could mean that people are avoiding the ER despite being sick. What's changed mostly is our luck. Our ICU is finally feeling the strain that many others across the province felt last week.”

Omicron presents hospitals with a new challenge to balance available resources. Current COVID patients are, in general, less sick than those who developed the disease earlier in the pandemic but the sheer volume of cases, due to the highly contagious Omicron variant’s increased rate of transmission, is still sending waves of people to the hospital. Even if they stay for a shorter period of time with much less severe symptoms, patients are still using hospital beds. 

“The average patient on the floor is much less sick than with Delta, but some do convert to ICU admissions,” Doctor Jacobs tweeted. “The conversion rate is much lower than in previous waves, but given the high volume of COVID in the community, it's a numbers game and the numbers are against us.”

Data from Ornge, the provincial body responsible for organizing the transfer of critical care patients across Ontario, show the Omicron wave has impacted hospitals differently. 

Last year, in January 2021, a total of 209 transfers were ordered across the province to relieve intensive care units that were at breaking point. By contrast, Ornge organized 16 patient transfers last month and 36 between January 1 and 18 of this year. 

In previous waves, Peel’s hospitals have relied on patient transfers.

(Image from Isaac Callan/The Pointer Files)

Credit Valley Hospital and Mississauga Hospital have required fewer than five transfers each this month compared to five and nine respectively last January. Brampton Civic has not transferred any patients this month; in January 2021 it needed to transfer 17 patients. 

Civic’s situation illustrates how Omicron is impacting the healthcare system. The hospital declared a Code Orange emergency at the beginning of January, indicating no more patients could be admitted, to deal with staffing shortages and capacity issues brought on by rising infections among employees and increased hospitalizations. The already problematic capacity realities that were present before the pandemic hit Civic, which serves a city of more than 700,000 people, have repeatedly pushed it to the limit of its resources during the ongoing COVID public health crisis.

In September 2020, as a wave of viral infection rose across much of Ontario, and Brampton in particular, Civic called a Code Gridlock eight separate times. That meant, in Osler’s own words, the hospital was at a “standstill” with the number of patients waiting in the emergency department exceeding the amount of bed space available. 

Data from Peel’s wastewater systems suggests the Omicron wave could be plateauing.

(Image from Peel Public Health)

Figures from the Province show 2,343 adults in intensive care across Ontario with 492 beds available on January 18. The vast majority of people are in intensive care for non-COVID reasons, 24 percent were admitted with a COVID-related illness and 21 percent of beds were still available. 

Some front line intensive care physicians say the current picture is worse than provincial data suggests. Doctor Michael Warner, an intensive care doctor at Michael Garron Hospital, has said he and his team are unable to staff all their beds. “Funded beds are not staffed beds,” he tweeted. “Unstaffed beds are not usable beds.”

Doctor Brooks Fallis, also an intensive care physician, called the figures “a mirage”.

While key indicators of disease severity and patient outcomes suggest the COVID picture is not nearly as bad as it was earlier in the pandemic, largely thanks to the high rate of vaccination, it remains challenging to contextualize the best data needed to determine policy decisions.

Moore said Wednesday the recent high numbers of deaths reported are being carefully reviewed, as it’s not clear if COVID caused all of them, or what the disease’s actual impact was. He also said a “significant” number of recent deaths were caused by Delta, not Omicron, the “vast majority.”

Provincial officials on Wednesday were asked repeatedly if their optimism over the recent data and key indicators, such as stabilizing ICU numbers and much shorter length of stay, will prompt an easing of restrictions.

While they did not commit to any new policy, an announcement on pandemic restrictions will be made by the PC government this week, they said.

When pressed about the possibility of a decision being made too soon, before transmission data out of schools are understood, as students only returned to classes today (Wednesday), Elliott said there is “little evidence of high transmission in schools themselves (not community transmission).”

Any decision this week would be based on data gathered prior to the possibility of using information on Omicron’s potential spread inside schools. 

Moore assured the public that all the key data will be looked at before making any decisions on lifting restrictions, stating he is confident any loosening of current guidelines will be “phased, gradual.”

It remains unclear, as reporters pointed out on Wednesday to Moore and Elliott, how any decision could be made this week, considering relevant school data to show the transmission picture in classrooms will not be available for at least a couple weeks. 

But there was reason for optimism Wednesday.

Moore said hospital staff losses due to infection or precaution are starting to improve. While there are still “hotspot” hospitals like Civic that continue to face pressing capacity challenges, key indicators such as ICU admissions, demand for ventilators and average length of stay, suggest the Omicron wave might be far from a worst case scenario.

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