Even as the Omicron variant sweeps around
the world, public health officials have noted that, in most cases, the number
of Covid patients in hospitals remains significantly lower than during previous
pandemic surges.
That's not the case in the US, however,
where the number of patients with the coronavirus currently in hospital has
reached record numbers.
According to data from the Department of
Health and Human Services, 145,982 people were in the hospital with the virus on 11
January, surpassing a previous record set in January 2021.
On Thursday, US President Joe Biden was
expected to announce plans to deploy military medical personnel to help in six
of the states hardest hit by the influx of patients.
Similarly, hospitals in large parts of
neighboring Canada have also seen surges, with Quebec reporting a pandemic
high last weekend.
So what is going on, and why might North
America's experience be different from South Africa and Europe so far?
What do the numbers show?
Let's begin with this chart comparing how
many people in several countries have been in hospital with Covid-19 during the
pandemic. It's adjusted to account for population size and represents a ratio
of the number of infected hospital patients per million inhabitants.
The various peaks represent times in which
each nation was hit by a new Covid wave, including the initial outbreak and
influx of hospital patients, last winter's surge, or the summer spike caused by
the Delta variant.
The green line, for example, shows how
hard Italy was hit at both the beginning of the pandemic and again last year,
reaching a high of 638 infected patients per million inhabitants on 23
November 2020.
On the right side of the chart, every
country has experienced a large spike in Covid-infected hospital patients due
to Omicron. What's interesting, however, is to compare the rates each country
is hitting now with those previous peaks.
For Italy, France, and the UK, we see that
the number of patients in hospital with Covid remains much lower than in
previous waves. In the UK, 291 patients with coronavirus per million were in
hospital on 10 January. Just under a year ago, the ratio stood at 576 per
million. In France, the ratio stood at 347 per million on the same day,
compared with a high of 490 in November.
In the US, on the other hand, 411 US
Covid-19 patients per million people were in hospital as of 9 January -
surpassing a previous peak of 400 per million sets on 14 January 2021.
Similarly, the data shows that in Canada,
206 people were in hospital per million as of 11 January, compared to previous
peaks of 118 in April and 128 in January 2021.
What has the impact been on hospitals?
Hospitals
around the US have reported that the spike in infected patients has exacerbated
pressure on facilities already strained by the pandemic.
Dr. Juan
Reyes, the director of hospital medicine at George Washington University in
Washington DC - which is among the US cities with the highest per capita
hospital admissions rate - said that this surge "has been a lot more
challenging" than previous ones.
"The
challenge that we're feeling now is that it's happening at a larger volume and
things are a little bit tighter," he told the BBC. "The difference
now is a lot of fatigue, on healthcare workers and the population at
large."
Dr. Lewis Rubinson, the chief medical
officer of Morristown Medical Center in New Jersey, reported that the current
admissions surge "is about twice the size" of its previous high in
the winter of 2020, despite less severe infections among patients.
He attributed the rising numbers,
partially, to increased testing of everyone who comes in the hospital for any
reason. In the US, UK, and Canada, newly admitted patients are tested for Covid
regardless of what brought them to a hospital.
Still, "the overall impact on
hospitals by the sheer numbers is tremendous," he said. "[If] you
take off even a third of those, it's still an enormous amount of patients that
we're tackling."
In the UK, this proportion of so-called
incidental Covid cases has been estimated by National Health Service bosses to
be between 20-30% of cases.
What's happened in South Africa?
In South
Africa - where the Omicron variant was first detected in November - researchers
found that those infected with Omicron are less likely to be sent to hospital
and more likely to recover quickly.
While
up-to-date data regarding the rate of Covid patients in hospital per capita is
not available, many South African hospitals reported that the number was
significantly less than during previous surges.
The Steve
Biko Academic Hospital in the City of Tshwane, for example, reported to the
International Journal of Infectious Diseases that the number of infected
patients was about half of that recorded before mid-November.
Researchers
believe that South Africa's previous Covid-19 waves and relatively low
vaccination rate meant that many residents had already likely been exposed and
had built up some level of immunity.
Why is the US different?
Experts point to several reasons why the
rate of Covid patients in hospitals is higher in North America than in most
other parts of the world.
Professor David Larsen, an epidemiologist
and global health expert at Syracuse University in New York, told the BBC that
the US population is markedly different from that of both Europe and South
Africa.
"We have an older population than
South Africa. That's a big one," he said. "[The US] is kind of
similar in age structure to Europe. But there's also a less healthy population
than in Europe."
For example, Dr. Larsen noted that rates of
hypertension and obesity - both of which are comorbidities that increase the
risk of Covid - are higher in the US than in most other countries.
Dr. Larsen added that "it's incredibly
frustrating" to hear Americans downplay the ongoing threat of Omicron and
believe that, like South Africa, the US may soon emerge from the current surge.
"The seasonality is also
different," he said. "Omicron's surge through South Africa was during
their summer, and it's hitting us in winter when we know more people gather
indoors and there's more transmission…it's going to be bad."
Dr. Mark Cameron, an associate professor in
the department of population and quantitative health sciences at Case Western
University in Ohio, told the BBC that he believes the US is suffering from
"a perfect storm" of Covid-19, comorbidities, uneven access to
healthcare, and hostility to vaccines, masks, and other preventative measures.
"When all of that 'perfect storm'
nature of vulnerabilities that are unique to the US combine, you've got an
outbreak of the virus that can quickly lead from increased cases to increased
hospitalizations, which tax the local hospitals and health community."
Just over 63% of the US population is
fully vaccinated, much lower than in the UK (71%) as well as Italy and France
(both 75%). In Canada, almost 79% of the population is fully protected.
What about Canada?
Dr. Donald Vinh, an infectious disease
specialist at McGill University Health Centre in Montreal, said that in Quebec
- and other places across Canada - as many as half of all new hospital
admissions are among the "inadequately vaccinated".
"As a percentage of the population,
it's a low number. Maybe 10% of the eligible population are not doubly
vaccinated," he said. "They tend to be clustered in urban dense
spots. When you have highly transmissible variants and it can affect an
inadequately vaccinated population, this leads to ongoing propagation and the
high community transmissions we're seeing."
Like the US, Dr. Vinh said that he believes
Canada is plagued by an "incongruent" public health policy when it
comes to Covid-19.
"In other words, there isn't a single
unified method in how we're going to do things across the board," he said.
"It's more regional than national, and because of that, you have gaps. The
consequences of that are people getting hospitalized."
What about the Delta variant?
Doctors also warn that the high level of
hospital admissions in the US and Canada may be due to the Delta variant being
more prevalent in many areas.
A study published in August by The Lancet
Infectious Diseases - which investigated 43,000 patients in the UK - found that
the Delta variant had more than double the risk of hospital admission than
previous variants.
Dr. Monica Gandhi, an infectious diseases
physician and professor at the University of California San Francisco, said
that while she believes Delta patients form a significant portion of Covid-19
hospital admissions in the US, the true figure is hard to determine.
"We don't know how much Delta there
is," she told the BBC. "What the US has started to do is look at the
number of new infections and sequences. Omicron is 95% of new infections, but
we don't know how much Delta we still have around."
In her own hospital, Dr. Gandhi added, some
patients "are sicker and some are less sick, and that feels very much like
Delta and Omicron are both there".
What's next?
In many countries, researchers believe
that the Omicron variant has begun to subside, possibly signaling the end of
the increase in hospital patients with Covid.
A computer model from researchers at the
University of Washington, for example, has projected that the number of daily
cases in the US will reach a high of 1.2 million by 19 January. Some researchers
have predicted that cases may even peak sooner.
In the short term, however, experts
believe that hospitals will continue feeling the strain of elevated patient
numbers in both the US and Canada, even as they fall in other countries.
"The situation is bad. There's really
no other word to describe it," Dr. Vinh said of the pandemic in Canada.
"I would love to start seeing an inflection point that tells us we're at
the plateau, but right now all I'm seeing is a hill. It's not even a hill
anymore. It's a wall."
Dr. Larsen, for his part, said he believes
that the US needs "more urgency around systemic change" to move past
Covid-19.
In the US, both Dr. Cameron and Dr. Gandhi
suggested that they believe hospital admissions may peak in February or March.
"It still could make for a miserable
winter," Dr. Gandhi said. "I think that for the next month, life is
going to be really hard in schools and hospitals."
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