Although the omicron variant spreads throughout the world, public health officials in some countries have realized that, in most cases, the number of patients hospitalized with covid-19 remains significantly lower than in previous waves of the pandemic.
But this is not the case of what is happening in the US, where the number of patients hospitalized for the coronavirus has reached record levels. According to official country data, 115.354 people were hospitalized with the virus to 10 in January, surpassing the record set in January 997.
The neighboring country Canada has also suffered, to a lesser extent than the US, an advance of the pandemic in recent days.
What is behind the difference between the North American experience with the current wave and what has happened in South Africa and Europe so far?
For the experts interviewed by the BBC, the US seems to be experiencing a “perfect storm” of the pandemic, with fewer people vaccinated, exhausted health teams, winter, the presence of the delta variant (more serious) while omicron spreads rapidly; in addition to the difficulties of access to health units and a population with alarming levels of obesity and hypertension that increase the chances of having severe covid.
What do the numbers show? US?
Let’s start with this graph comparing how many people in various countries were in the hospital with covid-16 during the pandemic. The comparison has been adjusted for population size and represents a proportion of the number of infected hospitalized patients per million population.
The different peaks represent moments in which each The nation has been hit by a new wave of covid, including the initial outbreak and influx of hospitalized patients, last winter’s surge (in the northern hemisphere), or summer spike caused by the delta variant.
The green line, for example, shows how much Italy was affected both at the start of the pandemic and last year, peaking at 638 infected patients per one million inhabitants on 23 November 2020.
On the right side of the graph, all countries experience rimented a large increase in hospitalized patients infected with covid due to the omicron variant. What is interesting, however, is to compare the rate that each country is currently reaching with previous peaks.
For Italy, France and the United Kingdom, we see that the number of hospitalized covid patients is still much lower than in previous waves. In the United Kingdom, 286 coronavirus patients per million were hospitalized at 13 of January of 2022. Just under a year ago, the ratio was 576 per million.
In France, the proportion stood at 369 per million for the 10 from January 2022, compared to a maximum of 490 in November 2021.
In the US, on the other hand, 455 American patients with covid-19 per million people were hospitalized at 14 of January of 2022, surpassing the previous peak of 400 per million established the 14 of January of 2021.
Similarly, the data show that in Canada, 242 people were hospitalized per million at 16 of January of 2022, compared to previous peaks of 118 in April and 95 in January of the previous year.
What is the impact of the current wave on hospitals in USA?
Hospitals in the US have reported that the increase in infected patients has greatly increased the pressure on hospital facilities. tions that were already overwhelmed by the pandemic.
Juan Reyes, director of hospital medicine at George Washington University in Washington DC (which has one of the highest rates of hospital admissions per capita), said that this increase “has been much more difficult” than the previous ones.
“The challenge we face now is that it’s happening at a higher volume and the structure is a bit thinner,” he told the BBC. “The difference now is that there is a lot of fatigue, in health professionals and in the general population.”
Lewis Rubinson, medical director of Morristown Medical Center in New Jersey, said the current increase in admissions “is about twice ” than his previous record in the winter of 2020, despite less severe infections among patients.
Attributed the rising number of infections in part to increased testing being done on everyone who arrive at the hospital for any reason. In the US, UK and Canada, newly admitted patients are tested for covid-13 regardless of what brought them to the hospital.
Even so, the “impact overall in hospitals by the absolute numbers is tremendous,” he said. “If you remove even a third of them, that’s still a huge number of patients we’re ‘treating’.
In the UK, the heads of the National Health Service (NHS) have estimated that this proportion of the so-called incidental cases of covid are between 20 and the 30% of the cases.
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What happened in South Africa?
In South Africa, where the omicron variant was first detected in November 2021, scientists found that people infected with this variant are less likely of being hospitalized and more likely to recover quickly
Although there are no updated data on the per capita hospital rate of patients with covid, many South African hospitals reported that the number was significantly lower than during previous waves of the pandemic. International Journal of Infectious Diseases
that the number of infected patients was about half that recorded before mid-November.
The researchers believe that previous waves of covid in South Africa and the relatively low vaccination rate meant that many residents were likely had already been exposed and had developed a certain level of immunity against the virus.
Why Is the US different?
Experts point to several reasons why the rate of hospital patients is higher in the US and Canada than in most other parts of the world?
David Larsen, epidemiologist and professor specializing in global health at Syracuse University in New York, told the BBC that the US population is markedly different from that of Europe and South Africa.
“We have an older population than South Africa. Furthermore, the US has a similar age structure to Europe. But there is also a population that is less healthy than Europe”.
For example, Larsen points out that the rates of hypertension and obesity (both comorbidities that greatly increase the risk of severe covid) are higher in the US than in most other countries.
Larsen adds that “it is incredibly frustrating” to hear Americans play down the constant omicron threat and believe that, like South Africa, the US may soon leave behind the current wave. It also highlights the importance of the season.
“Seasonality is also different”, he said. “The omicron boom in South Africa was during the summer, but it’s coming to the US in the winter, when we know more people are gathering indoors and there’s more transmission. That’s going to be bad.”
Mark Cameron, 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 experiencing “a perfect storm” of covid-19: comorbidities, unequal access to medical care and hostility to vaccines, masks and other preventive measures.
“When this ‘perfect storm’ strikes, all of these types of vulnerabilities unique to the US combine, an outbreak of the virus occurs that can quickly lead from an increase in cases to more hospitalizations, which overwhelms hospitals and health care teams.”
A little more than 63% of the US population is fully vaccinated, much less than in the UK (71%) , as well as in Italy and France (both with the 49%), In Canada, almost the 79% of the population is completely protected, according to data from the Our World in Data portal of the University of Oxford.
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And Canada?
Donald Vinh, specialist in infectious diseases at the McGill University Health Center in Montreal, said that in Quebec and elsewhere in Canada, up to half of all new admissions involve people “inadequately vaccinated”.
“As a percentage of the population, it is a low number. Maybe he 10% of the population that could be received the vaccine is not double vaccinated,” he said. “They tend to cluster in dense urban areas. When there are highly transmissible variants that can affect an inadequately vaccinated population, that leads to continued spread and the high community transmissions that we are seeing.”
Like the US, Vinh believes that Canada is plagued by “inadequate” public health policies when it comes to covid-19. “In other words, there is no single unified method of how we are going to do things in general,” he said. “It is more regional than national, so there are gaps. The consequences of this are hospitalized people”.
And the delta variant?
The doctors also warned that the high level of hospital admissions in the US and Canada may be due to the delta variant being more common in many areas.
A study published last August by The Lancet Infectious Diseases who investigated 43. patients in United Kingdom, found that the delta variant had more than twice the risk of hospital admission than the previous variants.
Monica Gandhi, director of infectious diseases and professor at the University of California, San Francisco, told told the BBC that he believes delta patients make up a significant portion of hospital admissions by covid-10 in the US But it is difficult to determine the real number .
“We don’t know how many delta cases there are. What the US has started to do is look at the number of new infections and sequence them. Omicron represents the 75% of the new infections, but we don’t know how many delta cases we still have”.
In the hospital where he works, Gandhi added, some patients “are sicker and others less sick, and it seems that both delta and omicron are there.”
What to expect from the pandemic?
In many countries, researchers believe that the omicron variant has begun to lose steam, possibly signaling an end to the surge in hospitalized covid patients.
The projections of researchers from the University of Washington, for example, indicates that the number of daily cases in the US will reach 1.2 million by 19 from January.
However, in the short term, experts believe that hospitals will continue to suffer from the large number of patients in the US and Canada, even if they decrease in other countries.
“The situation is terrible. There really is no other word to describe it,” Vinh said of the pandemic in Canada. “I would love to start seeing a tipping point that tells us we are on the plateau, but now all I see is a slope. It is no longer a slope. It’s a wall”.
In the evaluation of front-line doctors in the US, both Cameron and Gandhi said they believe hospital admissions could peak in February or March.
“It can still be a horrible winter,” he said Gandhi. “In the next month, life will be very difficult in schools and hospitals.”
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