Omicron is only now hitting seniors. Here’s why this may spell more trouble for Ontario hospitals
The Omicron variant is now infecting Ontario seniors at record rates, prompting experts to warn of the risk of explosive growth in hospitalizations among these vulnerable adults.
Cases among those 60 or older have skyrocketed since the New Year. Ontario reported another 1,596 confirmed cases in the age group on Wednesday, including another 354 in seniors over 80. Despite the fact the province says its reported case counts are now unable to keep up with the variant's spread, these totals are now significantly larger than the worst single-day highs of previous waves.
More than 92 per cent of Ontarians 60 plus have received two doses of the COVID-19 vaccine, but, as of Wednesday, about 58 per cent had received a booster, according to the province, meaning many seniors still lack additional protection from a virus now many times more transmissible than the previous Delta variant.
The biggest concern is, are we going to have enough beds available even to provide basic levels of care for COVID patients coming in that don't necessarily require an ICU bed, but require a bed nonetheless? The worry is that we might not have enough of those," said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network.
The people who will pay the biggest price around that will be older adults."
With Omicron, vaccinated patients - especially those who are boosted - are likely to have significant protection against serious illness compared to the unvaccinated seniors of previous waves. However, the sheer number of older Ontarians becoming infected is likely to translate into growing demand for hospital beds in the coming weeks, even if the per case rate of patients needing care is lower.
That demand, experts say, has the potential to slam a health care system already beset by staffing shortages due to COVID cases among nurses and other hospital workers.
Palliative care physician Dr. Amit Arya noted that with so much COVID spreading in the community, frail and elderly people - particularly those suffering from conditions like congestive heart failure, lung disease or dementia - are most likely to face the brunt of a health system overrun by Omicron.
To be honest, I think that very quickly, the hospital situation is going to get a lot worse over the next few weeks," he said. I think it's going to spiral out of control."
Arya added that, in his experience, many patients who receive home care have not been able to get their third dose yet due to accessibility issues or social isolation. If these individuals need to come into the hospital for treatment, they could be at risk, especially if they are already immunocompromised, he said.
Sadly I've seen some cases of people who've become infected with COVID-19 after being admitted, so then this is life-threatening and very often life-ending," he said.
Indeed, the province has reported a large spike in hospitalizations since the New Year - 2,081 admitted patients with COVID as of Wednesday, up from 1,173 on New Year's Eve. The province's record hospitalization rate of just under 2,500 concurrent admissions, set in Wave 3, is on track to be broken in the coming days.
The first weeks of Ontario's Omicron wave largely spared seniors. Even as Ontario started reporting record numbers of infections in the days leading up to the Christmas holidays, cases among Ontarians age 60 or older remained well below levels reported in the province's first three COVID waves.
That has changed dramatically in the last 10 days, and reported infections in seniors have only surpassed the earlier records this week.
This matters because, throughout the pandemic, age has consistently been one of the largest risk factors for serious outcomes, with per case hospitalization and deaths rates both several times higher among seniors than the population as a whole. According to provincial data, patients 60-79 were about four times more likely to be hospitalized than the population as a whole in Wave 4; for those over 80, that rate has been about eight times higher. For the whole pandemic, more than 90 per cent of all COVID deaths have been patients over 60.
Meanwhile, reports of outbreaks in vulnerable settings like seniors homes and hospitals are also spiking this week. The 110 active COVID outbreaks in Ontario hospitals are another record high for the province.
As the Star has previously reported, Ontario hospitals have been the second-deadliest setting for COVID infections in the province, after only long-term-care homes.
Starting Wednesday, the provincial government is imposing a suite of new restrictions akin to Step 2 of its road map to reopen, including gym closures, a 21-day ban on indoor dining at restaurants, capacity limits in malls and businesses as well as for indoor and outdoor social gatherings.
The province has also provided new guidance to long-term-care home operators at a time when these facilities are seeing alarming growth in cases - another sign that Omicron is now hitting vulnerable older patients. On Wednesday, the province reported 372 active outbreaks at long-term care homes or retirement homes, up from just 42 on Christmas Eve.
Although this spike in reported outbreaks has not yet surpassed Wave 2 - which was the deadliest period of the pandemic largely because of the virus' spread in vulnerable seniors' homes - it is on track to hit record levels in the coming days.
Changes to the province's guidance to long-term-care homes include pausing entry into facilities for general visitors, except for those visiting residents receiving end-of-life care; cancelling residents' day absences for social purposes; and new testing requirements for residents who take day absences for essential, medical or compassionate reasons.
Laura Tamblyn Watts, CEO of CanAge, a national seniors advocacy group, said general societal restrictions in Ontario should have been brought into place earlier, before Omicron had a chance to get into long-term care so that facilities would not be facing further lockdowns now.
It's like there's one set of rules that limit things for seniors and another set of rules for everybody else. It's always the older people who are losing out in this, and it's not going to get better," said Tamblyn Watts, noting that staff availability in long-term care are plummeting."
What we are most worried about in the next two to three weeks is less that older people who are receiving care will be themselves infected with Omicron and more that there will be no staff to care for these vulnerable seniors."
In the broader community, Tamblyn Watts says she's extremely worried" about making sure seniors who live at home have access to care.
If you live far away from your mom and your mom takes ill and can't get to a medical appointment and doctors aren't seeing people in person, I can see a situation in which seniors will get increasingly sick at home and have no eyeballs on them," she said. It's very scary."