The Many Mysteries of SARS-CoV-2 Infections

"We've taken the elderly, the above-80s and, to a large extent, the above-70s, our most vulnerable patients, out of play [through inoculation]."

"But what we're left with is a group of patients who have a good chance of being saved, but the resources required to save them are sometimes astronomical."

"[Patients are remaining in intensive care longer, numbers intubated and attached to a ventilator increasing], and I think that's because we have a more salvageable population. They are appropriate to intubate, they are appropriate to care for, for a very long period of time, in the hopes that they eventually improve."

"There are some people in whom it was 100 percent predictable they were going to get bad disease because they have really bad co-morbidities [cancer, compromised immune systems]."

"But then we have a lot of people who either have no co-morbidities or just the usual things that so many people in that age group have, and why did they end up in the ICU? They were really unlucky. They got a really bad disease or their body reacted to it badly."

"You give the same virus to 20 people, one of them ends up in ICU, five of them don't have any symptoms, and they caught the same disease. It's bad luck. And nobody likes that answer."

"About a third of my ICU beds are taken up with COVID patients. We're not seeing waves, we're seeing non-stop COVID for over a year. But we've been very lucky we've been able to handle it."

"[Watching what's happening in Toronto], and we're terrified. Toronto has top-level hospitals with top-level ICUs and with a good number of ICU beds per capita, and they're struggling."

Dr.Paul Warshawsky, chief, Division of Adult Critical Care Medicine, Jewish General Hospital, Montreal 

Registered nurse Jane Abas tends to a COVID-19 variant patient who is intubated and on a ventilator in the intensive care unit at the Humber River Hospital during the COVID-19 pandemic in Toronto on Tuesday, April 13, 2021. Nathan Denette/CP

"Their hypoxemia was really out of keeping with their symptoms."

"The bulk of the ICU cases are still people in their 50s and 60s, but the ones that are standing out in everyone's attention are the ones in their 40s and into their 30s."

"There is clearly something different about this wave. It does seem like it's affecting younger people more."

"It's workplace exposure that's driving most of these infections, not children getting it at school and bringing it home to their parents."

Dr.James Downar , palliative and critical care specialist, Ottawa

 

"They're in a demographic that hasn't been vaccinated yet, and the variants are more infectious."

"We're seeing this greatly in all of the hospitals."

Dr.Anju Anand, respirologist, Toronto

 

"[While a few older teens have required ventilation}, all have been discharged in pretty good health. So kids have done well."

"I don't think we've seen more severe illness over the course of the year."

Dr.Jeremy Friedman, associate pediatrician-in-chief, Hospital for Sick Children, Toronto

 

In this, the third wave that has struck British Columbia, Alberta, Quebec and Ontario, the face of the pathogen that is COVID has changed in its targeting. In the first wave, COVID struck the health- compromised elderly in long-term care residences more than any other age group and more elderly people died than in any other age demographic. Younger people were thought to be fairly safe and children virtually immune. Now, outcomes have changed so dramatically with the SARS-CoV-2 virus infection that people are dying at home. Their symptoms advance so quickly they haven't the opportunity to go to hospital before they succumb.

 

They're being identified with hypoxia, it's what overcomes mountain summiteers when they rise too quickly in ascending toward mountain peaks where the oxygen becomes progressively diluted and it becomes difficult to breathe in enough oxygen without become acclimatized gradually at lower levels. The silent hypoxia creeping up on people so unexpectedly presents as a baffling condition of low levels of oxygen, people failing to understand how ill they are absent symptoms such as shortness of breath or gasping for air. 

 

"Younger daycare workers, ride-share drivers, factory workers ... and their families are dying", commented Dr.Michael Warner, head of critical care at Michael Garron Hospital in Toronto. In
Calgary, ICU nurses have reported entire families -- husband and wives, mothers and sons -- in critical care. Of those arriving to emergency many are essential workers or racialized populations without work-from-home options as well as those living in multi-generational homes or in cramped student housing. The more elevated community transmission is, the more opportunity of becoming infected.

Now, close to 90 percent of Canadian seniors age 80 and above have at least one dose of a COVID vaccine, leaving them with a level of protection not yet available to the younger population. And these younger people are remaining in intensive care longer with those being intubated and attached to a ventilator on the increase. It is specifically that increase of younger patients that is inexplicable. Many experts believe logically enough that variants are driving the increase leading to the "younger and sicker" phenomenon.

Close to 95,000 confirmed cases of variants of concern have been reported, the UK version accounting for fully 96 percent. Variants in Ontario are responsible for 90 percent of new infections. Mutants, according to the province's science table, carry a 63 percent higher risk of  hospitalization, a 103 percent increased risk of requiring intensive care, and a 56 percent increased risk of dying, in comparison to earlier versions of the SARS-CoV-2 virus.

 

Researchers reported in the European Journal of Epidemiology on the P.1 variant that emerged in Brazil and now spreading in Canada, linking it with a noted increase in the 20 to 59 year-olds in Amazonas requiring hospitalization and intensive ventilation care "as well as increased mortality in this age group during the second wave". Evidence has surfaced that the variants spread a higher virus dose, presumably affecting how sick someone exposed to it may become.

People sit at a restaurant patio to take advantage of sunny weather in Ottawa, March 20, 2021. Photo by Ashley Fraser/Postmedia

"[In the first wave it took ten to 14 days post-symptoms of] grumbling along [staying home until people got short of breath ending up in emergency or straight to the ICU]."

"[Now], it's becoming more in the neighbourhood of five to seven days. [Why?] Is it because younger people react differently to the virus, and we're only seeing  younger people now?"

"Is it because of the variants? It's still not 100 percent clear to me."

Dr.Paul Warshawsky, Jewish General Hospital, Montreal