Ruminations: The New Omicron COVID Presentations

"We are still catastrophizing COVID. The emotion and fear are so overwhelming."
"We have somehow made when you have a positive result equal disaster in a lot of people's minds."
"It's very difficult to try to break through this."
Dr,Martha Fulford, infectious diseases specialist, chief of medicine, McMaster University Medical Center

"[Canadian doctors see a lot of COVID in emergency departments] And it's all Omicron."
"The cases coming to the emergency room are basically all comers [ranging from mild symptoms, no shortness of breath but worried people who want to be tested -- up to those with seriously] robust [pneumonia]."
"Why that scares me is that it tells me that this virus is as bad a player as any other before it. It can be a milder virus, but it can also be quite severe."
"You don't want to spread panic, but you also don't want to be blase about what can be a very dangerous virus."
"Most people are coming [to emergency] because they feel very unwell. Most are using emergency services appropriately. We want to continue to get the message out there, if you have mild symptoms, you should stay home to decrease the risk of exposure to other people, particularly our emergency room staff. But of course, if you are ever concerned you come right into emergency, and we'll always be here. Not just Humber, but any hospital."
Dr.David Jacobs, radiologist, Humber River Hospital, Toronto

"We aren't seeing as many patients gasping for air. Thankfully the COVID patients aren't as sick. BUT there are SO many of them."
"But for most, COVID seemed to topple a delicate balance of an underlying illness [diabetes, for example where a COVID infection can trigger serious ketoacidosis, potentially fatal]. It's making people really sick in a different way."
Dr.Craig Spencer, emergency doctor, New York City

"We're not seeing a lot of admissions for respiratory failure, we're not seeing a lot of patients being put on high-flow oxygen being intubated."
"What we are seeing is people who are being admitted because they are extremely weak, dizzy, a fall risk. [Respiratory distress and respiratory failure are not encountered as much]; That's not so much an issue thi8s time."
"We're not seeing a huge number of COVID pneumonia [patients] and people requiring intensive respiratory support. We're not seeing that very much at all."
Dr. Eric Legome, emergency sites, Mount Sinai Health System, New York City

Close-up of someone doing a lateral flow test

A number of scientists have expressed concern that while Omicron appears to be milder, it is highly transmissible, meaning hospital numbers and deaths could rise rapidly without intervention. Photograph: Ben Stansall/AFP/Getty Images

New strain, new symptoms, new presentations and a sigh of relief; concerns over yet another mutated COVID virus hammering health systems, exhaled. But wait; there's the signal issue of infectability and sheer, overwhelming numbers of new infections overwhelming health care systems, upsetting the balance of 'less threatening--more infectious' against 'less infectious--more dangerous', and the outcomes level out. The sheer volume of infections mitigate against relief and produce serious cases flooding ICUs and causing deaths. With SARS-CoV-2 you just can't win for losing.

Imagine, if another strain were to appear just when Omicron appears to be cresting. A strain with the qualities of both. Say, Delta picking up about 10 Omicron mutations. Mightn't that result in a far more dangerous strain; the threat of Delta's more serious outcomes allied with far greater infectiousness. Well, it's been named Deltacron and it has surfaced in Cyprus. And given the lightning speed with which Omicron shoved Delta aside as the dominant strain in a matter of weeks, the world has yet to assess how threatening this new strain will be.

One step forward, two steps back has become COVID's overwhelming presence in our lives. As matters now stand, emergency rooms in Canadian hospitals are being overwhelmed by endless numbers of people suspecting they have been infected with COVID, showing symptoms ranging from that of a mild cold to severe COVID pneumonia, surfacing mostly in the unvaccinated and the vulnerable. Front line doctors report arrivals in hospital with minimal symptoms driven by anxiety.

A health-care worker wearing PPE transports a patient in the dialysis unit at the Humber River Hospital during the COVID-19 pandemic in Toronto. THE CANADIAN PRESS/Nathan Denette

The public is confused, with no clear idea how to respond if they've contracted COVID. Explosive growth has been seen in hospitalizations with the advent of the hugely contagious Omicron variant. Ontario has directed its hospitals to put off non-emergency surgeries, to brace for a potential "tsunami" of infections in coming days and weeks, as daily case numbers explode. Still, January 2022 is not a reflection of March 2020, when no vaccines were available.

Doctors and health-care workers in New York City during the first SARS-CoV-2 wave were trailblazers -- where now hospitalizations soared beyond 10,000 this week for the first time in 20 months. Back in March 2020 lung inflammation was the first wave's major issue when people were suffering respiratory failure. As with earlier waves there are some people who present short of breath, requiring supplemental oxygen, but they're now a distinct minority.

According to new research Omicron infects and homes itself in the bronchi, not as deep in the lungs as per Delta. That difference appears to explain its spreadability and less severe outcome.

Bit as with previous strains, it is the unvaccinated that appear to make up a disproportionate number of the sickest patients with COVID. Severe cases of Omicron are little different than those seen in the Delta infection heights and the first wave. The difference now is vaccination status, immune status and age grouping. Again, as with all strains of COVID, it is the elderly who are the most vulnerable, alongside the immuno-compromised.

Among patients presenting in hospital emergencies and hospitalized most are there because of COVID, and a lesser but comparable number are hospitalized as an incidental diagnosis; admitted for example for a broken leg or appendicitis or to deliver a baby and they happen to have COVID, explained Dr.Jacobs."Of those in the ICU their numbers are "Much much lower than we've had with previous waves".

Because COVID is the universal threat, people search for clear guidance "And it's very hard for them to know and access reliable information. They want treatment, they don't know what's available for treatment and there is very little public guidance around this", stated Dr.Andrew Morris, professor of medicine at University of Toronto, an infectious diseases specialist at Sinai Health System in Toronto.