Wednesday, May 18, 2022

Ontario’s Omicron death toll on the rise and getting worse

Ontario has reported more than 1,000 new deaths from COVID-19 since Dec. 1, raising the pandemic’s overall toll in the province to more than 11,000.

That figure will continue to climb for weeks, even as some evidence indicates we may be at or near the peak of the Omicron-fueled fifth wave.

One researcher is predicting that by the spring this could end up being Ontario’s deadliest stretch of the pandemic.

Meanwhile, the province is dealing with the highest number of COVID hospitalizations, more outbreaks in long-term care than ever before and crushing staff shortages across the health-care sector.

This, despite widespread vaccine coverage and a supposedly milder new variant, the overall effect of which is anything but.

“What’s mild about any of this?” asked Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network.

But the current situation, wrought by Omicron’s heightened infectiousness, could have been avoided, Sinha said, adding that the story of this wave of the pandemic in Ontario is one of “missed opportunities” for not rolling out booster shots more quickly to those at the highest risk.

“I think right now we’re seeing the devastating consequences of just not being as proactive as we needed to be,” he said.

The early narrative of Omicron’s relative mildness may have led both policy-makers and individual people to not be as vigilant as they could have been, Sinha said.

“We may have talked ourselves into not doing everything that we could to actually better support our population overall, but in particular, our oldest citizens.”

As has been the case throughout the pandemic, older adults continue to comprise the vast majority of deaths from COVID-19. More than half the deaths in Ontario since Dec. 1 have been people 80 years or older, while 90 per cent have been 60 or older, which mirrors the pandemic as a whole.

Sinha said we didn’t make it easy enough for older people — particularly those living in the community rather than in long-term care or retirement homes — to get their booster doses before Omicron hit.

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“Then we have the situation in December where older people were competing with younger people (for booster shots), and we really squandered a lot of valuable time,” he said.

“Maybe it’s because we’ve looked at this population as one that is living on borrowed time, and frankly, isn’t a priority, but if these were children who were at risk, would we have responded so slowly and in such a patchwork fashion?”

Dr. Nathan Stall, one of Sinha’s colleagues at Sinai, said that when considering the mildness of Omicron it’s important to distinguish between what’s happening at the patient level and the system level.

Dr.  Nathan Stall, a geriatrician and researcher at Sinai Health, photographed last January.  “At the individual patient level it's true that Omicron may result in milder illness and we now have accumulating evidence to suggest that,” he said.  “But at the macro level — at the system level and at the societal level — Omicron is anything but mild.”

“At the individual patient level it’s true that Omicron may result in milder illness and we now have accumulating evidence to suggest that,” he said. “But at the macro level — at the system level and at the societal level — Omicron is anything but mild.”

As different as this wave is from previous ones, Stall said, it continues to be a pandemic largely of the unvaccinated and under-vaccinated.

“If this was like wave one, without vaccines, it’s unthinkable what would have happened,” he said. “So the vaccines are still miraculous. But we have to recognize that it’s not an insubstantial amount of death.”

The province does not report deaths by vaccination status, but more than half of the people currently in intensive care in the province have one or fewer doses of a COVID-19 vaccine, despite comprising just 11 per cent of the province’s 12 and older population.

Put another way, in hospital ICUs right now, there are 287.7 unvaccinated COVID-19 patients, per million Ontario residents, compared to 24.2, per million, who have received at least two doses, according to Ontario’s Science Advisory Table.

Tara Moriarty, an infectious diseases researcher at the University of Toronto, says we are only beginning to see the death toll of the Omicron wave in Ontario, which she predicts will actually be the deadliest of the pandemic.

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“This is the very early stage,” she said. “It’s going to get a lot worse.”

Moriarty, who uses data from across the country to estimate future COVID-19 mortality, predicts the number of daily deaths in Ontario – which averaged 48 in the past week — will “at least” double before it reaches its peak.

That would exceed the highest single-day death toll in Ontario — 84 on April 19, 2020.

The weekly COVID-19 death toll in Ontario continues to climb and could soon match the peaks of the first and second waves.

Moriarty said the total number of reported deaths in the current wave will, by early March, “almost certainly” exceed the more than 2,800 that occurred in the first wave. By spring, she said, the total will surpass the more than 4,100 that occurred in the second wave.

“I see no signs of a short, sharp peak.”

(Moriarty’s estimates, which she publishes on Twitter, have not been peer-reviewed.)

Sinha, who has called on the province to update the meaning of “fully vaccinated,” said describing two doses as “fully vaccinated” gave some of his patients the impression they would be fine without a booster.

“I had a lot of older patients who were like, ‘I’m fully vaccinated, let somebody else get that third dose. I don’t want to be greedy,’ not appreciating that third dose can be the difference between life or death.”

He said one of his patients, a man in his 90s who hadn’t yet received a booster dose, was recently admitted to hospital.

“So all I can do now is just console the family and say they’re in the right location. … But we’re not sure my patient is going to make it, because that’s the reality of us not getting doses out quickly enough, especially booster doses.”

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