The resident of Mississauga, Ont. lost her husband of six decades in early 2021 and was diagnosed with Parkinson’s disease. But she was healthy, active and still enjoying time with family, including a meal with loved ones in September. “And she looked perfect,” recalls her son Victor. “We were all talking, laughing … then a week later, the circumstances changed.” That’s when Josephine started showing symptoms of COVID-19. And, despite having received four doses of the vaccine, the virus took a heavy toll. The 89-year-old went to a local hospital in late September and spent a few days in an emergency room bed waiting for a room. At first her illness seemed mild — with none of the tell-tale breathing problems that afflict so many COVID patients — but she slowly began to decline. WATCHES | The pandemic continues to pose a threat to those at risk:
Deaths from COVID-19 are rising again in Canada
Data shows the number of Canadians dying from COVID-19 each week is rising once again, a stark reminder that for those most at risk the pandemic remains a real and legitimate threat. Victor and his sister Laura visited their mother as much as possible, often playing her favorite oldies, until the hospital stopped allowing visitors during a COVID-19 outbreak. “Then it just took a turn for the worse,” Laura said. During her last days in the hospital, Josephine was put on oxygen and developed pneumonia. She didn’t want to be intubated, so she was never taken to the intensive care unit. He died on October 9. “I always believed in myself that my mom had some good years with her,” Victor said. “Suddenly you realize that the disease that has captured so many lives is actually affecting the lives of your family.” People like Josephine – who are elderly or medically frail for other reasons – are now the classic victims of COVID-19. And hundreds of Canada’s most vulnerable people are still dying every week, with deaths across the country remaining stubbornly high in recent months, federal data show. This means Canadian families continue to lose loved ones to this virus on a regular basis, while hospitals continue to admit seriously ill patients with COVID-19 amid ongoing staff shortagessurgical delays and a busy season of respiratory viruses. “We’ve all gone through another phase of life with the virus,” said Dr. Callie Barrett, a critical care physician at University Health Network in Toronto. “But for those at risk, the pandemic remains a real and legitimate threat.”
“Completely different patient population”
Canada’s weekly death rate from COVID-19 has soared and then declined in dramatic peaks and valleys since it began spreading in early 2020. However, while weekly deaths fell into double digits at many points in 2020 and 2021, the toll has not fallen below 137 in all of 2022. (The numbers are provided to the federal government by the provinces and territories and no longer include Nunavut or in the Northwest Territories.) This change follows provinces lifting public health restrictions while Omicron’s family of sub-variants continued to evolve to better evade our immune systems. For nearly four straight months, weekly deaths from COVID-19 in Canada have remained above 200 — and the latest figures available show 305 lives lost during the week of October 16. CBC News spoke to multiple doctors to understand what’s behind this trend and who is dying of COVID-19 in late 2022. Canadians who are older, already struggling with multiple pre-existing health conditions or undergoing immunosuppressive treatments such as chemotherapy all are at higher risk of death. Some end up in intensive care, while others are now hospitalized for their illnesses and eventually die in other settings, including other hospital wards. Laura Moschitto shares old memorabilia, including a photo of her mother Josephine in her younger days in the living room of her parents’ Etobicoke home. (Evan Mitsui/CBC) “It’s a completely different patient population than previous waves,” said Dr. Bram Rochwerg, critical care physician at Hamilton Health Sciences in Hamilton, Ont. He recounted the horror stories of the early days of COVID: Young, healthy adults becoming incredibly ill and ending up in intensive care with mechanical ventilation or even extracorporeal membrane oxygenation (ECMO), the highest form of life support. “We’re not seeing these young, previously healthy, super sick people that we saw at the top of the Delta,” he said. Fabreau credits effective vaccines and treatments for this shift. Vaccinated people—that is, those who completed their initial series of COVID-19 vaccines and had at least one booster dose—were three times less likely to be hospitalized and five times less likely to die from their disease, compared to the unvaccinated. Canadians. according to data from the end of August to the end of September 2022. Fabreau said more recently that his seriously ill COVID-19 patients are usually medically frail, immunocompromised or still unvaccinated. Rochwerg, in Hamilton, agreed. “It’s the elderly, those with immunocompromised states on chemotherapy with advanced cancer, frail co-morbidities, who end up getting sick with COVID-related illness,” he said. “It’s extremely rare to see someone who doesn’t have these comorbidities end up in the ICU with COVID.” WATCHES | Canada’s hospital crisis leaves days waiting for care:
Canada’s hospital crisis leaves days waiting for care
Waits for care in Canada’s emergency rooms are getting longer. In Winnipeg, a woman says her uncle with terminal cancer waited two days for care, while an ER doctor says he’s considering quitting because of the “unacceptable” condition.
Deaths of the elderly, with comorbidities
The most recent data available from the Canadian Institute for Health Information (CIHI) suggests that the trend remains across the country, with worse outcomes seen for patients with more than one disease or condition. Those who died in hospital were also older than those who did not, with an average age of 76 compared to 60. Canadian COVID-19 patients with at least one comorbidity had an average hospital stay of eight days longer than those without comorbidities and a higher in-hospital death rate of 20 percent compared to 7 percent. south of the border, The US Centers for Disease Control data was released in September also shows that while overall mortality for patients primarily hospitalized for COVID-19 has decreased, the elderly are still hardest hit. The vast majority of 2022 deaths, more than 80%, were among those aged 65 and over, and three-quarters had three – or more – co-morbidities. But, to be clear, people who experience many health problems are not necessarily close to death. Siblings Victor and Laura Moschitto stand on the front porch of the Toronto home where their mother Josephine lived. (Evan Mitsui/CBC) In Toronto, the majority of COVID-19 patients who end up in Barrett’s intensive care unit are already weak from cancer treatment. Many, he said, may have had many years to live before developing COVID-19. “These were patients who might – if they went through their chemotherapy – make a full recovery and go back to a normal life,” he said. Several doctors also noted that other patients are admitted to the hospital for different conditions but also test positive, with some contracting the virus during their stay. “There are hospital-acquired cases that are still occurring that account for some of these numbers that we’re seeing,” said Dr. Neeja Bakshi, an internist at the Royal Alexandra Hospital in Edmonton. These differences may cloud the data about exactly why people die, but Barrett emphasized that whenever a patient is battling both COVID-19 and another health problemincreases their risk of poor outcomes.
Hospitals on the rise for COVID
The high number of patients suffering from this virus threatens to further strain Canadian health care systems this winter. “We just can’t expand any further and we don’t have the resources to go into the season,” Bakshi warned. “And I can tell you that no one at any level of hospital administration or clinical care is sleeping soundly.” Across Canada, the number of hospital beds occupied by patients with COVID-19 increased from 3,875 to more than 4,100 between October 17 and 24, federal figures show. Even if a small percentage of COVID-19 patients still become seriously ill, that’s capable of adding enormous stress to health care systems, Rochwerg said. “Our ability to treat critically ill patients right now has never been lower than it is right now,” he said. WATCHES | Hospitals, already under pressure, prepare for busy flu season:
Doctors prepare for busy flu season with hospitals already under pressure
Doctors are bracing for the peak of flu season, with hospitals already feeling the strain of COVID-19 and RSV and waiting times increasing. Their message: Wear a mask, get your flu shot and get a COVID-19 booster. The sickest patients with COVID-19 are now being cared for more widely on all hospital wards, including emergency departments and hospitals also facing pressure from other respiratory diseases, from flu to respiratory syncytial virus (RSV). This is coupled with efforts to cover the multitude of thousands of surgeries and procedures. More Canadians are expected to come to hospitals with more serious forms of cancer the lingering health effects from previous COVID-19 infections — all the ripple effects from this multi-year pandemic. “It led to a really perfect storm,” Rochwerg said.
