`THEY'RE YOUNGER, THEY'RE SICKER'
Hospitals seeing `clear shift' in speed of illness
Younger people are getting more severely ill with COVID, and more quickly, prompting desperate “rescue” interventions for people as young as 22 at one Toronto Hospital.
On Monday, 17 people with COVID-19 were connected to extracorporeal membrane oxygenation, or ECMO, at Toronto General Hospital, the highest number since the pandemic began. Their ages ranged from 22 to 61. Four are in their 20s or 30s.
“Certainly, we've seen a shift in the kinds of patients that we're seeing coming to the ICU in this wave,” said Dr. Eddy Fan, medical director of the Extracorporeal Life Support Program at Toronto's University Health Network, or UHN. His ECMO unit, the largest in Canada, is also a provincial referral centre.
In wave one and two, most of those put on ECMO because of COVID-ravaged lungs were older, in their 50s and 60s, and with chronic health problems. Now, they're younger, many previously healthy.
What's also different is how swiftly some people are progressing from sick to mortally ill. In earlier waves, ICU doctors saw a typical pattern among patients, said Dr. Niall Ferguson, head of critical care medicine at the UHN. “They were sick at home for a week, sick at another hospital for a week, then intubated and on a ventilator for a week, and then they got bad enough to need to come to us.”
People are now getting to that state in a matter of days, not weeks. “That's been a very clear shift,” Fan said.
It's not clear what's driving that shift, but Fan and other doctors say highly contagious variants of the SARSCoV-2 virus are undoubtedly playing a role.
On social media, doctors are describing previously healthy people “in the prime of their lives” on life-support with COVID.
“This wave is worse than a year ago. Worse than January. They're younger. They're sicker,” Dr. Shankar Sivananthan, a critical care doctor with the William Osler Health System, a hospital serving Brampton and North Etobicoke, tweeted last week.
Ontario's COVID-19 science advisory table was due to release data Monday showing that the fast-spreading SARS-CoV-2 “variants of concern” roughly double the risk of ICU admission and increase the risk of dying from COVID-19 by 60 per cent.
The variants have picked up a mutation that makes it easier for the virus to latch onto receptors on human respiratory cells. “Clearly there is something that is making them both more transmissible and able to replicate more quickly,” Ferguson said.
Young adults are much less likely than older people to become seriously sick with COVID. But their risk of needing ICU care or dying is not inconsequential, said Dr. Scott Solomon, professor of medicine at Harvard Medical School and senior physician in the cardiovascular division at Brigham and Women's Hospital in Boston.
Solomon is a co-author of a recent analysis reported in JAMA Internal Medicine. He and his colleagues analyzed the medical records of 3,222 people, aged 18 to 34, admitted to American hospitals with COVID in the spring wave of 2020.
In all, 21 per cent required intensive care, 10 per cent mechanical ventilation and three per cent died.
The death rate was lower than that reported for older adults with COVID, but roughly double that of young adults with a sudden heart attack. Severe obesity, high blood pressure and diabetes increased the likelihood of severe “outcomes” from COVID in the young. So did being male.
“The demographics of COVID-19 infection are clearly changing from the spring (of 2020),” Solomon said. In Canada, new infections are highest among the 20- to 29-year-olds, a more mobile and socially active group, but whether the new variants alone are contributing to more younger people being hospitalized “is hard to know for sure,” Solomon said.
More elderly people are being vaccinated. Remove the most vulnerable, and the face of the pandemic changes.
“These are not simple metrics to analyze, because there are multiple parameters that are influencing what we are seeing right now, and we have to be very careful to make these statements that, `Oh, yes, the younger people, we're seeing more of them in hospital,'” said the University of Ottawa's Dr. Marc-André Langlois, who is helping spearhead a new national Coronavirus Variants Rapid Response Network. “We're seeing more of them because we're not seeing as many elderly in proportion.”
Mutational changes are making it easier for the virus to bind to human cells, Langlois said. “But why the younger adults? Why is it not affecting just everyone in the same way, in the same proportion? There are layers to that complexity that are still poorly understood.”
“In the end, this is a numbers game — the more individuals in the younger age group who get infected, the more will have severe disease requiring hospitalization and potentially intensive care support,” Solomon said.
All of which makes masking, distancing and avoiding gatherings (bars, nightclubs, parties) that can fuel transmission important until vaccines are rolled out to younger people, he said.
THIS WAVE IS WORSE THAN A YEAR AGO. WORSE THAN JANUARY.