COVID-19

Hospitalized “because of” or “with” COVID-19: should we make the distinction? | Coronavirus

According to Dr. Caroline Quach-Thanh, yes, it is interesting to make this distinction. We want to know who is hospitalized because of the virus; otherwise, the morbidity and virulence of the virus may be overestimated. We want a better picture of complications related to COVID-19, says the pediatric microbiologist-infectologist at the Sainte-Justine University Hospital Center (CHU).

Dr. Quach-Thanh adds that the high rate of people hospitalized with COVID-19, therefore, with a primary diagnosis other than COVID-19, is a sign that community transmission remains very high.

The Omicron variant, which is dominant at the moment, is 50% less virulent than the others, as Caroline Quach-Thanh reminds us. The doctor also points to a South African study that estimates that during previous waves, 1 to 2% of cases were asymptomatic; with Omicron, it’s more like 30%.

According to Dr. Gilbert Boucher, president of the Quebec Association of Emergency Medicine Specialists and an emergency physician at the Montreal Heart Institute, this statistic is also partly good news: It shows that double vaccination works. People [vaccinées] who have COVID-19 have few symptoms. And the vast majority of those who are vaccinated and go to the emergency room with symptoms of COVID-19 are not admitted.

On the other hand, if Benoit Mâsse, professor of social and preventive medicine at the School of Public Health of the University of Montreal, knows very well that there is a proportion of people hospitalized with COVID-19, he wonders why the figure mentioned, 50%, is so high. It is surprising that one in two people hospitalized for reasons other than COVID-19 is infected [et asymptomatique]. This is a disproportionate ratio to what we see in the population. That would mean almost all of Quebec would be infected…, he said.

Same story for Dr. Alain Vadeboncœur, an emergency physician at the Montreal Heart Institute. I wonder about the very nature of the data, how it is calculated, he says.

He points out that sometimes it is difficult to decide whether or not the reason for hospitalization is linked to COVID-19. We know that COVID-19 causes complications in many systems. For example, an old man falls, breaks his leg and is hospitalized; we found out you have COVID-19 on admission. But did he fall from a dizziness caused by COVID-19? We do not know. Doctors make a judgment.

Benoit Mâsse and Dr. Alain Vadeboncœur add that more data is needed to fully understand the situation.

For example, people admitted with Does COVID-19 subsequently develop symptoms that require a longer hospital stay? When was the person tested? Could he have contracted the virus in the hospital? If a patient’s symptoms are later found to be caused by COVID-19, is the person considered hospitalized? overcome of COVID-19?

It should be noted, however, that this phenomenon is not new: during the last waves, there were also hospitalized patients with COVID-19, as Benoît Mâsse reminds us.

Plus difficult moments future

So why talk about it now?

Maybe it’s to tell people that it’s not so bad [la situation dans les hôpitaux] and that the measures can be relaxed. But we can’t do this again, underlines Dr. Vadeboncœur, who adds that hospitals will experience difficult times for a few more weeks.

During a recent press conference, the Minister of Health, Christian Dubé, did not offer an explanation about the methodology and the reasons that push the government to present the data related to hospitalizations differently. However, he pointed out that if the government chooses to make this distinction, the presence of those hospitalized with COVID-19 continues to be a problem for the health system.

It would be easy for us to say: it’s not 2,000, it’s 2,000 cases minus 40%. But even if these people came back for another reason, these people, we need to treat them differently. You cannot give birth to a pregnant woman who has COVID together with a woman who does not have COVID.

A significant impact on the health system

With Omicron being so contagious, the absolute number of patients hospitalized due to COVID-19 remains high, as Dr. Caroline Quach-Thanh reminds us.

So it doesn’t matter if people are hospitalized on account of Where with COVID-19, the very high number of people infected in hospitals greatly complicates the situation, which is already critical. They are still occupied beds, says Mr. Masse.

It still puts pressure on the hospital, the staff, the equipment, even if it’s an asymptomatic case., adds Dr. Vadeboncœur.

« We cannot allow an infected person to be placed next to another patient who is not infected. So what changes, in the end? [qu’on parle de personnes infectées « avec » la COVID-19]? »

a quote from Dr. Alain Vadeboncœur, emergency physician

In addition, the protocols for infected patients are much more complex to apply. We must protect patients, workers; You have to disinfect everything, wear protective equipment…, explains Dr. Boucher.

The significant lack of staff forces, everything takes more time, which can also affect the length of stay.

Benoit Mâsse explains that these protocols are very important to avoid nosocomial infections, infections contracted during a hospital stay.

Dr. Gilbert Boucher adds that many surgeries have to be canceled when the patient is found to have COVID-19. These patients, even if they are asymptomatic, could suffer more complications after surgery due to the virus. Knowing this, Dr. Boucher indicates that many patients take enormous precautions. You see many people who stay home for three weeks before surgery because they are afraid of getting it., he said.

Dr. Boucher believes that the hospital model must be adapted to deal with the many patients admitted “with” COVID-19. He says some hospitals have begun not routinely isolating people hospitalized “with” the virus in a dedicated COVID-19 unit: if you have symptoms you are placed in a COVID unit, otherwise it is better to be in specialized units to receive adequate care.

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