While hospitals are still under strain from an influx of patients and staff shortages due to quick spreading omicron variant, they’re now seeing a marked increase in patients who have COVID-19, but were admitted for some other medical issue.
That’s a change from earlier waves of the pandemic, when a majority of people entering hospitals with COVID-19 had trouble breathing or low blood oxygen levels and often needed respiratory support.
Also different is how the current omicron variant appears to affect most people, resulting in fewer falling seriously ill. But don’t take that to mean the health care system is in the clear or that people should dismiss the virus, medical experts say.
And regardless of what let to their hospitalization, statistics on how many patients are infected are still an important indicator of where we are in the pandemic – and what to expect from the disease when it’s considered an endemic virus that flares up seasonally.
What’s changed
In the early days of the pandemic, “the overwhelming majority of people who were COVID-positive were there (in the hospital) because of respiratory need,” said Dr. Shruti Gohil, associate medical director of epidemiology and infection prevention at UC Irvine Medical Center.
Patients seeking care were experiencing chest pains, shortness of breath, high fevers and body aches, Hospital Association of Southern California CEO George Greene said.
UC Irvine researcher Daniel Chow said in August 2020 that data on more than 500 patients with COVID-19 who had been treated at the university’s medical center showed an estimated 90% were hospitalized for coronavirus-related symptoms.
Vaccines weren’t available until the end of that year, fewer medications were available to treat people once they were infected, and health care workers were still figuring out the best ways to treat people with the virus.
Hospitals ran short of resources for critically ill COVID-19 patients. During the virus’s delta variant wave at Providence Mission Hospital in Mission Viejo, “we were at one point down to one ventilator,” said Dr. Jim Keany, the associate director of the hospital’s emergency department.
At UCI Medical Center, the ECMO (extracorporeal membrane oxygenation) machine – a last-resort treatment that functions like an external heart and lungs – was used for 13 patients in the first week of January 2021. In the first week of this month, no patients needed it, according to data the hospital provided.
Today, with omicron causing fewer patients to become seriously ill, the picture looks different. Orange County’s supply of available ventilators – which dipped into the 30% range in January 2021 – has stood between 60% and 70% for at least the past three months, according to county data.
“It’s a totally different landscape now,” because when the virus was new, no one had immunity, Gohil said.
“It’s not a level playing field to compare then and now because back then the entire population was vulnerable.”
‘Mixed bag’
Today, with 2.1 million of Orange County’s nearly 3.2 million residents vaccinated and some others with a degree of immunity from a previous infection, many people who get COVID-19 are less sick and can ride out the virus at home. Also omicron is believed to trigger less severe illness in many.
Some patients showing up at hospitals have unrelated emergencies or are seeking care they delayed earlier because they were afraid of getting infected, Greene said. But then they test positive for the virus, adding to the reported COVID-19 hospitalizations.
“The way that we describe it is people are being hospitalized with COVID rather than for COVID,” Greene said.
Gohil called the current patient population “a mixed bag” and said it also includes COVID-positive people who aren’t in the hospital for COVID-specific symptoms, but “even if they’re mild, in certain people (it) can destabilize your underlying conditions.”
For example, she said, people may have chronic conditions such as diabetes, COPD or heart failure under control until getting COVID-19 – and with their body trying to fight off the new infection, that long-standing health issue sends them to the hospital.
At UCI Medical Center, Gohil and Chow estimate the split is now close to 50/50 among COVID-positive patients who get admitted for symptoms or complications of the disease and patients with some other primary diagnosis.
Reflecting this shift, state health officials in New York and Massachusetts said earlier this month they would change how COVID-19 hospitalization data is reported to separate “incidental” cases.
California doesn’t currently make that distinction in publicly available data, nor does Orange County, but OC Health Care Agency Deputy Health Officer Dr. Regina Chinsio-Kwong said she’s been talking to hospital officials to try to get more detailed information on who’s in hospitals with COVID-19.
What it means
The upshot of all this, health experts said, is that although omicron appears to make people less sick than earlier virus variants, it doesn’t mean this surge has been easier on hospitals.
They still have to keep COVID-positive patients separate from those who aren’t infected, regardless of what brought them to the hospital, and nurses have to don and frequently change protective gear. And with omicron spreading so easily, a larger number of people getting infected inevitably means more infected people ending up in hospitals.
Gohil said rehab and long-term care facilities that normally take people who no longer need hospital-level care, but aren’t ready to go home, are now filling up or dealing with outbreaks, so some patients may have to stay in the hospital longer.
“What I think we should take away is that we are still in pandemic mode,” Gohil said. “We don’t want another variant to come on the scene,” because it could be worse than omicron.
Health officials continue to urge everyone who’s eligible to get a vaccine or booster, because it’s been shown to protect people from the most serious complications of COVID-19. County statistics show 86% of hospital patients with COVID-19 are unvaccinated, as are 87% of COVID-positive people in intensive care.
With the sheer volume of people infected by omicron, “it would have looked a lot like New York City during the first round, with bodies piling up, if it wasn’t for the vaccine and natural immunity (from a prior infection) combined,” Providence Mission’s Keany said.
And even though the available data for Orange County and California doesn’t fully reflect the shift in the patient population, the hospital association’s Green said the numbers are still a valuable indicator of what direction things are headed.
Without tracking cases and hospitalizations, it would be unknown what percentage of people are developing antibodies, and knowing how the virus behaves is essential to develop protocols for “I hate to say it – the COVID season,” when the virus is endemic, he said.
