H5N1

Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic

Via the Canadian Institute for Health Information: Hospitalizations for COVID-19 among Canada’s youngest surged by more than 600% in the second year of the pandemic. Excerpt:

The second year of the pandemic saw a surge of hospitalizations for COVID-19 and other infections among Canadian children age 0 to 4. Data from the Canadian Institute for Health Information (CIHI) shows that COVID-19 was the sixth most common reason kids in this age group were hospitalized in 2021–2022. This represents an increase of more than 600%, with a total of 2,315 COVID-19 hospitalizations among this cohort in 2021–2022 compared with 325 hospitalizations in 2020–2021. See Inpatient Hospitalization, Surgery and Newborn Statistics, 2021–2022 (XLSX).  

CIHI’s report shows that in addition to an increase in hospitalizations for COVID-19, respiratory infections (including pneumonia) and other viral infections returned as top 10 diagnoses that required hospitalization for Canadians age 0 to 4 in 2021–2022. The increase in hospitalizations for virus-related illnesses coincided with the easing of public health measures across the country.  

“This uptick in hospitalizations for COVID-19, respiratory infections and other viral illnesses seen among the youngest Canadians in the second year of the pandemic is concerning both for the health of our youngest and most vulnerable, and for the additional strain placed on health systems and health care workers that were already stretched thin,” said Juliana Wu, Director, Acute and Ambulatory Care Information Services, CIHI. “We are continuing to monitor hospital activity in this third year of the pandemic to understand the ongoing impacts of COVID-19 on Canadians.”  

COVID-19 continued to present challenges for Canadians of all ages and was the second most common reason for hospitalization in Canada in 2021–2022, jumping from seventh in 2020–2021. This represents an increase of more than 60%, with a total of 77,344 hospitalizations in 2021–2022 compared with 47,715 hospitalizations in 2020–2021.

China records almost 60,000 Covid-related deaths after abrupt shift in policy

Via the South China Morning Post: China records almost 60,000 Covid-related deaths after abrupt shift in policy. I wish I could believe it. Excerpt:

China said on Saturday it had recorded almost 60,000 Covid-related deaths between December 8 and January 12, and the current wave has already peaked.   

It is the first time China has released a death toll since its abrupt pivot away from the zero-Covid policy last month.  

Jiao Yahui, director of the National Health Commission’s medical affairs department, said medical institutes had recorded 5,503 deaths as a result of respiratory failure triggered by Covid infection and 54,435 deaths of people infected with Covid-19 but with underlying conditions, such as cancer or cardiovascular diseases.  

The average age of those who died was 80.3, and 90 per cent of fatalities were aged 65 or over.  

Jiao also said the current wave of cases had peaked. “The number of fever clinic visitors is generally on a downward trend after peaking, both in cities and rural areas,” she added.  

Jiao said the number of emergency patients was also declining and the ratio of patients who had tested positive for Covid-19 was steadily falling as well.  

Jiao said there had been 128,000 patients with severe Covid-19 on January 5, but the number had dropped to 105,000 by January 12.  

The use rate for intensive care hospital beds was 75.3 per cent, she added.  

Among the critically ill Covid-19 patients on January 12, there were 97,000 patients with severe underlying conditions, accounting for 92.8 per cent. The remainder, some 7,357 people, had Covid only.

‘It’s insane’: China’s doctors struggle to cope amid COVID surge

Via Sixth Tone: ‘It’s Insane’: China’s Doctors Struggle to Cope Amid COVID Surge. Excerpt:

Just weeks after China ended its “zero-COVID” policy, Dr. Xu Zuping and her outpatient department find themselves confronting an unprecedented crisis.  

The team in Shanghai is treating up to 600 patients a day — almost 20% more than the same period last year, Xu estimates. And they’re having to do so with four out of six doctors infected with COVID-19.  

“I’ve worked at this hospital for over 30 years, but I’ve never seen the emergency room as busy as it is now,” says Xu, who spoke with Sixth Tone using a pseudonym to protect her privacy. “Ambulances keep arriving with people in a critical condition. When I treat my patients, I constantly worry about whether there are enough seats in the infusion center.” 

Hospitals all over China are struggling to cope as a wave of COVID-19 infections rips through the population. Doctors describe shocking levels of overcrowding, shortages of key supplies, and medical teams weakened by mass infections.  

China abruptly dismantled its strict “zero-COVID” system in early December, and since then the virus has spread at breakneck speed. It’s unclear how many people have been infected, but local authorities estimate that case numbers in Shanghai alone have surpassed 10 million.

A surge in hospitalizations soon followed. According to China’s health commission, around 8% of COVID-19 patients in China developed pneumonia in 2022. Though this appears to be a relatively low ratio, it translates into a huge number of people with lung infections due to China’s vast population.   

By the end of December, Xu’s department was already receiving record numbers of patients. The team is based at one of two major hospitals in Chongming — an island on the northeastern tip of Shanghai, where the Yangtze River bleeds into the East China Sea.  

Most of the patients are in their 80s and 90s, and the vast majority have pneumonia, Xu says. The hospital’s emergency room has been completely overrun.  

“Given the crisis at the emergency room, we can no longer transfer patients for hospitalization,” she says. “The few remaining beds in the inpatient department are reserved for patients from the emergency room.”

Up to 70% of Shanghai population infected with COVID-19: Top doctor

Via Channel NewsAsia: Up to 70% of Shanghai population infected with COVID-19: Top doctor. That means about 17.5 million people in Shanghai alone have COVID-19.

SHANGHAI: A senior doctor at one of Shanghai's top hospitals has said 70 per cent of the megacity's population may have been infected with COVID-19 during China's huge surge in cases, state media reported Tuesday (Jan 3).  

The steep rise in infections came after years of hardline restrictions were abruptly loosened last month with little warning or preparation, and quickly overwhelmed hospitals and crematoriums.  

Chen Erzhen, vice president at Ruijin Hospital and a member of Shanghai's COVID-19 expert advisory panel, estimated that the majority of the city's 25 million people may have been infected.  

"Now the spread of the epidemic in Shanghai is very wide, and it may have reached 70 per cent of the population, which is 20 to 30 times more than (in April and May)," he told Dajiangdong Studio, owned by the Communist Party mouthpiece People's Daily.  

Shanghai suffered a gruelling two-month lockdown from April, during which over 600,000 residents were infected and many were hauled to mass quarantine centres.  

But now, the Omicron variant is spreading rampantly across the city and experts predict infections there will peak in early 2023. In other major cities, including Beijing, Tianjin, Chongqing and Guangzhou, Chinese health officials have suggested that the wave has already peaked.  

In neighbouring Zhejiang province, disease control authorities said Tuesday that there had been one million new infections in recent days and that the province was entering a peak plateau for COVID-19.  

Chen added that his Shanghai hospital was seeing 1,600 emergency admissions daily - double the number prior to restrictions being lifted - with 80 per cent of them COVID-19 patients.  

"More than 100 ambulances arrive at the hospital every day," he was quoted as saying, adding that around half of emergency admissions were vulnerable people aged over 65.  

At Tongren Hospital in downtown Shanghai, AFP reporters saw patients receiving emergency medical attention outside the entrance of the overcrowded facility on Tuesday.  

The corridors overflowed with dozens of elderly patients lying on beds crammed together, hooked up to IV drips. Some patients wore oxygen masks attached to bedside canisters.

China’s President Xi battles to save face as Covid U-turn weakens his grip on power

Via The Guardian: China’s President Xi battles to save face as Covid U-turn weakens his grip on power. Excerpt and then a comment:

China’s leader Xi Jinping told his country it stands on “the right side of history” in a new year address on Saturday, but experts have warned that the president starts 2023 diminished by his chaotic U-turn on Covid strategy.  

He may struggle to deflect blame for the human and economic costs of zero-Covid’s failure, and control the national narrative, even if public signs of dissent are crushed.  

Officially, China has registered just over 5,200 deaths from Covid, but there is a yawning gap between the picture presented by the usually efficient communist propaganda apparatus and the reality reflected in social media posts and anecdotes from across China.  

Hospital emergency wards are overflowing with desperate patients. Medical supplies are running low, with pharmacies selling out of drugs ranging from anti-viral to basic painkillers. Police patrolled one Beijing crematorium where Reuters reported long queues of hearses last week.  

In his first public comments to the Chinese people on Covid since his government changed course three weeks ago, Xi used his speech on Saturday to claim the government and Chinese Communist party (CCP) had “put the people first and put life first all along”.  

For many in China, that phrase will ring hollow, particularly those fighting for medical care for loved ones newly struck down by the disease.  

Questions about why the country clung so long to zero-Covid, at such heavy cost, and did so little to prepare for opening up are likely to undermine Xi, even if the damage to his authority isn’t visible beyond the walls of the secretive leadership compounds.  

“The fact that the CCP’s posture towards the pandemic has now completely reversed after a popular uprising can only mar Xi Jinping’s carefully cultivated air of infallibility,” said Orville Schell, director of the centre on US-China relations at the Asia Society in New York.  

“Xi is virtually immune from public expressions of criticism within China,” he added. “But my Chinese friends are all shaking their heads in incredulity at the contrariness of Xi’s policies.”

Foreign analysts, scouring the internet and official pronouncements for clues, estimate there are already thousands of deaths a day, with more to come.  

A first wave in urban areas is expected to peak in January, but a second, bigger wave will race through rural areas – where health systems are even weaker – in February and peak in early March, according to British health analytics firm Airfinity.

In a recent Tyee article, I argued that COVID-19 is only one of China's looming problems; economic uncertainty and climate disasters, especially water security, are making matters even worse.

Some hospitals in China overwhelmed in national COVID-19 wave

Via CBC News, an AP report: Some hospitals in China overwhelmed in national COVID-19 wave. Excerpt:

Yao Ruyan paced frantically outside the fever clinic of a county hospital in China's industrial Hebei province, 70 kilometres southwest of Beijing. Her mother-in-law had COVID-19 and needed urgent medical care, but all nearby hospitals were full.  

"They say there's no beds here," she barked into her phone.  

As China grapples with its first national COVID-19 wave, emergency wards in small cities and towns southwest of Beijing are overwhelmed. Emergency rooms are turning away ambulances, relatives of sick people are searching for open beds, and patients are slumped on benches in hospital corridors and lying on floors for a lack of beds.  

Yao's elderly mother-in-law had fallen ill a week ago with the coronavirus. They went first to a local hospital, where lung scans showed signs of pneumonia. But the hospital couldn't handle serious COVID-19 cases, Yao was told. She was told to go to larger hospitals in adjacent counties.  

As Yao and her husband drove from hospital to hospital, they found all the wards were full. Zhuozhou Hospital, an hour's drive from Yao's hometown, was the latest disappointment.  

Yao charged toward the check-in counter, past wheelchairs frantically moving elderly patients. Yet again, she was told the hospital was full, and that she would have to wait. 

'Terrified' over elderly woman's condition  

"I'm furious," Yao said, tearing up as she clutched the lung scans from the local hospital. "I don't have much hope. We've been out for a long time and I'm terrified because she's having difficulty breathing."  

Over two days, Associated Press journalists visited five hospitals and two crematoriums in towns and small cities in Baoding and Langfang prefectures, in central Hebei province. The area was the epicentre of one of China's first outbreaks after the state loosened COVID-19 controls in November and December. For weeks, the region went quiet, as people fell ill and stayed home.  

Many have now recovered. Today, markets are bustling, diners pack restaurants and cars are honking in snarling traffic, even as the virus is spreading in other parts of China. In recent days, headlines in state media said the area is "starting to resume normal life."  

But life in central Hebei's emergency wards and crematoriums is anything but normal. Even as the young go back to work and lines at fever clinics shrink, many of Hebei's elderly are falling into critical condition. As they overrun intensive care units and funeral homes, it could be a harbinger of what's to come for the rest of China.

'Living with COVID': Where the pandemic could go next

Via Reuters: 'Living with COVID': Where the pandemic could go next. Excerpt:

LONDON/CHICAGO, Aug 1 (Reuters) - As the third winter of the coronavirus pandemic looms in the northern hemisphere, scientists are warning weary governments and populations alike to brace for more waves of COVID-19.  

In the United States alone, there could be up to a million infections a day this winter, Chris Murray, head of the Institute of Health Metrics and Evaluation (IHME), an independent modeling group at the University of Washington that has been tracking the pandemic, told Reuters. That would be around double the current daily tally.  

Across the United Kingdom and Europe, scientists predict a series of COVID waves, as people spend more time indoors during the colder months, this time with nearly no masking or social distancing restrictions in place.  

However, while cases may surge again in the coming months, deaths and hospitalizations are unlikely to rise with the same intensity, the experts said, helped by vaccination and booster drives, previous infection, milder variants and the availability of highly effective COVID treatments.  

"The people who are at greatest risk are those who have never seen the virus, and there's almost nobody left," said Murray.  

These forecasts raise new questions about when countries will move out of the COVID emergency phase and into a state of endemic disease, where communities with high vaccination rates see smaller outbreaks, possibly on a seasonal basis.  

Many experts had predicted that transition would begin in early 2022, but the arrival of the highly mutated Omicron variant of coronavirus disrupted those expectations.

"We need to set aside the idea of 'is the pandemic over?'" said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine. He and others see COVID morphing into an endemic threat that still causes a high burden of disease.  

"Someone once told me the definition of endemicity is that life just gets a bit worse," he added.  

The potential wild card remains whether a new variant will emerge that out-competes currently dominant Omicron subvariants.  

If that variant also causes more severe disease and is better able to evade prior immunity, that would be the "worst-case scenario," according to a recent World Health Organization (WHO) Europe report.

Omicron 'going to get worse' as California hospitalizations up

Via The Los Angeles Times: Omicron 'going to get worse' as California hospitalizations up. Excerpt:

The number of COVID-19 patients hospitalized in California over the weekend reached levels not seen in months as the rapid spread of the Omicron variant caused major airline interruptions and sent throngs of people to testing sites.  

Officials said they expected Omicron’s spread to worsen in the coming weeks, with President Biden promising the federal government will do all it can to assist states facing surges in coronavirus cases. Biden acknowledged those who faced long waits for tests over the holiday and said his administration was seeking to alleviate the issue.  

“Seeing how tough it was for folks to get a test this weekend shows we have more work to do,” Biden said, “and we’re doing it.”  

There were 4,001 coronavirus patients hospitalized Sunday — California’s highest single-day total since Oct. 9 and a nearly 14% increase from last week.  

Some areas are contending with even sharper rises. Los Angeles County has seen a 30% bump in COVID-19 hospitalizations since last week. In Orange County, the patient count has swelled nearly 45% during the same period.  

Overall, the greater Southern California and Sacramento regions have posted a 20% jump in hospitalizations during the same span, while the San Francisco Bay Area has recorded a 13% increase.  

Officials and experts have long noted that hospitalizations are a lagging indicator of coronavirus spread, usually rising about two weeks after increases in infections.

That’s a potentially worrisome trend, given that California is battling a significant new spike that officials say is driven by circulation of the Omicron variant, perhaps the most heavily mutated and highly transmissible edition of the coronavirus.  

Over the last week, California reported an average of 11,914 new coronavirus cases per day, a 73% jump from two weeks ago, according to data compiled by The Times.  

The surge has been especially profound in Los Angeles County, which announced more than 20,000 combined new cases Saturday and Sunday — an eye-popping total officials say is actually an undercount because of reporting lags over the Christmas weekend.

How America's ICUs are dealing with another Christmas of death and distress

Via The New York Times: How America's ICUs Are Dealing with Another Christmas of Death and Distress. Excerpt:

INDIANAPOLIS — Of all the Covid patients that Ronda Stevenson is treating over Christmas, there’s one she cannot stop thinking about. He has been hospitalized for 10 months, and in all that time his 7-year-old daughter has never once been allowed to visit, prohibited from the hospital by age restrictions that keep families separated. Situations like this are bringing even veteran health care workers to tears.  

Ms. Stevenson, an intensive care unit nurse at Eskenazi Health in Indianapolis for the past seven years, cries as she talks about her patients and their families, making clear the grinding toll of the pandemic on already exhausted hospital work forces.  

“We’re pretty short-staffed,” Ms. Stevenson said. She added: “It’s getting harder.”  

Instead of taking holiday vacations this weekend, workers at strained hospitals across the nation are working 16-hour shifts. Some have been on the job every day for weeks. Festive meals have been replaced with protein bars and sports drinks.  

This Christmas weekend, with the United States facing another surge of illness stoked by a proportion of the population that remains unvaccinated, frontline workers are again sacrificing time at home with family to tend to Covid patients. In Indiana, which has among the highest rates of hospitalization and lowest rates of vaccination in the country, the situation is especially acute.

“A lot of people, including myself, had scheduled time off but are now being asked to come in and pick up shifts to cover for one another and meet the increased demands of patient care,” said Dr. Graham Carlos, the executive medical director at Eskenazi, which is at capacity and has had a backlog of patients in the emergency room.  

He worries that it will only get worse. “If the numbers continue as they are, a tidal wave of infections is going to hit hospital systems, putting us in dire straits,” he said.  

Nearly two years into a pandemic that shows no sign of abating, doctors, nurses and other frontline workers have already faced the emotional toll of mass death in their hospitals. They have endured the frustration of pleading with the public to take precautions only to watch outbreaks unfold as people ignored the call for help. They have suffered the moral distress of not being able to give patients the ideal level of care.  

But this season, there is a new strain on the system: Many workers who persisted through the first year of the pandemic have departed jobs because of burnout and anxiety. And with the Omicron variant pushing case numbers up dramatically, the caregivers who remain are getting infections, too, straining staff levels in unpredictable ways.

“This is the worst I’ve ever seen it,” said Maureen May, a nurse with 37 years of experience who serves as president of the Pennsylvania Association of Staff Nurses and Allied Professionals. She canceled her own holiday plans to pick up a shift on Christmas Day so that a co-worker could have time away.

US hospitals struggle with staffing shortages and Omicron outbreaks

Via The Guardian: US hospitals struggle with staffing shortages and Omicron outbreaks. Excerpt:

On her fourth day of Covid symptoms, Ruth woke up in the worst pain of her life. It felt like her joints were filled with broken glass; she couldn’t walk, couldn’t move. “It was worse than childbirth,” she said.  

When friends texted to check on her, she couldn’t hold the phone or move her fingers to write back. Her doctor called in medication, and it took Ruth 40 minutes to shuffle to the pharmacy half a block away.  

Ruth – who did not want her full name used – is certain that if she weren’t vaccinated and boosted, she would be in the intensive care unit or worse right now. But while she’s recovering from this “mild” case, she’s unable to work even as cases surge in her region.  

Ruth is an emergency nurse in Washington DC. Her case of breakthrough Covid shows what may happen when the more contagious variant hits health workers all over the country – and the pressures Omicron will put on a US health system already groaning under the weight of the pandemic. In this wave, it’s not a shortage of beds but a shortage of qualified workers to care for people in those beds that is raising alarm bells.  

“What do you do when you have a tidal wave coming at you in a little paddle boat?” Ruth asked. “There’s going to be a huge uptick. Our entire waiting room is going to be all Covid-positive.”  

In Washington DC the infection curve looks like a straight line up. On Saturday, the city nearly tripled its previous record-high number of cases. At least two of Ruth’s colleagues were already out sick with Covid.  

In a matter of weeks, Omicron has become the dominant variant in the United States. It accounts for 73% of sequenced cases, six times higher than last week. As the holidays approach, officials and experts warn of an unmanageable crush of patients and potentially catastrophic staffing shortages.  

“This is a big concern,” said Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials. “This is a highly contagious variant, and we really think it could cause significant issues with the workforce.”  

Omicron is spreading like wildfire and slamming into hospitals, and “​​there’s no question that this is going to be on us, really in the next week or so”, Plescia said.  

Others agreed. “There’s no question” that Omicron outbreaks among healthcare workers are “significantly diminishing the workforce”, said Georges Benjamin, executive director of the American Public Health Association. “It has profound implications for our ability to not just take care of people with Covid but [also] the other diseases that are out there.”  

The American Nurses Association is urging US officials to declare the nursing shortage a national crisis, and the American College of Emergency Physicians has expressed concerns the shortage will affect patient care.