When omicron isn’t so mild

She started having difficulty breathing, even
after taking her usual medications. “It kind of took over, almost,” she said.
She wound up at St. Luke’s Hospital in Allentown, Pennsylvania, for most of a
week at a time when nearly all the COVID-19 patients sampled had contracted the
omicron variant.

The episode frightened her. While doctors were
able to get her asthma and breathing under control, “I’ll probably be scared
for the rest of my life,” she said. Perez, who was fully vaccinated and is now
recovering at home, said she had spent the past two years doing everything she
could to avoid infection, including working from home and rarely going out. She
has not yet gotten a booster shot.

Throughout the pandemic, people like Perez
have been at higher risk for serious illness from COVID-19 because they have
underlying medical conditions, like asthma, diabetes, heart or lung disease.
More than half of American adults have at least one underlying chronic
condition, and for many of them, the omicron wave hasn’t been as mild as it has
for the larger, healthier populations around the world.

Omicron has indeed caused far lower rates of
severe illness and death in the US population, especially among those who are
vaccinated and have received booster shots. Still, the variant’s high
transmissibility did lead to record-setting case counts that resulted in
pandemic-high hospitalisations.

Dr Rochelle Walensky, the director for the
Centers for Disease Control and Prevention, warned Wednesday that this surge
was still imposing a heavy burden. “Importantly, ‘milder’ does not mean
‘mild,’” she said. “And we cannot look past the strain on our health systems
and substantial number of deaths — nearing 2,200 a day as a result of the
extremely transmissible omicron variant.”

In the past few weeks, the rate of
hospitalisation has declined considerably in some regions, where omicron first
arrived and sent case counts soaring. While a smaller share of people with the
variant are being hospitalised, according to a recent report from researchers
at the CDC, the soaring number of omicron infections has led to higher
admissions than in previous surges. Nationally, hospital admissions are still
averaging about 150,000 people a day, including many rural regions where
facilities are stretched thin.

“Our experience is that it’s worse right now
than it’s ever been,” said Craig Thompson, CEO of Golden Valley Memorial
Healthcare, a small rural hospital in Clinton, Missouri. This month, the
COVID-19, heart attack and stroke patients that the hospital would typically
transfer to larger facilities were boarded in the emergency room for days.
Staff members made about 200 phone calls to get beds for patients — at times up
to 400 miles away.

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The majority of those hospitalised with severe
illness during the omicron surge are unvaccinated, public health experts say.
But some who were vaccinated and have existing health conditions have also been
at risk for more serious illness caused by the virus, and for the infection
potentially worsening their existing diseases, increasing their chances of

While they may not be hospitalised for
respiratory illnesses, “we are seeing some exacerbation of other conditions in
individuals who are vulnerable,” said Dr Sandra Nelson, an infectious disease
specialist at Massachusetts General Hospital and an assistant professor of
medicine at Harvard Medical School. In some cases, patients were dehydrated
from the effects of a virus infection and came in with kidney failure.

Doctors say that it is not always clear what
role omicron plays, but there is a plausible biological explanation for a virus
causing patients to develop systemic issues. “You’re going to see kidneys get
worse, etc.,” said Dr Panagis Galiatsatos, a critical care specialist and
assistant professor of medicine at Johns Hopkins Medicine.

At St. Luke’s, where Perez was admitted,
roughly two-thirds of the coronavirus-positive patients in the system’s network
had a primary diagnosis of COVID-19, but an additional 15% to 20% were
diagnosed with other illnesses, like sepsis or acute kidney failure, that
doctors said were clearly related to a virus infection.

“It isn’t an incidental diagnosis,” said Dr
Jeffrey Jahre, an infectious disease specialist who is senior vice president
for medical and academic affairs at St. Luke’s University Health Network, which
operates 11 hospitals in Pennsylvania and New Jersey.

In some cases, these patients may have had a
“smouldering” case of diabetes or high blood pressure that a COVID-19 case
pushed over into serious illness, said Dr Nicholas Kman, an emergency physician
at the Ohio State University Wexner Medical Center in Columbus, Ohio. In other
cases, individuals who had successfully been managing their conditions before
becoming infected, like Perez, are coming in with high blood sugar levels or
worrying hypertension.

Others, like transplant or cancer patients —
although fully vaccinated — are not able to mount a sufficient immune response
to protect themselves from serious disease when they become infected.

Doctors say these admissions — often
categorised as “with” COVID-19 rather than “for” COVID-19 — have had
significant effects on stressed hospitals. “All those patients add to the surge
and the volume,” Kman said, adding that “one or two extra patients can push a
health system over the edge.”

Hospitals at maximum capacity have also been
dealing with nationwide shortages of basic supplies that are needed to care for
patients with complicated conditions, including intravenous bags of saline
solution, small syringes of saline solution and small plastic tubes to take
blood samples.

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Front-line nurses, already parcelling out a
few minutes an hour to each patient under their care, say juggling unfamiliar
products or adjusting to workarounds makes their jobs even more fraught.

The caseloads have had a rippling effect, far
more pronounced in this wave than in others. Severe staffing shortages at
nursing homes and dialysis clinics have made it difficult to discharge patients
from the hospital who were still positive for the coronavirus, said Dr David
Margolius, an internal medicine specialist at MetroHealth in Cleveland. Some
facilities do not accept COVID-19 patients, and others have been so
short-staffed that there are no openings.

“With COVID, for COVID, it’s putting so much
stress on the health care system because of the implications of having COVID
for placement,” he said.

Other patients at high risk — including
pregnant women — have also become seriously ill. Alex Chandler, 27, a teacher
in Killeen, Texas, who was vaccinated and had received a booster shot, was
diagnosed with COVID-19 when she gave birth Jan 9, according to her mother,
Jenny Clay. That week, omicron made up 99.7% of the COVID-19 cases in Texas and
surrounding states, federal data show.

Initially her throat felt as if she had
swallowed broken glass, and her chills were hard to shake. But her symptoms
gave way to the consuming care of her firstborn child, Beau.

Five days after giving birth, Chandler sought
follow-up care for her son, and staff members noticed that she was breathing
heavily, Clay said. Her oxygen saturation read 76%, far lower than the typical
95% to 100%.

A CDC spokesperson, Belsie González, said that
women have higher heart rates, lower lung capacity and immune system changes
during pregnancy. Nearly all of the pregnant women admitted to critical care in
Europe were unvaccinated, according to a study published Friday.

Her mother said Chandler was admitted to the
hospital Jan 14, and developed pneumonia and a pneumothorax, or punctured lung,
a known COVID-19 complication. By the following morning, she had been put on a
ventilator, and she is in the intensive care unit at AdventHealth Central Texas
in Killeen.

Clay has been helping care for her grandson.
She noticed that he has his mother’s eyes and like his mother as a newborn, he
eats well and rarely cries.

“I’m just thinking, ‘His mom should be here
and sharing this with me,’” Clay said. She documented the first precious days,
planning to share with her daughter later. At nearly two weeks on the
ventilator, Clay said, her daughter showed some signs of progress but then lost
ground. “They said when it’s time, we’ll know,” Clay said. “There’s not really
a lot of hope right now.”

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Others who have trouble mounting an immune
response are among those hospitalised in this omicron wave. Dr Craig Bunnell,
the chief medical officer at the Dana-Farber Cancer Institute in Boston, said
the strikingly high number of infections — even with omicron’s reduced
virulence — had led to the increased rate of hospitalisations among cancer
patients. “The ICUs are still full,” Bunnell said. “The beds are still full.”

He said the newly available treatments,
including monoclonal antibodies and antiviral pills, remained in very short
supply. Those who are getting very sick resemble the patients from previous

Some of the patients seen by Dr Natalia
Solenkova, an intensive care physician who works at hospitals in Florida and
Tennessee, are organ transplant recipients who she said “did what they were
supposed to do” by getting vaccines and booster shots. They are typically on
immune-suppressing drugs that keep their bodies from rejecting a donor organ,
which makes them highly vulnerable to COVID-19.

“They are very sick,” Solenkova said. “Many
are on ventilators and on life support and they are dying.”

Amanda Halks, 36, of Tampa, Florida, who was
vaccinated and had a booster, had succeeded in avoiding COVID-19 until the last
day of December, when omicron was responsible for 95% of the cases in Florida.
She had survived a difficult eight-day hospitalisation with pneumonia in 2011
and feared any residual damage would make her susceptible to a severe case.

Her fears came to pass Jan 11, when she was
admitted to a Tampa hospital with her blood oxygen level just below 80. While
her hospital stay was brief, her oxygen levels have continued to drop with mild
exertion. She was diagnosed with post-COVID MIS-A, or multisystem inflammatory

She bristles at the notion that the omicron
variant is mild. She recounted joking with a friend that it is “hot and spicy.”

Dr Mark Lewis, a cancer specialist at
Intermountain Healthcare in Salt Lake City, said he had found that omicron
presents in patients as “a completely different beast.” While the variant
appears less likely to descend into a patient’s lungs and cause pneumonia, it
may still result in a patient’s condition flaring up. “It’s a profoundly
inflammatory state,” Lewis said.

Clay said her daughter’s precarious condition
was a clear sign that omicron is not always mild, a notion she views as
dismissive and stemming from those fatigued by the lengthy pandemic.

“I know we all want to be done, but it’s not
time to be done,” Clay said. “This is serious and it’s not over.”

© 2022 The New York Times Company

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