What it's like inside a Halifax COVID-19 hospital ward during Omicron

The head of a COVID-19 inpatient unit in Halifax says the rapid spread of Omicron is filling up hospital beds with patients who are often dealing with complex health issues.

"I don't think anyone can really, truly understand how chaotic the inpatient wards are in the hospital across the board right now, especially on the COVID unit," Dr. Christy Bussey told CBC Radio's Information Morning on Thursday.

Bussey is the COVID-19 inpatient unit medical lead for the central zone of Nova Scotia Health, and the QEII Health Sciences Centre site lead for hospitalist services. 

Her conversation with Information Morning host Portia Clark has been edited for clarity and length.

Take us into the ward with you. What do you see and hear and who do you see when you go in? 

We have a lot of patients, so we have a lot of staff … whether that's nursing, physicians, allied health or COVID infectious diseases expert team, physiotherapy, respiratory therapy.

The ward rooms are filling up with patients so we don't have private rooms — these are patients in shared rooms. It's a loud, chaotic environment. We have patients on continuous oxygen monitoring, so those sensors are sort of blasting all throughout the day. I don't think any of us really, truly appreciate how loud and intense the shifts are there until you leave and it's silent, and you actually can reflect on how disruptive being there for even a shift can be, let alone being there for weeks and months at a time, as most of us have been since Wave 1.

Do you have a sense of the percentage of patients who have Omicron versus Delta? 

At this point, we're considering all these patients to have Omicron. There comes a point, I think, after which the majority of tests in a province have been revealed to be a certain variant, continuing to test for that particular variant may not be worthwhile. We do see other areas in the world and in the States, small pockets where Delta may be more prevalent, but certainly here in Nova Scotia, it seems to be Omicron. 

Is there any difference between the third wave, which involved a lot of Delta patients, and the Omicron patients in terms of severity? 

It's really complicated to say. I know in the media and even in some preliminary research, there's evidence that Omicron may be less severe in the lower respiratory tract. However, this is also a time when we have vaccination rates that are improving and increasing compared to Wave 3.

Last spring, when we were really just starting to improve our vaccination rates here in the province, we had a different variant being Delta, and we also had patients that preliminarily were not vaccinated. And so now we're seeing most patients are vaccinated, which may be lowering the severity of their disease, and then there's a different variant. I think more information will likely come on that the more experience we gather with Omicron.

How are the COVID patients different this time around in terms of how they feel, their needs, and how they're getting through this?

The patients this wave are quite complex. I think any of my colleagues would agree with that. In Wave 3 with Delta, we had a lot of patients who were younger, sure, who may have had some co-morbidities, but didn't have a high level of frailty, generally. Not all, but many.

Those patients would come into the hospital with respiratory symptoms, and many would deteriorate quite quickly and require a higher level of care. Now with Omicron, we are still finding some patients do come in and follow that pattern, but the majority of patients come in sick and unwell, needing hospitalization, but they're having effects on their chronic health conditions that may be outside of primary respiratory issues. 

So we have patients who are frail or co-morbid with other medical problems that now have flares of their medical problems, which makes it quite difficult sometimes to distinguish between patients that are in hospital because of COVID versus in hospital with COVID. I hear those descriptors sometimes being used to distinguish two groups, but I think as a clinician, it's very difficult to distinguish those two groups. 

The truth is, we don't know when we get COVID, how sick we are going to get ...- Dr. Christy Bussey, site lead of COVID-19 inpatient unit at QEII

Do we know, or is the research still being done, whether Omicron is more or less likely to cause long COVID? 

I don't think we have any data to suggest Omicron is less likely. We know from all previous waves through a variety of research across the world, and the World Health Organization ... that the severity of the patient's initial COVID infection does not predict whether or not they will develop long COVID in the future. Even in previous waves, we've had patients who have had an infection that did not warrant hospital admission, but they did go on to develop long COVID. 

And then we have other patients who were sick and in the hospital and in intensive care who went on to develop long COVID. I don't think we can make any assumptions that Omicron, whether it's less severe or not, carries with it a lower risk of developing long COVID, which is perhaps one of the main reasons I find it a little off-putting with people having the perception of, you know, we're tired of COVID … so why don't we just get COVID and get it over with?

The truth is, we don't know when we get COVID, how sick we are going to get.… Even if the acute infection is bearable and doesn't require you to be admitted to hospital, you're still quite miserable at home, followed by you still have a risk of developing long COVID.