"Throughout the pandemic, people like
Ms. Perez have been at higher risk for serious illness from Covid 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 U.S. 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 hospitalizations.
Dr. Rochelle Walensky, the director
for the Centers for Disease Control and Prevention, warned on 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.”
The majority of those hospitalized
with severe illness during the Omicron surge are unvaccinated, public health
experts say. But some who were vaccinated and have underlying 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 hospitalization.
While they may not be hospitalized
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 Ms. Perez was
admitted, roughly two-thirds of the coronavirus-positive patients in the
system’s network had a primary diagnosis of Covid, but an additional 15 to 20
percent 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 “smoldering” case of diabetes or hypertension that a Covid case
pushed over into serious illness, said Dr. Nicholas Kman, an emergency
physician at the Ohio State University Wexner Medical Center in Columbus. In
other cases, individuals who had successfully been managing their conditions
before becoming infected, like Ms. 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
categorized as “with” Covid rather than “for” Covid — have had significant
effects on stressed hospitals. “All those patients add to the surge and the
volume,” Dr. 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.
Frontline nurses, already parceling
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 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 when she gave birth on Jan. 9, according to her
mother, Jenny Clay. That week, Omicron made up 99.7 percent of the Covid 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, Ms.
Chandler sought follow-up care for her son, and staff members noticed that she
was breathing heavily, Ms. Clay said. Her oxygen saturation read 76 percent,
far lower than the typical 95 to 100 percent.
A C.D.C. spokeswoman, 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 she was admitted to
the hospital on 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.
Ms. 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,’” Ms. Clay said. She documented the first
precious days, planning to share with her daughter later. At nearly two weeks
on the ventilator, Ms. Clay said, her daughter showed some signs of progress but
then lost ground. “They said when it’s time, we’ll know,” Ms. Clay said.
“There’s not really a lot of hope right now.”
Others who have trouble mounting an
immune response are among those hospitalized 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 hospitalizations among
cancer patients. “The I.C.U.s are still full,” Dr. 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 waves.
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.
“They are very sick,” Dr. Solenkova
said. “Many are on ventilators and on life support and they are dying.”
Amanda Halks, 36, of Tampa, Fla.,
who was vaccinated and had a booster, had succeeded in avoiding Covid until the
last day of December, when Omicron was responsible for 95 percent of the cases
in Florida. She had survived a difficult eight-day hospitalization with
pneumonia in 2011 and feared any residual damage would make her susceptible to a severe case.
Her fears came to pass on 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 syndrome.
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,” Dr. Lewis said.
Ms. 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,” Ms. Clay said. “This is serious and it’s not over.”"
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