Beyond the numbers: Alberta doctor discusses pre-existing conditions in COVID-19

The Alberta death toll from COVID-19 is mounting daily, and the province has now passed 2,600 deaths. 

When Alberta Health releases information on who has died, it often notes the person’s age and whether or not they had a pre-existing condition. 

Dr. Philippe Couillard, ICU medical director at Foothills Medical Centre in Calgary, says that term includes any severe illnesses that puts the entire body under pressure.

This could mean immuno-deficiency, a heart condition, cancer or lung, kidney or bone marrow disease. 

“You could imagine that a pre-existing condition makes you a little less resilient, or not as strong to fight for your life,” he said. 

Couillard cautions against using the term pre-existing conditions as a buffer to how serious the virus is. Pre-existing conditions are a lot more common than people think, and everyone is at risk of having a pre-existing condition. 

About one in five Canadians has high blood pressure alone. Couillard says that, along with diabetes, are the most common pre-existing conditions he sees in ICU. 

More than statistics 

He says numbers don’t tell the full story of what some people with COVID-19 are dealing with. 

“You see someone in front of you struggling to breathe, and it doesn’t really matter if they have [a pre-existing condition] or not. You see someone who is struggling, you see someone who is fighting for their life.” 

On Wednesday, a woman in her 30s who had no known pre-existing conditions died of COVID-19, the province reported. 

Patients in apparent good health, without pre-existing conditions, still have a risk of dying from COVID-19, Couillard says, and the risk is much higher for those who are not vaccinated. 

Alberta Health uses information from a variety of sources to identify pre-existing conditions when reporting COVID-19 deaths, a spokesperson said.

For cancer, data is obtained from the Alberta Cancer Registry; for immune-deficiency, information is captured via case investigators in the Communicable Disease Outbreak Management system; for all other pre-existing conditions, administrative data is used.  

ICUs across the province are operating at 83 per cent capacity (including surge beds). Without surge beds, admissions would be at 177 per cent of capacity. 

Intensive care units in the central zone are at more than 100 per cent of their capacity, even with surge beds. 

If hospitals in the province need to enact triage policy — decisions about the order of treatment for patients — the move would need the approval of the CEO of Alberta Health Services, and it would apply to all health-care facilities in the province.

Couillard says thinking about triage protocol and the limit of what can be done for patients is unpleasant. 

“It’s scary and repulsive, both at the same time … someone is ill, they need help, we help them — that’s our pattern.” 

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