Inside an Ontario ICU where the COVID-19 patients are largely young, and all unvaccinated

TORONTO — The truth of the fourth wave of COVID-19 in Canada is starkly clear inside the intensive care unit at Hamilton General, where the majority of the COVID-19 patients struggling on life support are young — and unvaccinated.

The team at Hamilton General invited CTV News inside the tense ICU in the hopes of giving Canadians a look at the reality they go through every week as Delta cases climb.

“I think it’s important for Canadians to see that this is real,” Dr. Sunjay Sharma, medical director of critical care, told CTV News. “None of these people thought two months ago they would end up here. And now they’re here. And some of them won’t survive.”

Inside this ICU, on the day of CTV’s visit, 30 per cent of the 45 beds are COVID-19 patients fighting for their lives, most of them infected recently.

And every person that was admitted during the fourth wave declined vaccination or just didn’t get around to it before they fell ill. 

“It’s crazy people don’t believe it,” Sharma said. “We come to work every day. This is real. It’s like someone telling you the sky is not blue.”

They want those who don’t believe the risk of COVID-19 is real to see the enormous strain that this work is having on health care workers, who are already exhausted from almost two years of fighting.

The unvaccinated COVID-19 patients this hospital is seeing are younger and healthier, in their 30s and 40s. Many them require a specialized form of life support called ECMO, in which their blood is removed to be given oxygen and pumped back into the body because their lungs have failed.

It’s the “highest level of life support you can get anywhere,” Sharma said.

He pointed out a patient in his 40s, who is hooked up to an ECMO machine.

“There’s a catheter the size of a garden hose in his neck, and there’s a catheter the size of a garden hose [at his] groin,” Sharma said.

“And basically it takes the blood out of his groin, puts it the machine, takes the carbon dioxide out, [puts in] the oxygen, and then comes back into his heart.”

Most of the patients who are on ECMO with COVID-19 don’t have significant co-morbidities.

“It’s scary. It’s people younger than me, in some cases healthier than me,” Sharma said.

Only four hospitals in Ontario offer ECMO support. Toronto General is one of the four, and told CTV News that they have 13 COVID-19 patients on ECMO currently, all of whom are unvaccinated.

And it’s not only happening in Ontario. Alberta’s Chief Medical Officer of Health, Dr. Deena Hinshaw, tweeted Wednesday that of the 218 COVID-19 patients who are in ICU in the province, 92.3 per cent are unvaccinated or partially vaccinated.

There are several million Canadians who are not vaccinated, some who have chosen not to get even one dose of the vaccine.

Some may have legitimate medical exemptions.

But there are others who refuse saying the vaccines don’t work, they aren’t safe, that COVID-19 itself is a hoax.

Health workers who see patients stricken with the virus every day know it is no hoax and say that across the country hospitals and ICU’s are slowing filling up with patients — almost all of whom are unvaccinated.

The fourth wave is a wave almost entirely among those who have not gotten their shot, they say.

At Hamilton General, all of the COVID-19 patients in the ICU are unvaccinated, and eight are on ECMO.

Dr. Faizan Amin, medical director of the ECMO unit, said he hoped seeing into the situation in the hospital would change some minds.

“Some of the viewers that have those beliefs will be able to watch this on TV, and there is nothing unreal about these people, they’re real life people, they’re real fathers, mothers, brothers, sisters — real human beings and they’re getting very sick,” Amin said.

A month ago, this ICU had just one COVID-19 patient. Now they have 14 — and four-to-five requests a week to accept more patients from other hospitals who need more intensive care.

And as the ICU fills up with COVID-19 victims and other patients suffering from urgent issues such as strokes, heart attacks and physical trauma, other surgeries get cancelled.

“This ICU serves cardiac surgery, or surgery and trauma, vascular surgery, stroke. It is the regional hospital for all of this region for 2.5 million people,” Sharma said, adding that around 15 other hospitals frequently send patients here if they need a higher level of care.

THE VACCINE STRUGGLE

Some COVID-19 patients have expressed regret once they understand the magnitude of their situation.

Erin, an ICU nurse who asked us not to use her last name, told CTV News that “a lot of people have been asking for vaccines, right before they get intubated. But it’s too late.”

But some skeptics don’t change their mind even when on the edge of death, she reported, adding that some who have been on ECMO and recovered still say there isn’t enough research about the vaccines that would’ve likely prevented their own suffering.

“There is a small subset of people that we’re still seeing who feel that this is not a real disease, or it’s not as dangerous as some people are making it out to be — but the reality is in front of our eyes,” Amin said.

One of the patients who has been on ECMO in Hamilton General for the longest period of time is a patient in his 30s who has been in the hospital for months — he fell ill before he was able to be vaccinated because it hadn’t been opened up to his age group yet.

Unlike the COVID-19 patients coming into the ICU this month, “he did not have a choice,” Sharma said.

The man has been totally healthy before he contracted COVID-19, Sharma said.

Health care workers are dedicated to giving everyone the best care possible, but it is frustrating seeing patients who didn’t need to be suffering to this degree, they say.

“To know that their families didn’t have to go through that and the patients didn’t have to go through that, if they just got [a shot] that takes 30 seconds,” Sharma said. “It’s frustrating, and you just can’t understand the rationale behind why you wouldn’t get a vaccine.

“We see this every day — this is where you end up when you don’t.”

Sharma said that when they have patients who are unvaccinated, their family members often change their own minds about vaccination after seeing their loved one suffer.

“Many of the family members of people who are here and are unvaccinated, after seeing their family members here for a week, get vaccinated,” he said.

“It’s unfortunate that it’s taken sort of that experience to change some behaviours,” Amin said.

Sharma is not only frustrated with the individuals, but with the larger machine of misinformation that leads people to be confused about vaccines and what is best for their health.

“It’s anger with the social contract that got them into this situation, it is anger of people posting on social media that COVID-19 is not real, or that vaccines don’t work,” Sharma said. “That basically preys on vulnerable people, that makes them make bad decisions that lands them up here.”

Seventy-eight per cent of eligible Canadians have been fully vaccinated. Side effects are rare according to public health officials* as are breakthrough COVID-19 cases, and vaccines have been proven to drastically minimize severe cases of COVID-19 as well as death in the event of a breakthrough case.

And yet, in this fourth wave, we’ve seen a baffling level of animosity displayed towards health care workers from a small subset of people, ranging from anti-vaccine groups protesting outside of hospitals to individual health care workers receiving threats.

A year ago, it went unquestioned that health care workers were heroes. But now some groups are looking for someone to blame.

“This morning I got some angry phone calls from people in the public because of my advocacy for vaccines,” Sharma said.

He said it’s not only frustrating, but personally insulting that people would think that he’s taking time away from his family not to take care of sick patients but to prop up some lie about the virus.

“I have two young kids who I went for weeks without seeing, because I was here [at the hospital],” he said.

“I don’t think that there’s any motivation for healthcare workers to lie.”

Nurses told CTV News that they know colleagues who have been spat on by protestors, booed.

“They think it’s a hoax and that honestly is a slap in the face to us after everything that we’ve been doing,” said Erin.

A HEALTH CARE HOUSE OF CARDS

That animosity is one more burden for health care workers during this fourth wave, on top of increasing burnout and short staffing.

Amin pointed out that when the third wave hit in the spring, it put more pressure on the health care system than had occurred in a year of COVID-19.

“We’ve been going at this in full gear for 18 months, and working that hard for that long for all the healthcare providers here that are looking after these patients, it’s very difficult,” he said.

Michael Plaunt, clinical manager of the coronary care unit at Hamilton General, told CTV News that everyone is tired.

“They’re burnt out, they’re exhausted,” he said. “At the beginning, we didn’t have any way to prevent this. And now that we have a way to prevent this, we should be seeing that improve, and we’re not. So that’s the frustration.”

Health care workers say the circumstances of many of these fourth wave cases eats away at the compassion that is integral to their work.

“We will come in in the middle of the night to take care of a sick patient, no matter the time of day or the day of the week,” Amin said. “But when it’s an easily preventable situation, you start to start to lose some of the empathy. And that’s a key factor of what we do as healthcare providers — we are empathetic and compassionate and you want to continue being that way.”

Medical staff are becoming clearly fatigued, in more ways than one. At Hamilton General alone, around 12 staff members have left their job between the third and fourth waves.

“The system is cracking,” Amin said. “The fourth wave is in many ways worse than the third wave. Although the number of cases in the community are not as high as we were seeing in the third wave, the amount of resources we have left within the healthcare system are much less now than they were in the third wave because of things like burnout and exit of staff members.”

He pointed out that because of the burden on the health care system from COVID-19 patients, those who are getting ill from other diseases and conditions are having their care further delayed because of mostly preventable COVID-19 cases.

Health care workers are urging those who are still on the fence about vaccination to get their shots.

“I don’t think we are at the crest of the fourth wave,” said Sharma. “I think the wave is building. I think it’s going to get worse.”

And if health care workers don’t get a moment to breathe soon, it could mean big problems not just for COVID-19 patients, but everyone.

“I don’t think a wise thing would be to push those people again to the max, because we still have a healthcare system to run after COVID is over,” Sharma said. “And I think we can’t lose sight of that.”

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