The number of new admissions of corona patients in hospitals has been increasing cautiously for a few days. This growth will accelerate in the coming weeks, RIVM expects, now that omikron is spreading in full force. It means that hospitals have to prepare for a flow of patients that is just different from the previous one.
But what does the typical omikron patient look like? Three doctors talk about their first impressions, but explicitly state that this is a first image, the patient numbers are still too small for far-reaching conclusions. More will become clear in the coming weeks.
What is clear in any case, says Joost Wiersinga, internist-infectiologist at Amsterdam UMC, is that omikron is milder. Far fewer patients end up in hospital. This is also apparent from the figures in the Netherlands.
Wiersinga: ‘Currently, the omikron variant is present in more than 95 percent of the infections and this has been dominant in Amsterdam for weeks. Yet half of the patients in the hospital are still infected with the delta variant, even with the new admissions. Delta is therefore heavily overrepresented. That fits with the image that delta is more sickening.’ Delta patients also spend longer in hospital on average for this reason.
In the Erasmus MC in Rotterdam, the omikron-delta division is still fifty-fifty, says internist Robin Peeters. ‘Hospital occupancy is still falling, because the delta patients are still recovering and then leave the hospital.’
Different disease course
You see that the course of the disease is different in infected people who do not have to go to hospital, says Wiersinga. ‘Research shows that omikron adheres less well to the cells in the lower airways. It settles mainly in the nose and pharynx and ensures a higher viral load there. This explains the fact that omikron is more contagious, but also the pattern of complaints. Omikron gives more flu-like complaints, the classic cold, a runny nose, sneezing, sore throat, muscle pain. At delta the picture was more diverse, to the point of loss of smell and taste and stuffiness.’
Many patients in Amsterdam UMC and Erasmus MC are in single rooms, so that they can easily be nursed in isolation. This means that Wiersinga and Peeters do not actually encounter patients who are admitted for a reason other than corona, but who nevertheless turn out to be positive. After all, they can go to the regular hospital wards (such as surgery or neurology) in isolation. ‘In our hospital, this concerns about one third of the infected patients,’ says Peeters.
The situation is different in the Haga Hospital in The Hague, where all infected patients end up in the cohort ward (a ward where only patients with the same infectious disease are nursed). Internist Geert Labots has noticed something in recent weeks. ‘We have clearly seen the covid patient change in recent weeks. We see much less the typical stuffy picture, with clear abnormalities in the lab values and the lungs.’
More often it concerns a patient who reports to the hospital with another problem and who also happens to be covid positive. And what also often happens: that covid is not the primary diagnosis, but it is indeed part of the cause of the admission.
Labots: ‘Nowadays, older people live independently at home for longer. That’s all fine, but if they contract corona, it can push them just over the edge. They get fever spikes, go down in the legs, get delirium. Then someone is so weakened that staying at home is no longer possible. The only solution is for them to be recorded for a while.’
Corona may not lead to a hard medical indication – extra oxygen is not or hardly necessary – but there is a care problem, says Labots. ‘They are in the hospital for a few days, so that there is time to arrange home care or a place in the nursing home, for example.’ Had these people not received corona, ‘we might have seen them a month later after a trip or a bladder infection’.
Not so grim anymore
It changes the atmosphere in the hospital, says Labots. Not as grim as two months ago, ‘we feel a little more optimism across all layers’.
Nevertheless, says the Amsterdam internist Wiersinga: ‘If a patient really has to be admitted by omikron, you will no longer see any clinical difference. They get the most out of oxygen.’ Peeters has the same experience with him in the department.
The omikron variant has eliminated one treatment option. Previously, doctors had good results with so-called monoclonal antibodies in patients without antibodies against the coronavirus (because they were not vaccinated, or the immune system did not pick up the vaccine). But those medicines no longer work with the omikron variant. The spike protein has undergone too many mutations, causing the treatment to lose its effectiveness. But good news, says Wiersinga: ‘From next week we will probably have access to new monoclonal antibodies from another pharmaceutical company that do work against omikron. We look forward to that.’
Finally, an IC recording is less often necessary. Virtually no omikron patient is on a ventilator in Erasmus MC. ‘But the number of omikron patients in total is also very small here,’ says Peeters. “I haven’t transferred a covid patient to ICU in weeks,” says his colleague Labots. ‘The patients lying there are still the tail of the delta wave.’