Hospitalizations steady despite rising COVID-19 cases. But this could change quickly, experts say

Despite a spike in COVID-19 cases across Canada, hospitalization rates in most provinces have remained steady. Younger people bear the brunt of new infections in the country, but the virus will likely spill over to other demographics if cases continue to increase, according to infectious diseases specialists.

Stable hospitalization, ICU rates could change in next few weeks due to reporting delays

Hospitalizations of people with COVID-19 remain steady across Canada, despite an uptick in cases. Expect that to change if infections continue to climb, say infectious diseases specialists. (Craig Chivers/CBC)

An uptick in COVID-19 cases across the country in the last 10 days has prompted many public health officials to remind Canadians to be on high alert and follow set guidelines to limit the spread. 

But the relatively stable hospitalization data should not provide too much comfort, as ICU units may begin to fill if cases continue to increase, infectious diseases experts told CBC News. 

As well, blame placed on younger people, who are apparently driving new infections, may be misplaced as some may be exposed to infections due to factors such as a precarious work environment, rather than being irresponsible, they said. 

Currently, new cases across Canada mostly represent those under the age of 40. Yesterday, Ontario reported 313 new cases, with 67 per cent falling within that demographic. British Columbia has similarly reported increases tied to outbreaks affecting younger people as well. 

Lower hospitalization rates support data that indicates a younger age group bearing the brunt of new infections, said Ashleigh Tuite, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health.

"We know that younger people are less likely to be sick enough to require hospitalizations. And right now, a lot of cases are happening in younger people, so that's part of it," she said. 

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Cases of the coronavirus have begun to surge in Canada over the last 10 days, as daily new infections for the entire country are now at around 618, compared to about 390 cases a day this time last month. 

When it comes to hospitalizations, in September, there have been less than 300 people in hospital across Canada due to COVID-19. The hospitalizations peaked in the second half of April when there were well over 2,000 people in hospital.


Although younger people are less likely to be hospitalized, it doesn't mean that it's impossible, said Tuite. Out of over 11,000 hospitalizations that the Public Health Agency of Canada (PHAC) has data for, more than 1,000 in hospital were under the age of 39.

As a spike in cases is only becoming apparent in the last week or so, and it takes time for someone to show symptoms of COVID-19 — increased hospitalizations of younger people may become more visible if new infections within this demographic continue in the coming weeks, she said. 

"We saw something similar in the spring where we started to see an increase in cases and then in a week or two, we started seeing an increase in hospitalizations and then increases in ICU occupancy and then mortality," she said. 

She said COVID-19 will not stay within a specific age group and will eventually migrate to older people, particularly with schools opening. 

"Even though we see cases at this point predominantly concentrated in younger age groups, we can anticipate just by the way we interact.… Young people do interact with older people, so we do expect to start seeing cases in older people as well," she said. 

Tuite said it may take time for hospitalization data to be reflected in official public health records, which is why it's important to watch for a rise in hospitalizations, as it would be an indication to reimpose lockdown restrictions. 

"The challenge is you want to respond quickly if you start seeing increases in hospitalizations, because you don't want to be back at the point where we were in March," she said.

Long-term care homes more prepared

While it's encouraging that Canada isn't yet seeing the level of hospitalizations that was occurring in the spring, evidence from other countries shows that that could change quickly, said Dr. Lynora Saxinger, an infectious diseases specialist and associate professor of microbiology and immunology at the University of Alberta in Edmonton.

"I would point to someplace like Florida … where they had fairly sustained higher transmission in younger age groups, and then it started to spill over into more vulnerable populations in six to eight weeks," she said. 

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As Canadians head into colder months, one important difference between now and what occurred in March and April is that long-term care homes may be more prepared for a possible increase in COVID-19 cases, said Saxinger. That could also contribute to lower hospitalization rates. 

The majority of deaths due to coronavirus in Canada have been within long-term care homes, at over 7,000, according to the National Institute on Aging.

"I'm hoping that lessons have been learned, that we really have to be attentive to who's working and who's going between places.… It might keep the most vulnerable population safer," she said.

Don't judge

However, placing blame on younger people and assuming they are driving new infections due to ignoring public health guidelines is a mistake, Saxinger said.

"One thing worth being mindful of is not judging the reasons why that may be occurring. A lot of people have jobs they can't do at home — lower paid jobs."  

Canadians should be questioning whether younger people have access to the proper support and information to keep themselves and others safe, she said.

Targeting those groups and determining why COVID-19 is spreading will help keep the disease from reaching more vulnerable populations, and that could include more access to sick days, Saxinger said 

"We have to make sure people aren't being disadvantaged … and that supports are given for people in service and essential industries." 

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