Some patients go in for COVID-19, others are infected alongside another issue. In hospitals, those lines blur

Inside a busy intensive care unit in Toronto's east end, Dr. Martin Betts often sees patients grappling with a double diagnosis: a serious health issue coupled with — or caused by — COVID-19.

As chief of critical care for the Scarborough Health Network, Betts has treated several patients with diabetic ketoacidosis, a build-up of acids in the blood that's a life-threatening complication of diabetes, which can be triggered by viral infections.

Other people have been admitted for heart inflammation, heart attacks and even cardiac arrest caused by a SARS-CoV-2 infection — yet COVID-19 is often listed as a secondary diagnosis, a situation Betts describes as "misleading."

"Incidental COVID patients actually have potentially a longer length of stay, and higher mortality ... they actually should be considered a bigger burden on the system than being described as incidental cases," he said.

"I think that's a story that really needs to be told."

As an Omicron-drive surge keeps sending more COVID-19 patients into hospitals, some jurisdictions — including Ontario earlier this month, following the lead of various U.S. hospitals — are breaking down hospital data differently.

They're now distinguishing between people admitted directly for COVID-19 and those admitted for other health issues who also test positive, since the variant is infecting such a wide assortment of patients.

In other words, you're either in hospital for COVID-19, or with COVID-19.

The data distinction might make it easier to brush off incidental infections, downplay the pressure on hospitals, or assume the crisis phase of this pandemic has already passed.

But Betts and other clinicians say the reality on the ground is more complicated, and those binary buckets don't capture all the nuances of patient experiences and care in a system under strain during a pandemic. 

"I think the impression in the community is that these COVID infections really aren't much, that it's just a sort of bit player in this patient's illness," Betts said. "That's not the case."

In recent weeks, sky-high infection rates began muddying COVID-19 data in a few ways. Record-breaking case spikes proved too tough to track, and many areas of the country have scaled back testing, leaving Canada in the dark about just how many people are getting infected each day.

At the same time, this variant is operating differently, often causing less severe illness than its predecessor, Delta. That's partly thanks to Omicron's vast array of mutations, and partly because millions of Canadians are now largely protected from dire health impacts, thanks to vaccinations.

That means while unprecedented numbers of people became infected in mere weeks, many aren't presenting in hospitals with classic COVID-19 pneumonia, but rather a wider array of symptoms, or while coping with another health issue.