Why being hospitalized 'for' COVID and 'with' COVID are different and why it matters

Hospitalized "forCOVID-19" or "withCOVID-19"?

It's a distinction New Brunswick Public Health has been making recently in how it reports the number of people in hospital with the disease, and one whichhighlights the complexity around crediting COVID-19's role in certain illnesses, experts say.

"It's an important distinction to make and it's helpful information to have,but at the end of the day, it's a challenging distinction to make," said Dr. Isaac Bogoch,an infectious diseases specialist at Toronto General Hospital.

Over the past month, COVID-19 hospitalizations have risen to record levels, straining the province's health-care system and prompting the latest quasi-lockdownwith the move to Level 3, the most restrictive levelof the government's COVID-19 winter plan.

On Tuesday, the province reported 138 COVID-19 hospitalizations, with 82of those being people who tested positive after being admitted for something else.

Bogoch said he can usually break up COVID-19 positive hospital patients into three categories: those who require hospitalization for obvious COVID-19 symptoms, those who were admitted for conditions totally unrelated to COVID-19 but subsequently testedpositive, and those who were admitted for conditions that could have been exacerbated by COVID-19 but only received a positive test result after admission.

Bogoch said when it comes to the first two categories, it's usually easy toclassifysomeone as being in hospital for COVID-19 versus being admitted with COVID-19.

The third category, however, can be tricky.

"For example, someone might have an abnormal heart rhythm or a frail or elderly individualmight have had a fall, or someone might havean exacerbation of their underlying breathing condition because of a COVID infection as well.

"Those are hospitalizations that might get categorized, you know, one way or another, but COVID still brought that person into hospital."

Allison McGeer, an infectious diseases physician at Mount Sinai Hospital in Toronto, said making that distinction can bedifficult and comes down to the opinion of the staff taking care of thepatient.

"If I test positive for COVID and I have a stroke, COVID caused the stroke? It can, right? It might or might not have," McGeer said.

"Soone of the challenges of trying to divide this up like this is that there's COVIDthat admits you to the hospital directly. And then there's complications of COVID, where you're admitted because you had COVID, but not necessarily directly for the COVID."

In an email to CBC News, Department of Health spokesperson Bruce Macfarlanesaid regardless of whether a patient was admitted for or with COVID-19, they remain part of the overall COVID-19hospitalizations statistic for as long as they are infectious or demonstrating acute severe symptoms of the disease.

Asked why patients who are admitted for reasons other than COVID-19 are counted at all, Macfarlane said such patients might still develop severe COVID-19 symptoms during their hospital stay.

"Nevertheless, the increase in resources needed to take care of these patients (e.g. additional PPE, dedicated wings) add strain to the hospital system which cannot be discounted," Macfarlane said.

Still the same strain on health-care system

One of the criteria PremierBlaine Higgs's government used for justifying the move to Level 3 was the province exceeding 100 COVID-19 hospitalizations.

As of Monday, 57 people were hospitalized because of COVID-19, with the other 74 testing positive after admission.

McGeer said it might be easy for some people to look at the distinction in hospitalizations as a way to downplaythe threat of the Omicron variant and question whether the province is justified in ramping up restrictions.

However, whether people were admitted for COVID-19 or with COVID-19 doesn't change the strain on health-care staff and resources, she said.

"People who have COVID, even though they're admitted for something else, are still a significant stress in the health-care system," she said.

Dr. Amol Verma, a physician and scientist at St. Michael's Hospital in Toronto, said he's seen the politicization of COVID-19 restrictions in society, with attention paid to the number of people who are testing positive after hospital admission compared to the number being admitted for COVID-19.

The distinction, however, becomes less relevant when health-care resources become strained, regardless of whether someone is in hospital for or with COVID-19, he said.

"My response to those people would be to say, 'Look, it's really important that we protect our health-care system to keep our hospitals functioning so that we can keep delivering health care and keep everyone healthy, not just the people who are infected by COVID-19,'" he said.

"And so sometimes we have had to resort to pretty extreme public health measures in order to do so."