Hundreds of Canadians are still dying of COVID-19 every week. Who are they?

Even in her 80s, Josephine Moschitto still cheered on her beloved Toronto Blue Jays, went grocery shopping near her retirement home, and had recently discovered the joys of playing Wordle on her iPad.

The Mississauga, Ont., resident lost her husband of six decades in early 2021, and had been diagnosed with Parkinson's disease. But she was healthy, mobile and still enjoyed time with family, including a lunch with her loved ones in September.

"And she looked perfectly fine," her son Victor recalled. "We were all talking, laughing ... then a week later, circumstances changed."

That's when Josephine started showing symptoms of COVID-19. And, despite her having received four vaccine doses, the virus took a serious toll.

The 89-year-old went to a local hospital in late September, and spent a few days in a bed in the emergency department, waiting for a room. At first her illness seemed mild with none of the telltale breathing problems that used to strike so many COVID patients but she slowly began to decline.

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Victor and his sister Laura visited their mother as much as possible, often playing her favourite oldies, until the hospital stopped allowing visitors during a COVID-19 outbreak.

"Then she just took a turn for the worse," Laura said.

In her last few days at the hospital, Josephine was put on oxygen and developed pneumonia. She didn't want to be intubated, so she was never transferred into intensive care.

She died on Oct. 9.

"I always thought to myself that my mom had a few good years left in her," Victor said.

"You all of a sudden realize that the disease that has captured so many lives is actually affecting your family's life."

People such as Josephine who are elderly, or medically frail for other reasons are now the classic victims of COVID-19.

And hundreds of Canada's most vulnerable are still dying, every single week, with countrywide deaths stuck at stubbornly high levels in recent months, federal data shows.

That means Canadian families continue to lose loved ones to this virus on a regular basis, all while hospitals are still admitting seriously ill COVID-19 patients in the midst of ongoing staff shortages, surgery backlogs and a busy respiratory virus season.

"We all have sort of moved into another phase of living with the virus," said Dr. Kali Barrett, a critical care physician with the University Health Network in Toronto.

"But for those at risk, the pandemic continues to be a real and legitimate threat."

'Completely different patient population'

The weekly death rate from COVID-19 in Canada has skyrocketed, then dipped, in dramatic peaks and valleys since it began spreading in early 2020.

But while weekly deaths dropped into the double digits at several points in 2020 and 2021, the tally hasn't dipped below 137 throughout all of 2022. (The numbers are provided to the federal government by the provinces and territories, and no longer include Nunavut or the Northwest Territories.)

That shift follows provinces lifting public health restrictions, all while the Omicron family of sub-variants kept evolving to better evade our immune systems.

For nearly four months straight, weekly Canadian COVID-19 deaths have remained above 200 and the latest available data shows there were 305 lives lost during the week of Oct. 16.

CBC News spoke to multiple physicians to get a sense of what's behind that trend, and who's dying of COVID-19 in late 2022. Canadians who are elderly, already battling multiple pre-existing health conditions, or undergoing immune-suppressing treatments such as chemotherapy all remain at a higher risk of dying.

Some are winding up in critical care, while others are now being treated for their illnesses and eventually dying in other settings, including other hospital wards.

"It's a completely different patient population than the earlier waves," said Dr. Bram Rochwerg, a critical care physician with Hamilton Health Sciences in Hamilton, Ont.

He recounted the horror stories of COVID's early days: Young, healthy adults becoming incredibly sick and winding up in intensive care on mechanical ventilation, or even extracorporeal membrane oxygenation (ECMO), the highest form of life support.

"We're not seeing those young, previously healthy, super-sick folks that we saw at the peak of Delta," he said.

Dr. Gabriel Fabreau, an internal medicine physician in Calgary and an assistant professor at the University of Calgary, credits effective vaccines and treatments for that shift.

Vaccinated individuals meaning those who completed their primary COVID-19 vaccine series and had at least one booster dose were three times less likely to be hospitalized, and five times less likely to die from their illness, compared to unvaccinated Canadians, according to data from late August to late September 2022.

Fabreau said more recently, his seriously ill COVID-19 patients are typically medically frail, immunocompromised, or still unvaccinated.

Rochwerg, in Hamilton, agreed. "It's older folks, it's those with immune-compromised states on chemotherapy with advanced cancer, frail comorbidities, that are ending up getting sick with COVID-related illness," he said.

"It's extremely rare to see somebody that doesn't have these comorbidities that ends up in the ICU sick with COVID."

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Deaths among elderly, with comorbidities

The latest-available data from the Canadian Institute for Health Information (CIHI) suggests the trend persists across the country, with poorer outcomes observed for patients with more than one disease or condition.Those dying in hospital also skewed older than those who didn't die, with a median age of 76 compared to 60.

Canadian COVID-19 patients with at least one comorbidity had an average hospital stay eight days longer than those without comorbidities, and a higher in-hospital death rate of 20 per cent compared to seven per cent.

South of the border, U.S. Centers for Disease Control data released in September also shows that while theoverall mortality for patients hospitalized primarily for COVID-19 has dropped, seniors are still hardest hit.

The vast majority of 2022 deaths, at more than 80 per cent, were among those 65 and older, and three-quarters had three or more comorbidities.

But, to be clear, people juggling multiple health issues aren't necessarily close to death.

In Toronto, the majority of patients with COVID-19 who are ending up in Barrett's intensive care unit are already frail from cancer treatment. Many, she said, might have had years left to live before developing COVID-19.

"These were patients who may have if they got through their chemotherapy were going to fully recover and go back to a normal life," she said.

Several physicians also noted other patients are admitted to hospital for different ailments but also test positive, while some catch the virus during their stays.

"There are hospital-acquired outbreaks that are continuing to happen that do account for some of those numbers that we're seeing," said Dr. Neeja Bakshi, an internal medicine physician at the Royal Alexandra Hospital in Edmonton.

Those differences may muddy the data on why exactly people are dying, but Barrett stressed that any time a patient is battling both COVID-19 and another health issue, it heightens their risk of poor outcomes.

COVID hospitalizations rising

The high number of patients falling ill with this virus threatens to further strain Canadian health-care systems this winter.

"We simply cannot expand any further and we don't have the resources to go into the season," Bakshi warned. "And I can tell you that nobody in any level of hospital administration or clinical care is sleeping easy."

Canada-wide, the number of hospital beds occupied by COVID-19 patients increased from 3,875 to more than 4,100 between Oct. 17 and 24, federal data shows.

Even if just a small percentage of COVID-19 patients are still falling seriously ill, that's capable of adding a huge amount of stress to health-care systems, Rochwerg said.

"Our capacity to deal with critically ill patients right now has never been lower than it is at this moment in time," he said.

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The sickest COVID-19 patients are now being cared for across hospital wards more broadly, including emergency departments and inpatient wards that are also facing pressure from other respiratory illnesses, from influenza to respiratory syncytial virus (RSV).

That's layering on top of efforts to catch up on a backlog of thousands of surgeries and procedures, all while more Canadians are expected to present to hospitals with more serious forms of cancer or lingering health impacts from prior COVID-19 infections all ripple effects from this years-long pandemic.

"It's led to truly a perfect storm," Rochwerg said.

Seniors, loved ones urged to take precautions

As the temperature dips and Canadians spend more time indoors, inadvertently spreading viruses such as SARS-CoV-2, influenza and RSV, physicians say it's critical that vulnerable seniors and their families take precautions.

Dr. Samir Sinha, director of geriatrics for Sinai Health and the University Health Network in Toronto, recommended all Canadian seniors consider getting three different shots this fall season: An updated bivalent COVID-19 booster, annual flu shot and pneumonia vaccine if they're eligible.

"You can actually get all three of those at the same time," Sinha said.

Elderly Canadians living in long-term care facilities or retirement homes might have an easier time accessing these shots, Sinha said.

The bigger concern? Seniors living independently in communities, who may require help from family members or neighbours.

Loved ones should also consider taking extra care around any-at risk relatives, Sinha added. That could mean some combination of being vaccinated, wearing a quality mask, or taking a COVID-19 rapid test before family events this fall and winter.

"The loneliness will just kill you alone," Sinha said. "The idea is, try to live your life, but do so safely."

'A bigger risk than we realize'

As the Moschitto family continues mourning the recent loss of 89-year-old Josephine, her children take comfort knowing they tried to protect her, and that her retirement home was vigilant in maintaining COVID-19 precautions.

"You can't stop it, at some point, from infiltrating you it's hard to deal with," Victor said. "But you have to at some point come to accept what happened."

Still, both siblings hoped Josephine had a few more years left to live.

A few more years filled with morning conversations about how long it took her to guess the day's Wordle, or family dinners featuring her beloved recipe for spaghetti and meatballs, or moments spent with her three grandchildren.

"People want to return to normal, but you know, maybe there is a bigger risk than we realize with that return to normalcy," Victor said.