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Manitoba News Release
.................................................. ..........
June 16, 2009
BULLETIN #23 H1N1 FLU
. Manitoba Health and Healthy Living is reporting two deaths associated with H1N1 influenza in Manitoba. One is a man in his 40s from the Winnipeg health region who had been hospitalized and had no known significant underlying health conditions. The second is a woman in her 40s from the NOR-MAN health region who had been hospitalized and had significant underlying conditions. These are the first reported deaths associated with H1N1 flu in Manitoba.
. There are 74 new confirmed cases of H1N1 flu, bringing the Manitoba total to 226 reported laboratory-confirmed cases.
. The call to action for health-care workers in northern Manitoba is continuing. Two additional nurse practitioners have been working in a northern community. Three additional doctors will travel north this week. Additional staff responding to the call to action include two more nurse practitioners, 13 nurses and 10 medical residents. Logistical issues surrounding the supervision of medical residents and licences continue to be addressed.
. Interested physician and nurses can indicate their interest in working in northern communities that need additional resources by visiting the flu website at www.manitoba.ca where there will be a Physicians and Nurses Needed button.
. All Manitobans are at risk for exposure to the H1N1 virus. The influenza outbreak is provincewide and it is likely that H1N1 is present in every community in Manitoba. Although there has been an increase in the number of people with severe respiratory illness, this has been a small proportion of the people who have had "the flu" in Manitoba in the last two months. The majority of people in Manitoba who have become ill have not required hospitalization.
. In Manitoba, there continues to be no public health reason to close schools, community centres or other public gathering places or to avoid travel to any community. There also has not been a public health reason to exclude people from any public setting based on their ethnic background or home community. The same basic precautions are still the best defense against H1N1 influenza, no matter where you are or who you are with.
Two people in Manitoba have died after contracting swine flu virus, including a man who had no underlying medical conditions, provincial health officials said Tuesday.
The man, who was in his 40s, was from the Winnipeg area, health officials said at a press conference. He had been admitted to hospital prior to his death.
The second person is a woman in her 40s from the Nor-Man health region, in north central Manitoba. She had also been admitted to hospital but had significant underlying conditions, said officials.
"We fully expected that we would have deaths, as we do every year from influenza," said Manitoba health officer Joel Kettner. "It's particularly concerning, of course, when they occur in people in their 40s, because this is a premature death by anyone's test."
No additional information on the victims was provided by the government.
News of the deaths came as health officials announced that 74 new cases of swine flu have emerged in Manitoba, bringing the total number of confirmed cases in the province to 226.
While most swine flu cases are mild, there were at least 31 people in Manitoba's intensive care units with severe symptoms, said Kettner.
"These are very critically ill people. They're on ventilators. They cannot sustain their lives without very, very active life-support help .… It is not unreasonable to expect that we will have more deaths to announce as this epidemic goes through this phase of its course."
11 deaths in Canada
Quebec also reported two deaths related to swine flu on Tuesday, bringing the total number of reported deaths in Canada to at least 11.
The Quebec victims, a man and a woman who were between 30 and 50, had underlying medical conditions that made them susceptible to infection, health officials in that province reported.
In total, six Quebecers who had swine flu have died, along with two Ontarians and one Albertan. Prior to Tuesday, no deaths related to swine flu had been reported in Manitoba.
Responding to need in Manitoba's north
In Manitoba, the most severe cases of swine flu have involved aboriginal patients. Many patients have been airlifted from a cluster of reserves in a remote area 500 kilometres northeast of Winnipeg. Aboriginal leaders have said that poor living conditions, including cramped housing and a lack of clean water, have made some reserves a breeding ground for the flu.
Manitoba health officials say extra support is being sent to northern Manitoba.
"Two additional nurse practitioners have been working in a northern community [and] three additional doctors will travel north this week," stated a news release issued by the province.
Additional staff travelling north this week include two more nurse practitioners, 13 nurses and 10 medical residents, the release stated.
Medical professionals who are interested in temporarily working in the remote northern communities where swine flu, or H1N1 influenza A, has hit particularly hard are asked to go to the Manitoba website where there is a "Physicians and Nurses Needed" button.
"All Manitobans are at risk for exposure to the H1N1 virus. The influenza outbreak is provincewide and it is likely that H1N1 is present in every community in Manitoba," the news release stated. "Although there has been an increase in the number of people with severe respiratory illness, this has been a small proportion of the people who have had 'the flu' in Manitoba in the last two months.
"The majority of people in Manitoba who have become ill have not required hospitalization."
No need to restrict travel, close schools
In Manitoba, there continues to be no public health reason to close schools, community centres or other public gathering places, or to avoid travel to any community, the government release stated.
There is also no public health reason to exclude people from any public setting based on their ethnic background or home community.
"The same basic precautions are still the best defence against H1N1 influenza, no matter where you are or who you are with," the release stated.
Anyone who has symptoms of flu-like illness, such as fever, cough, aches and tiredness, is most contagious for three to four days, but it is possible to spread the disease for up to a week once symptoms start to appear, provincial health officials said.
They advise anyone exhibiting symptoms to:
Stay home from school or work while ill and limit unnecessary contact with others.
Contact a health-care provider or visit the nearest health-care centre if concerned about advice or care, or especially if symptoms are severe or worsening (i.e. shortness of breath, dehydration, worsening fever, cough or weakness).
Manitobans should continue to take the following precautions:
Cover a cough or sneeze by coughing or sneezing into your elbow or sleeve or using a tissue to cover your nose and mouth.
Wash your hands often with soap and water, especially after you cough or sneeze. Hand sanitizers are also effective.
Limit touching of your eyes, nose or mouth.
Take steps to maintain your health by taking care of yourself and those in your care, including eating a healthy, balanced diet, avoiding cigarette smoke and other harmful substances, being active and getting enough rest and sleep.
Manitobans seeking advice or care can call Health Links at 204-788-8200 or 1-888-315-9257. The telephone information service is staffed by registered nurses 24 hours, seven days a week, who can provide answers to health-care questions.
The demand for the service has spiked in the past week, with close to 200 calls taken on the weekend alone. The government has increased staff to manage the calls.
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
The swine flu pandemic is taxing the nursing staff at some Winnipeg hospitals, which are scaling back vacation time and retraining members for intensive care unit work.
The head of the Manitoba Nurses Union, Sandi Mowatt, said it's been a particularly stressful time for nurses at St. Boniface hospital, where most of the flu cases are being treated.
"They have a strain on their ICU bed situation and required some more nursing help with that. So they have seconded nurses in their own hospital who have previous intensive care experience to work in their ICU," she said.
BOXQUOTE: 'They have seconded nurses in their own hospital who have previous intensive care experience to work in their ICU during this period of time.'— Sandi Mowatt, Manitoba Nurses Union
Mowatt said nurses who haven' t worked in ICU for a while will be receive training before they care for patients.
"It's certainly disconcerting for the nurses who haven't worked in ICU for a little bit to come and work in an area that they may not be familiar with at this time, but having said that, nurses are the consummate professionals," she said.
The strain at St. Boniface has been heightened by an increased demand for care at Victoria Hospital. Consequently, a number of St. Boniface nurses have had to be posted at Victoria to help with the workload, Mowatt said.
Vacations on hold
With nursing resources stretched thin across the city, the union has put a hold on some vacation requests. Nurses are being closely monitored to ensure they are receiving enough down time, however, said Mowatt.
The Winnipeg health region may also look at moving some patients to another health region, such as Brandon, to ease the pressures, she said.
Manitoba confirmed another 33 cases of swine flu, or H1N1 influenza A virus, on Monday. The provincial total is now 152.
Dr. Joel Kettner, Manitoba's chief medical officer of health, is urging people to stay home from work for a full week if they feel they have even a mild case of the flu. That would help limit the spread of the virus, he said.
"It's not like you're struggling for five or six days with the flu and it's just not getting better. We're talking about people who become very ill, very quickly within the first 24 or 48 hours."
Ottawa's flu support on reserves shameful, says MP
Manitoba New Democrat MP Niki Ashton, who represents the Churchill riding, toured remote communities in the province's north this week, where H1N1 has hit hard.
She told CBC News that people in those First Nations communities are scared, and she blamed Ottawa for ill-preparing First Nations to deal with the outbreak.
BOXQUOTE: 'Over and over again, what people are telling me is, 'We know it's gonna come back worse in the fall, we're scared.'— Niki Ashton, New Democrat MP
"I've seen the [health guidelines] binder that they sent to leadership in these communities and it's a binder that has all these great ideas, but there's no resources to back it up. There's no human resources that have been offered," Ashton said, calling the level of support shameful.
"There have been very appreciative comments made [by residents and community leaders] of medical professionals that have come to respond to the urgent call for help. But [they] need a lot more than that."
Ashton wants the federal government to set up field hospitals in northern communities, which is an idea that has been raised over the past couple of weeks by First Nations leaders.
Ashton said many residents have expressed fear about the H1N1 when the fall flu season hits.
"Over and over again, what people are telling me is, 'We know it's gonna come back worse in the fall, we're scared.'"
David Harper, chief of Garden Hill First Nation, travelled to Winnipeg to gather medical supplies to stockpile.
In the past month, 38 people have been airlifted out of that community of 4,000 residents, located about 500 kilometres north of Winnipeg. Four cases of swine flu have been confirmed in Garden Hill residents.
"I know the worst is yet to come. I mean, between now and the next flu season, we gotta keep preparing," said Harper. "When you come from a remote community where there's no doctor, no hospitals, you don't take those chances."
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
Family of Manitoba swine flu victim in shock and grieving
Last Updated: Wednesday, June 17, 2009 | 4:05 PM CT
CBC News
The family of a Manitoba woman is grieving after health officials confirmed she died as a result of complications due to swine flu.
"The thing that's going through my mind right now is just the shock of her being gone," said Dianne Lehmann Ballantyne, whose cousin, Lorraine Wilson, 45, died on Tuesday.
"I'm glad that she went fast. I take comfort in knowing that she was a good person, and it didn't take long for her to go. She went on her own, and I'm happy with that."
'I take comfort in knowing that she was a good person, and it didn't take long for her to go.'? Dianne Lehmann Ballantyne
Wilson, who lived on the Opaskwayak Cree Nation, about 730 kilometres northwest of Winnipeg, went to hospital in The Pas on June 6. She was given Tylenol and sent back home, said Lehmann Ballantyne.
Wilson went back to the hospital the following day feeling even worse and was flown by air ambulance to Winnipeg, where doctors confirmed she had the H1N1 influenza A virus, said Lehmann Ballantyne.
Wilson also contracted pneumonia and was put on life support. As her kidneys failed and her condition got worse, Wilson's family met to decide whether to keep her hooked up to the machines. Before they could make a decision, she died of a heart attack on June 16.
"I'm glad she went on her own and the burden wasn't left on anybody to make the ultimate decision," said Lehmann Ballantyne. "It's hard enough to see someone in that shape and condition and idly waiting. It's comforting to know God stepped in."
Manitoba's first swine flu fatalities
Wilson, along with a Winnipeg man who was also in his 40s, were reported by the provincial government on Tuesday as Manitoba's first H1N1 fatalities. The man had no underlying medical conditions, provincial health officials said.
The identities of the victims were not been released by the government. Wilson's family was located by a CBC News reporter based in The Pas.
Members of her family sat on the back porch at the home of Wilson's brother, Guy Constant, remembering her on Tuesday.
Constant, 44, said he is looking forward to having his sister return home one last time for a celebration of her life and an emotional farewell.
Wilson, who worked as a librarian at the Joe A. Ross First Nations school on the OCN reserve, leaves behind a husband, 23-year-old daughter, and a stepdaughter.
Sydney Garrioch, grand chief of Manitoba Keewatinowi Okimakanak, an organization representing northern Manitoba First Nations, said the entire community is in shock and worried about whom the virus will strike next.
"The leadership in the community are very concerned about this unfortunate death. They are working very hard to make sure people [are] informed," he said.
I am currently entering this data into a spreadsheet to track it as H1N1 spreads throughout Manitoba. Since there appears to be a higher-than-usual number of severely ill patients in ICU units and on ventilators, I thought it might be useful to keep track over time.
It would be great if people could volunteer to do this for other provinces, so that we might be able to compare. I've already asked CanadaSue if she would be willing to do it for her province of Ontario. Any other volunteers for the other provinces?
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
It would be great if people could volunteer to do this for other provinces, so that we might be able to compare. I've already asked CanadaSue if she would be willing to do it for her province of Ontario. Any other volunteers for the other provinces?
CanadaSue can't do Ontario, she's not computer-savvy enough. Any takers over here at FluTrackers??
Another thing that is becoming apparent is just how quickly this virus can attack. We're going from healthy to critically ill within 24 to 48 hours, as evidenced by the warnings put out by various local authorities. That is scary as hell, and reminds me of stories about the Spanish Flu Pandemic of 1918/9.
Also, I bet there are some people in Europe and parts of the States have absolutely NO concept of the vast swath of Boreal forest we are talking about here. There are few roads in northern Manitoba, so much of this travel is by plane and therefore has to adhere to certain scheduling restrictions, I would assume. Given the great distances involved in travel between the northern communities in Manitoba, I bet one reason that we are seeing a lot of critically ill people from aborigianl communities is that a lot of that time is being spent in travel to and from the nearest health centre/hospital. If the person has to be sent to the best facilities in Winnipeg, that is a trip of hundreds of kilometres... the home of the woman who died from H1N1 was the Opaskwayak Cree Nation, 730 kilometres northwest of Winnipeg. How many hours did it take from the time she first reported feeling sick, to the time she arrived at an ICU unit in a Winnipeg hospital, likely Saint-Boniface? And when was she first given Tamiflu?
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
WINNIPEG — From Wednesday's Globe and Mail, Thursday, Jun. 18, 2009 03:45AM EDT
Four more Canadians - including an apparently healthy Winnipeg man in his 40s - have succumbed to swine flu, health officials said yesterday, pushing the national toll to 11.
The Winnipeg man is the youngest Canadian to die of the virus.
"It's particularly concerning when they occur in people in their 40s," said Joel Kettner, Manitoba's Chief Public Health Officer. "This is a premature death by anyone's test."
The second death in Manitoba, where the aboriginal population has been particularly afflicted by H1N1, was a woman from the northern part of the province who suffered from another serious health condition, though officials would not specify the nature of the ailment.
In Quebec, a Montreal man and woman between 35 and 50 years old marked the province's fifth and sixth flu deaths. Both had underlying health problems, according to health officials.
While the Winnipeg death is alarming considering the man's lack of known risk factors, one infectious-disease expert working on the front lines of Manitoba's pandemic response posited that the man likely died of something other than H1N1.
Ethan Rubinstein said the man collapsed in the waiting room of a Winnipeg clinic. He was resuscitated and rushed to Grace Hospital before collapsing a second time after several lucid hours.
"He originally arrived at the clinic with H1N1 symptoms, but it doesn't sound to me like that's what he died of," said Dr. Rubinstein, head of infectious diseases at the University of Manitoba. "He more likely died of a heart condition that wasn't known to physicians."
The two fatalities are the first recorded H1N1 deaths in the province. Around 100 people die of influenza every year in Manitoba, according to health officials, though the vast majority usually come during the more active winter flu season.
As of yesterday, 31 flu victims were hooked up to respirators in Manitoba. As many as two-thirds of those patients are aboriginal, according to health officials.
On Monday, the MP for the riding covering Manitoba's predominantly aboriginal northern region toured Garden Hill and St. Theresa Point, two native towns hard hit by the virus. Yesterday, she appeared alongside three Manitoba chiefs in Ottawa to appeal for more supplies and a meeting with federal Health Minister Leona Aglukkaq.
"When I visited those communities, people told me they are tired, they are scared," said MP Niki Ashton. "This is a national pandemic, this is a national disgrace."
Staff in Ms. Aglukkaq's office met with chiefs yesterday.
Ontario's Ministry of Health, meanwhile, has recommended physicians not test people for influenza unless they are pregnant, have been hospitalized or have underlying health conditions.
"The majority of lab tests that go forward come back negative." said Barbara Yaffe, Toronto Public Health's director of communicable disease control.
Toronto Public Health hasn't noticed any increases in emergency room visits or absenteeism at schools, and has told schools and offices to carry on with business as usual, even when they have confirmed cases of H1N1.
In British Columbia, the Burnaby School District will close Marlborough Elementary School for a week starting today because five people at the school have H1N1 flu.
Elsewhere in the province, people are following the advice of public health agencies. "I haven't seen any panic since the early days," said Perry Kendall, British Columbia's Provincial Health Officer.
With a report from Anna Mehler Paperny
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
Ethan Rubinstein said the man collapsed in the waiting room of a Winnipeg clinic. He was resuscitated and rushed to Grace Hospital before collapsing a second time after several lucid hours.
"He originally arrived at the clinic with H1N1 symptoms, but it doesn't sound to me like that's what he died of," said Dr. Rubinstein, head of infectious diseases at the University of Manitoba. "He more likely died of a heart condition that wasn't known to physicians."
So is the H1N1 supposed to be a "coincidence" or false positive??????
I wonder if young people dropping dead in 1918 while playing bridge or while riding in a street car were simply dying from an epidemic of heart attacks????
How about the previously healthy 20 year in San Marcos, California who died within hours of showing symptoms.
A few notes: The Opaskwayak Cree Nation is a Swampy Cree community of 2,500 across the Saskatchewan River from the northern Manitoba paper mill town of The Pas. It sounds as if she was put on vantilator in The Pas, a town of 5,589, and transferred to Winnipeg when her condition got worse.
Also, note in the last paragraph of this story how much territory we are talking about here in Northern Manitoba: 210,000 square miles.
Tragedies compounding pandemic: H1N1 victim twice turned away at hospital
WINNIPEG — A Manitoba woman who died of H1N1 complications was twice turned away by hospital staff who didn’t diagnose the virus, said her brother. Lorraine Wilson, 45, lived in the Opaskw...
By: Arielle Godbout and Larry Kusch
Winnipeg Free Press 18/06/2009 1:00 AM
WINNIPEG — A Manitoba woman who died of H1N1 complications was twice turned away by hospital staff who didn't diagnose the virus, said her brother.
Lorraine Wilson, 45, lived in the Opaskwayak Cree Nation, 730 kilometres north from Winnipeg, and worked at the local school library.
Lorraine Wilson’s family says her symptoms were first mistaken as a common cold.
She complained of chest pains and laboured breathing two weeks ago, and went to a local hospital in The Pas on June 3, said her brother, Guy Constant.
They told her she had a cold and sent her home, but she returned two days later. She was then told to take Tylenol and sent home again, her brother said.
"They didn't check her, they didn't test her, they didn't do anything," Constant said as he choked up during a phone interview.
As her symptoms worsened, she returned to the hospital for a third time and was put on a ventilator.
"That time they told us the symptoms of the influenza," Constant said, adding her doctors began to run tests.
Officials from Nor-Man Regional Health Authority -- which includes The Pas -- could not be reached for comment Wednesday night.
Manitoba reported 34 new confirmed cases of H1N1 influenza on Wednesday, bringing the total to 260 -- nearly half of which are in Winnipeg. Two people in Manitoba with H1N1 have died -- Wilson, and a middle-aged Winnipeg man.
Wilson's illness was not confirmed to be H1N1 until she was transferred to Winnipeg on Sunday, June 7, by air ambulance. Constant said his sister remained in a near-catatonic state for a week and a half before she died Tuesday, June 16.
Constant, her husband, Archie, and 23-year-old daughter, April, were among family members who flew to Winnipeg to be with her.
Wilson was also diagnosed with pneumonia, which Constant said was a complication of her H1N1 infection, and her lungs began to fill up with liquid.
She had a final responsive moment a week before her death, said her brother.
"For a brief few minutes, she was able to respond," Constant said. "My sister nodded her head, she wiggled her toes." Wilson's condition continued to worsen as her kidneys began to fail, and the doctors informed the remaining family they may need to decide whether to remove her from life support.
His sister died Tuesday from a heart attack, before Wilson's family were forced to make the difficult decision.
"The Good Lord just made that decision for her," he said.
Wilson's family gathered Wednesday evening at her home to share stories.
"My sister was very friendly, outgoing. She was just always helping out," Constant said. "She would just reach out and help you any way she could. She had a very big heart."
Wilson was one of 21 confirmed H1N1 patients in the Nor-Man health region, an area that includes The Pas, Flin Flon and Snow Lake.
In a news release Wednesday, the province said "all Manitobans" are at risk of exposure to the virus.
"The influenza outbreak is provincewide and it is likely that H1N1 is present in every community in Manitoba," the government said.
It said although there has been an increase in the number of people with severe respiratory illness, they make up a small proportion of the people who have had the flu in Manitoba over the past two months.
The majority of people who have become ill have not required hospitalization, the government said.
Meanwhile, Manitoba Public Insurance spokesman Brian Smiley said two employees working in one of MPI's Winnipeg facilities have confirmed cases of H1N1.
Smiley said the two have very mild cases of the virus, and other employees have been notified. Staff have also been encouraged to see a doctor if they're feeling unwell, and stay home from work.
The provincial Health Department Wednesday provided a breakdown, by regional health authority, of all confirmed cases.
Winnipeg has had 122 people test positive for the H1N1 flu virus over the past two months.
Another 80 cases have been confirmed in the Burntwood and Churchill regional health authorities, the government said.
Burntwood's territory covers 210,000 square miles north of the 53rd parallel, including the city of Thompson but excluding Flin Flon, The Pas, and Churchill. It also includes Garden Hill, St. Theresa Point and several other northern First Nations as well as the towns of Leaf Rapids, Lynn Lake and Gillam.
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
This is an EXCELLENT article by Helen Branswell that gives the most information I've yet seen on the critically ill swine flu patients. More from Winnipeg's Dr. Anand Kumar marked in red.
What is striking is that doctors and researchers do not yet know exactly WHY some patients develop viral pneumonia.
Note also the bolded statement in the article below: the WHO estimates that 2-5% of confirmed H1N1 cases require hospitalization. Compare this to the current situation in Manitoba: 30 critically ill on ventilators + 2 dead = 32, and 32/260 = 12% (the 260 is from the confirmed H1N1 case count in Manitoba as of June 17/09; these figures were not updated yesterday). The article clearly states that not all of these 30 patients have tested positive for H1N1, so the numerator of this fraction (32) may well be lower. And of course, nobody really knows the denominator of this particular fraction either, or, as Helen Branswell puts it so well, how much of the iceberg is under the water.
In other words, we're all still guessing here. But at least we know that the 12% figure here in Manitoba is the maximum, given what we do know so far. (What was the figure for H5N1 bird flu, 60% or something?)
Swine flu patients in ICU tough to manage, 'just really, really sick': doctors
In a typical flu season, the Winnipeg hospitals where Dr. Anand Kumar works might see one, maybe two life-threatening cases of viral pneumonia caused by influenza.
So seeing 10, 15 and more flu patients in those same hospitals' intensive care beds in June is still a shock, suggests Kumar, a critical care specialist who works at three different hospitals in the city.
"You just don't see this many of them," Anand says of the patients, struggling to survive swine flu infections.
"You don't see rows and rows of patients on ventilators because they have respiratory failure, a viral pneumonia kind of thing. It's unusual."
At last count, Manitoba hospitals had 30 respiratory distress patients in the ICU, some confirmed swine flu cases, others for whom tests are still pending.
In most people, swine flu behaves like regular flu - it makes you feel miserable, you head to your bed and in time you recover. But in an as-yet unknown proportion of cases, the virus seems to quickly trigger severe illness.
A report compiled by the World Health Organization said between two and five per cent of confirmed cases require hospitalization. But no one yet knows how big a portion of the iceberg is above water (the confirmed cases) and how much remains submerged (cases that never come to the attention of medical authorities).
People who end up getting admitted to hospital are generally presenting with shortness of breath. And by the time they get to the ICU, swine flu patients - most much younger than your average hospitalized flu patient - are gravely ill from a viral assault on their lungs.
"They're getting very bad, bad respiratory failure," says Dr. Michael Gardam, head of infectious disease prevention and control for Ontario's public health agency.
Kumar and others describe patients whose care is challenging.
"The patients are difficult to manage. They're unusually difficult to ventilate effectively," he says, referring to the practice of putting patients who cannot breath adequately for themselves on a machine called a ventilator that takes over the job temporarily.
"They're just really, really sick. It's impressive how sick they are."
Researchers are still trying to piece together how the new H1N1 virus attacks the bodies of those who develop a severe swine flu infection, and whether the damage is all the work of the virus.
One theory is that an over-exuberant immune response turns the body's defences against itself. That has been seen in human infections with H5N1 avian influenza, but it's not yet determined if this process - sometimes called a cytokine storm - is at play with swine flu.
"We don't know right now how much is direct toxic effect of the virus versus the effect of the body's immune system," says Dr. Nathan Dean, chief of pulmonary critical care at LDS Hospital in Salt Lake City, where he's treated about 25 swine flu cases in ICU over the past month.
Ask Dean what's happening to his patients' bodies and the response is both quick and rueful: "I would love to know."
In addition to trying to keep these patients alive, clinicians like Anand and Dean are gathering data. The case studies they are writing, and which will shortly be competing for space in medical journals, will help doctors who haven't yet see severe swine flu cases know how to handle them when they do.
Likewise, autopsies that have been performed on a number of people who died of their infections will help scientists figure out what the virus does in the body, information physicians may be able to mine for clues on how to improve a severely ill person's chances of survival.
The additions to the scientific literature will be welcome.
Finding out what is going on with severely ill patients has been a struggle, says Dr. Frederick Hayden, an influenza expert at the University of Virginia who co-authored the recent WHO report.
"The information is very important in terms of understanding how to manage the more seriously ill patients," Hayden insists.
He says the emerging evidence - confirmed by Anand's and Dean's observations - is that at least a portion of the sickest of the sick are suffering from an aggressive viral pneumonia.
Seasonal flu often lays low the body's defences. In the case of some, particularly the elderly, that opens the door to what are called secondary bacterial pneumonias. When people succumb to seasonal flu, these bacterial pneumonias are often the direct cause.
But at least most bacterial pneumonias can be treated with antibiotics.
There are fewer drug options for viral pneumonia. Of the four antiviral drugs that target flu, this particular bug is resistant to two. That leaves oseltamivir and zanamivir - Tamiflu and Relenza.
For optimum efficacy, they should be started within 48 hours of onset of illness. But, as it recommended for cases of H5N1 avian flu, the WHO suggests longer and perhaps higher doses of antivirals for gravely ill swine flu patients.
People who cannot breath for themselves are placed on a ventilator, which can bridge the patient to recovery. But breathing machines can pose risks as well. A portion of people go on to develop ventilator associated pneumonia.
Beyond that, treatment options are limited.
"It's basically supportive (care)," says Gardam. "You're supporting them long enough for their lungs to heal."
While most so far have survived, the swine flu death toll mounts daily. The ages of the dead are startling for influenza. Within the past several days, two healthy 40-year-old men died - in Winnipeg and in Chile. So did a 20-year-old woman in San Diego, Calif.
"The people who die in the short term die of acute severe lung injury, I think," says Dr. Allison McGeer, an influenza expert with Toronto's Mount Sinai Hospital.
"Now whether that's direct insult from flu, whether that's flu in combination with other viruses ... whether that's flu and bacteria - don't know."
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
(apologies, I screwed up the graph and will repost this evening)
For us, the challenge is to achieve a proper balance between the dire warnings of Chicken Little and the folly of playing ostrich. --Steven M. Wolinsky, Science, Feb. 10, 2006.
--Quiplash.
I've decided that, starting June 15, 2009, I am going to place any flubie posts to three places:
1. FluTrackers.com;
2. curevents.com (my original home); and
3. curevents.org (where the ever-on-top-of-it CanadaSue posts).
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