H1N1 - Are We Ready?

Update Sept. 28: Again, this cannot be overemphasized, that we the public have to realize that hospital staff are already working at full capacity, but the demands on them, on equipment and medications will increase to critical levels. As a community rep on a local ethics committee, I attended some very informative meetings lately, and can say that we are looking at the demands of ICUs possibly doubling, while at the same time, medical staff could be cut in half due to infection and staff family illnesses. So it is up to us the public, and the Dept. of Health to emphasize the need to cover coughs, sneezes, stay clear of anyone sick, avoid touching food or our eyes, nose or mouth with unwashed hands.
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Although the H1N1 virus (or swine flu) is not the category 5 pandemic of 1918 which took 20 million lives, it is a very serious cause for concern right now. H1N1 should NOT be taken for granted as just another flu bug, because it is not! Being a pandemic means that there is practically no immunity to this virus for anyone and it is potentially fatal. People born prior to 1958 may have been exposed to the virus and have a small level of antibodies for H1N1 - that was the last major "swine flu" outbreak. The earliest available vaccine is in November. Health care officials say there have been over 100 cases in Newfoundland by mid September, and a second wave is expected to roll in this fall and winter.

Just over a week ago, there was a provincial ethics pandemic planning day given at the Health Science Centre. The information presented illustrated how dangerous the H1N1 virus is, and the potential new health crisis that can and may develop.

One of the most anticipated and eye-opening sessions was a recap of the Winnipeg experience with H1N1 this year, which was presented at a Health Canada symposium on H1N1. Physicians and policy makers from across Canada attended, including local a intensive-care specialist. What they heard alarmed them. To say the least it was cause for a heightened level of concern.

One message was that, unlike the seasonal flu, it is not primarily the very young and old who are getting seriously ill. 40% of patients requiring ICU treatment were between the age of 15-50. One of the presenters at the Health Canada conference, Dr. Arnand Kumar, reported that young, healthy people were "essentially struck down in the prime of their life" and the hospitals were filled with "rows and rows" of patients in their 20s, 30s, and 40s.

A typical patient, who had been completely healthy, quickly became symptomatic, and required hospitalization. At the peak of the outbreak, Winnipeg's ICUs were beyond capacity, and near breaking points. The equipment and medications required to deal with infections caused by H1N1 were huge. One particular drug supply, which would normally last one year, was used up in 6 weeks. As well, there was a 25% increase in flu-related absenteeism among health care workers themselves.

Young people and aboriginal groups were disproportionately attacked by the H1N1 virus. In fact, 17% of the H1N1 hospital cases were First Nations peoples. Let’s hope that the Federal Government’s special communication initiative, announced Saturday, will adequately inform Aboriginal groups everywhere. Other at risks groups include pregnant women and the chronically ill who had higher rates of ICU admissions and deaths. Experts there warned that hospitals need to get ready for a surge of severely sick patients.

Another related issue was raised at last week's information session as well - ICU's here are already at full capacity. We regularly hear media reports of cancelled surgeries due to a lack of Critical Care beds. So when there are more cases needing ICU care but we have exhausted the space, or staff or supplies, what's to be done? Who gets priority? What is the health care worker's duty to care when they might fear becoming infected themselves? These are real issues with no easy answers at a rare time in disease history.

It is useful to learn from the H1N1 experience of another province so we can better prepare for what may lie ahead in this province. H1N1 is coming again this season but does not necessarily have to be a severe crisis that will paralyze our health care system. It is up to each and every one of us to do our part to reduce the risk of becoming infected and infecting others.

So are we ready in Newfoundland and Labrador? As a citizen I will keep these three public health goals in mind:

1. Delay transmission and lessen outbreak peak
2. Decrease burden on healthcare infrastructure, and
3. Reduce the number of cases

To be part of the solution, wash your hands well and often. Cover coughs and sneezes so others don't have to run for cover. Cough and sneeze into your sleeve or tissue, not your hand. Do not put unwashed hands to your eyes, nose or mouth, or touch food. Avoid close contact if someone is sick, and avoid others if you are sick yourself. Gargle three times a day, even with just water, as this helps eliminate the virus from the throat. These habits will protect you and also minimize possibly spreading a virus to anyone else.

What also ought to be spreading though, is not just communications and information about how to protect ourselves, but hospital plans for health care workers who could run into equipment, drug or space shortages. This concern was expressed at last week’s conference on pandemic planning, and needs to be addressed for front line health care workers.

In the event of illness, individuals need to have plans as well. We can borrow a habit that's also spreading across the world, given the name the "buddy system". Actually it is common sense – if you’re sick, just identify someone to get your meds for example, keep in touch, help look after their needs. But we can extend it a bit to remind friends and family to wash their hands after arriving from anywhere, after touching door handles, etc., to educate people who are still not aware of how flus are transmitted, to communicate to isolated groups or individuals.

This H1N1 pandemic is a rare experience that a society has to deal with. It happens only several times a century. At times like this, do not be surprised to see masks worn by people to reduce their risks of catching or spreading flu viruses. We could even adjust as a society to avoiding the good old handshake for a while, whether it's at work, a party, or at church – surely we can forgive the social faux pas for now.

As one member of the Ethics committee put it, "no one can protect all of us from H1N1 better than ourselves." Again, the impact of H1N1 can be mild if we work together, by simply doing our own part.