Via Google News, Helen Branswell of The Canadian Press has today's must-read: ICU docs who rode H1N1's first wave warn colleagues of what's coming. Excerpt:
Intensive care specialists who rode H1N1's rocky first wave are warning colleagues who've yet to see many of these difficult patients what they have in store.
ICU specialists from Mexico, Toronto and Winnipeg laid out their experiences before a standing room-only crowd Monday at the Critical Care Canada Forum, an annual meeting of intensive care specialists.
"There's very limited capacity to care for patients from the perspective of manpower and the perspective of machines and ventilators in certain parts of the country," Dr. Rob Fowler, an intensive care specialist at Toronto's Sunnybrook Health Sciences Centre, said on the sidelines of the meeting.
"That's because usually the need isn't there. And we're coming into a time when the need may be there and may be disproportionately there in some regions over others."
Fowler was one of the speakers and is one of several researchers internationally who are involved in trying to detail for the rest of the medical community what severely ill swine flu patients go through and how ICU teams have managed to pull survivors through.
He thinks the country will face a challenging time.
"Our system, whether we're in the middle of an urban centre in Canada or if we're in Nunavut or Northwest Territories is, I think, at the baseline usually stretched pretty tightly," said Fowler.
"We operate in the Canadian health-care system without a lot of margin. And that holds for the ability to transport people from one place to another. It certainly holds for transportation capacity in the North."
The bulk of the first wave activity was centred around a few places, Toronto and Winnipeg among them. That means many doctors elsewhere have only seen a few of these cases and may not fully understand what it will be like if their area gets hit with a lot of activity, said Dr. Anand Kumar.
Kumar is an infectious diseases and intensive care specialist in Winnipeg; he was in the thick of it last spring when that city's ICUs were jammed with more than five dozen gravely ill H1N1 patients.
"You've got to see it to believe it," he said. "Honestly, when we got hit, I had a little bit of a difficult time convincing people that we had a serious problem."
The "it" Kumar referred to is bed after bed filled with patients whose lungs are so overwhelmed by their infection they cannot breathe on their own. These aren't the seniors who flu normally attacks. They are teens. They are people in their 20s, 30s, 40s and 50s.
In terms of the overall population, their numbers aren't enormous. But the gravity of their illness makes a huge impact on ICU staff who have had to resort to extraordinary measures to keep these patients alive.In earlier pandemics, one widespread effect seems to have been mass amnesia: When people stopped dying, the survivors forgot about what had killed them.
Having forgotten, people had no reason to demand a stronger public health system, better training for healthcare workers, more surge capacity than absolutely needed. So politicians had no reason to tax the voters to pay for such idle luxuries.
In effect, they passed the costs of the next pandemic straight on to its victims: the asthmatic kids, the pregnant mothers, the diabetics, and even the apparently healthy young people who are now dying from Vancouver to Pune to Madrid to São Paulo.
Maybe this time we'll remember what happened, and the price the victims paid.
