Canada - We Must All Work Together

indigo girl · Jun 16, 2009

http://www.pddnet.com/news-ap-hl-swine-flu-is-hitting-first-nations-in-manitoba--061509/

Two points stand out for me in this article. The first is that two pregnant women suffered severe complications. The second is the reference to secondary pnuemonia, and that people can recover and then relapse from flu.

Manitoba's top doctor says it does appear that swine flu is hitting First Nations people in the province harder than non-aboriginal Manitobans.
"It appears from our information that . . . (among) our most severe cases, there's an over-representation from a population and demographic perspective, of First Nations and aboriginal people," Kettner, the chief medical officer of health, said Monday in an interview from Winnipeg.
He said his staff have been analyzing hospital admissions and other types of data to see who is getting sick and who among them is getting most severely ill.Epidemiological information like that is critical for public health officials trying to tailor advice on reducing risk of exposure. As well, authorities will need to know who is at highest risk so that they can revise priority lists for pandemic vaccine when it becomes available.
Kettner said two-thirds of 24 Manitobans in intensive care units fighting swine flu last week were First Nations people. Given that aboriginal peoples make up only 10 to 15 per cent of the population of the province, that seems an unduly large proportion, he said.
The average age of those in this ICU cohort was 35 years old-an unusually young age for people to need ICU care for flu.
"We're seeing very few people in intensive care older than 55," said Kettner. "And we're seeing very few infants, or under two (years of age)."
Chief David McDougall's northern Manitoba community of St. Theresa Point has had 27 people transported south for treatment of swine flu. Some of the people who have become severely ill aren't among those one would typically expect to see hospitalized for flu, he said. "I know some of the people. And some people were in relatively good health," McDougall said. Two were pregnant women. One miscarried, the other had to have her baby delivered by caesarean section.
A problem Sandy Lake is starting to see is secondary health problems setting in for people recovering from the flu, Fiddler said. The cases, still few in number, may be pneumonia, he suggested, adding people are being urged to seek care if they seem to be regressing after recovery. One of the recent evacuees had earlier recovered from H1N1 flu, he said.
Kettner acknowledged that epidemiologists might argue that the relative high numbers of First Nations people in Manitoba's ICUs may reflect the fact that more aboriginal people have been infected to date. Kettner travelled to St. Theresa Point last Friday with Manitoba Health Minister Theresa Oswald.
He said his staff are at work trying to tease out more details of what is going on. He said they are conducting a very detailed epidemiological analysis of all respiratory infections in at least one community and maybe more. He would not name the community or say whether it is a First Nations reserve. Kettner said figuring out whether First Nations people are being disproportionately harder hit is a necessary part of understanding swine flu.
"It may be an important indicator, not only of understanding the disease with respect to who gets most severely ill, but also it's just a marker to say 'Well, if that's the truth, whatever the reason is, people who are aboriginal or people ... looking after people who are aboriginal should be aware of that fact,'" he said.
The findings might guide how care is prioritized, he added.

(hat tip Avian Flu Diary)

lamazeteacher · Jun 16, 2009

It may be less expensive to send medical teams with needed supplies to the First Nations people, rather than have them enter areas with large populations that have myriads of organisms unencountered before by the isolated communities.

The stress of them travelling to formidable medical facilities could bring on more medical challenges, and then the number of those becoming ill would expand.

indigo girl · Jun 16, 2009

Lake of the Woods District Hospital

No Visitors - Until Further Notice

http://www.lwdh.on.ca/

Do they mean the whole hospital is closed to visitors?

We are currently experiencing an increase in numbers of patients with respiratory illness on our Complex Care Unit (2 East). As well we are aware that a large number of people in the community are sick with a respiratory illness. In order to protect our patients from unintended exposure to this illness we will not be allowing visitors in the inpatient units until further notice. We appreciate the cooperation of the public in protecting our patients.

lamazeteacher · Jun 16, 2009

:argue:

Lake of the Woods District Hospital
No Visitors - Until Further Notice
http://www.lwdh.on.ca/
Do they mean the whole hospital is closed to visitors?

-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-

That sounds like an excellent preventive move to me (and it will conserve PPE).

If I'd told the hospital where I worked as the Infection Control Nurse years ago, that visitors had to be prevented from coming into the hospital, I'd need support from our (politcally motivated Chairperson of the Infection Control Committee), the Chief of Medicine (who would sway as the wind blew), and the CDC and NIH, (they'd backtrack at 100 MPH). Then families and friends of patients would probably let out a hue and cry, getting in touch with their political representatives, to be allowed in. :argue:

In Toronto, during the SARS episode, visitors were barred from the floor where patients with SARS were, and there were pictures in newspapers showing their visitors outside the building, waving to their family members. If a close family member of a patient was there already when the restriction decision was made, they weren't allowed to leave that unit - although in the first few days of the episode, the wife of the 2nd patient to die (he'd been given the possibly unsanitary hospital room where the 1st patient (from China) died shortly after admission) was allowed to go to her daughter's home, as the daughter had already been exposed, too. :cry:

They were quarantined there for a week or so, during which the wife died after being admitted to that hospital, a day after leaving it. She and her husband (who had a cardiac problem responsible for his admission) were neighbors of my sister, on the 28th floor (with 6 condo's per floor) of their building. As you'd imagine, taking the elevator wasn't a choice there. It seems the virus didn't survive for more than a few minutes outside bodies, as no one who took the elevator after that couple did, caught SARS. The danger was so downplayed, that my (older) sister insisted that I follow through with our plans for me to come there that week, from CA. I said, "I don't think so........" :nono:

The most frightening thing about SARS, was that it's onset was rapid after exposure, with death occuring quickly. Nurses who had s/s of SARS at that hospital stayed there as inpatients. If they were at home when they developed s/s of SARS that weren't severe, they stayed there in quarantine, unless they had to be admitted due to lung complications. The Infection Control Nurses there were in charge of the measures taken and issued all official measures to contain the disease. Several nurses wrote articles in Canadian nursing journals about their experiences (which I may still have, in CA, but I'm in VA getting packed to go back there......). :down:

H1N1 has a longer incubation period (2 days to a week) and becomes severe (with secondary infections) in formerly compromised people and pregnant women only, and therefore is much less risky. The surprising thing about it, was the largest age group involved (those from 20 - 40 years of age), who usually are hale and healthy, resisting illness longer than others who are younger and older. The lack of susceptibility of seniors may indicate some previously acquired immunity from earlier experience(s) with a version of H1N1. :up:

indigo girl · Jun 17, 2009

Manitoba cases now at 226 after 74 new ones confirmed Tuesday

http://www.cbc.ca/health/story/2009/06/16/mb-swine-flu-death-manitoba.html

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 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."
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."
In Manitoba, the most severe cases of swine flu have involved aboriginal patients.
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.

(hat tip flutrackers/quiplash)