Swine flu fears spur Canada to stock up on ventilators

[indigo girl]

Swine flu fears spur Canada to stock up on ventilators

http://www.theglobeandmail.com/news/national/swine-flu-fears-spur-canada-to-stock-up-on-ventilators/article1207344/

Critical ventilators to help Canada cope with the swine flu outbreak are being ordered by the federal government amid dire warnings about the severity of this fall's flu season.

As the pandemic spreads globally, Canadian public health findings show - for unknown reasons - that victims here have been younger and sicker, and have required more ventilators than most other countries, including the United States.

For years, medical experts have been worried about the small number of intensive care nurses who would be available to treat patients during an influenza pandemic. But the first wave of the H1N1 virus, which killed 29 people in Canada and sent 663 to hospital as of Friday, has exposed another shortfall in national pandemic planning: the number of ventilator machines.

"It appears that there is a sub-population of relatively young people who very rapidly develop severe illness with this virus. And they are not a large number, but they require very intensive ventilatory support with new advanced ventilators," said Allison McGeer, an expert in infectious disease at Mount Sinai.

"We have very few oscillatory ventilators. We generally don't need them very often and usually it's for a very short period of time. So these young people are requiring a disproportionate amount of time on ventilators that we have very small numbers of."

Each jurisdiction has its own stockpile. And the Public Health Agency of Canada owns 130 that are to be distributed to the provinces and territories as they request them. Fifteen of them were recently sent to Manitoba where, a week ago, 38 ICU beds were occupied by patients on ventilators.

The federal agency "is currently in negotiations to purchase additional ventilators to increase its stockpile to 500," a spokeswoman said.

That means they're planning to buy 370 ventilators, which, at a cost of about $10,000 each, would mean an outlay of $3.7-million.

"I think it would be prudent to review the Manitoba experience and understand where our strengths are and where our weaknesses are. And certainly the issue of ventilator capacity is something that we ought to be paying attention to nationwide," Dr. Kumar said.

Dr. David Butler-Jones, Canada's chief medical health officer, said in a teleconference from Mexico last week that H1N1 is not going away.

"The one thing, to the extent that you can be certain about anything, is that we will definitely see this [disease] this winter and preparing for that," Dr. Butler-Jones told reporters.

In Ontario, there are 8,000 ventilators, about 1,100 of which are attached to critical-care beds. "If there is a large-scale health emergency, it comes down to the fact that you're dealing with only so many resources," said David Jenson, a spokesman for the province's Health Ministry.

That's why the Ontario pandemic plan contains a triage protocol that provides guidelines for decisions around optimal use of such things as ventilators, Mr. Jenson said.

The Canadian Pandemic Influenza Plan cites a research paper called Stand on Guard for Thee that was produced in 2005 by the Joint Centre for Bioethics of the University of Toronto. It identifies many of the ethical issues that could arise during an influenza pandemic, including the allocation of scarce resources such as ventilators.

Dr. Ross Upshur, director of the centre and one of the authors of the study, said it was always assumed that ventilators would go to younger people who have not lived full lives, rather than to older people, if tough choices had to be made.

But because this flu disproportionately hits younger people, it has become a choice of giving them to one young person or another young person, Dr. Upshur said. "This is a scenario that no one had actually anticipated."

[oramar]

Two thumbs up to the Canadian health service for recognizing this problem. The problem here in the US is different in that our health care is so decentralized. Whether you can handle large numbers of people on vents in any area totally depends on the local conditions. I think in the Pittsburgh area we can handle a heavy load of sever flu cases though it is NOT unlimited. Go to central Pa and their death rates will be much higher because they just don't have facilities or staff. I can't speak to things in Eastern Pa am I wondering how things are in Philly?.