The Possibility of Stressed Resources

[indigo girl]

Doctors fear swine flu will stress region's resources

http://www.sacbee.com/topstories/story/2139156.html

With most intensive care units already near capacity, doctors are worried the new H1N1 flu could put added pressure on beds, equipment and health care workers this fall and winter.

While H1N1, also known as swine flu, is mild in most people, those who do become seriously ill can linger on ventilators far longer than other patients in respiratory distress, sometimes needing minute-by-minute care.

"They're not dying, but a lot are spending weeks in the ICU," said Dr. Lewis Rubinson, a Seattle physician involved in federal emergency planning. The amount of care those people need has "huge resource implications," he said.

Doctors have been especially troubled by reports from Australia, deep in its own flu season, that 20 percent or more of ICU beds are being filled with H1N1 patients.

In Sacramento and beyond, doctors said, a similar surge would prompt some hospitals to delay elective surgeries and shift more stable patients out of intensive care to make way for those who are sicker.

Special equipment sometimes used in last-ditch efforts to save patients with failing lungs is almost certain to run short. Because such extreme "salvage" measures are largely unproven, though, no one knows whether running out of the equipment would increase flu death rates.

It is "moderately likely" that UC Davis Medical Center could fill up to the point that "an outlying hospital might want to transfer a patient to us and we won't be able to take them," said Dr. Christian Sandrock, an infectious disease specialist.

Carol Robinson, the medical center's chief patient care services officer, paints a starker picture: "If every hospital has to take 25 percent beyond their capacity with H1N1, everybody is going to be in trouble."

Nationwide, hospitals will probably be able to manage the upsurge in critically ill patients, said Dr. J. Randall Curtis, president of the American Thoracic Society. But his prediction is laced with unease.

"Is it conceivable that we might be in a situation where the need might outstrip the resources? Absolutely," Curtis said. "More probably than not, we would not hit that point ... but 'more probably than not' is not a very comfortable place to be."

Among intensive care doctors in Canada, where one city has already come close to running out of ventilators, "we're all getting increasingly anxious about this," said Dr. John Granton, president of the Canadian Critical Care Society. "Those who have been on the front line of this have been frankly frightened by the prospects."

H1N1 flu, a combination of swine, bird and human strains, drew worldwide attention in spring when it was linked to deaths in Mexico.

As it moved around the globe, doctors began to take the measure of its two faces. Much like seasonal flu, it sends most victims to bed for a few days, feeling miserable before rebounding. Much like seasonal flu, it kills a small percentage of those stricken. About 36,000 Americans die each year of flu, most of them very old or very young.

Two things are different about this flu, though: Because it's new, it could spread to more people. Even if the death rate stays low, that could mean more fatalities - one prediction suggested a U.S. death toll of 90,000.

The other twist is that a different age group is getting very sick - teens, young adults and those in early middle age.

Many of those desperately ill people linger in intensive care wards, their breathing assisted by ventilators. They often need frequent ventilator adjustments, made by specially trained respiratory therapists. Sometimes their kidneys are also compromised.

"These people decompensate very, very rapidly, and become incredibly sick for a long period of time," said Dr. Peter Murphy, director of the intensive care unit at Mercy San Juan Medical Center in Carmichael.

Since July, Murphy has cared for at least five people seriously ill with H1N1, including a pregnant woman whose baby had to be delivered in the intensive care unit because she was too sick to be moved. Most survived, but some will need months of rehabilitation.

(hat tip pfi/monotreme)

[oramar]

This is a shame that this is showing up in the media in late August when it is just about to late to do anything. It was perfectly obvious in April and May that this might be a problem. All you had to do was crunch the numbers. I say to all those people that were worrying about the new healthcare laws pulling the plug on grandma. Very shortly, you are going to have some real world problems.