Our local experience dealing with H1N1 - Dr. Peter Zalan

According to statistics compiled late last month, the Sudbury Regional Hospital had 17 confirmed or suspected H1N1 patients in isolation. Six of these patients are being treated in our Intensive Care Units (ICU). Cumulatively, since the start of the outbreak in early October, we have had 20 H1N1 patients in Sudbury’s ICU. These patients have been very sick, with long stays in ICU, on mechanical ventilation. Two patients have died.

Across Canada, there was an earlier wave of swine flu (H1N1) from April 12 to Aug. 29. During that time, 1,492 people were hospitalized and 76 died. In the second wave so far, approximately 1,000 people have been hospitalized by the start of November, with about 76 deaths nationally.

It is not the elderly and infirm who are carried off by the H1N1 influenza virus, as in past epidemics. Our Sudbury patients have varied in age between 25 and 65. Only half the patients had serious medical conditions prior to illness.

The other half were relatively healthy before infection. H1N1 has a nasty effect on lung cells. It is a cousin of the Spanish flu, that killed millions in 1918 and 1919.

The key fact is that in 2009 prevention is available for H1N1. Unrestricted vaccination is now available across Canada. The pandemic is not over. Our patient numbers have reached a plateau in Sudbury, but have not fallen. A third wave may be upon us next spring.

So it comes as a most curious fact that many folks do not want vaccination. Some have expressed the fear that the vaccine was rushed out too soon. Some recall reading articles about neurological syndromes post vaccination. This occurred with rarity in the 1970s and has not been reported since. Some folks complain of vague flu-like symptoms for a few days post injection.

With any medical intervention, whether a pill, surgery, or in this case vaccination, one needs to do a harm/benefit

analysis. Compare the benefit of avoiding multiple organ failure and death versus the risk of mild flu-like symptoms for a few days. All of our intensive care doctors have chosen vaccination.

Vaccination has a proud history of success. As recently as the twentieth century, smallpox was estimated to have been responsible for 300 to 500 million deaths. After successful vaccination campaigns in the 19th and 20th centuries, the World Health Organization (WHO) certified its eradication in 1979. Polio was one of the most dreaded childhood diseases of the 20th century, epidemics leaving crippled children in its wake. Vaccines developed in the 1960s have almost eliminated this disease.

The fact is that we are witnessing the largest mass vaccination program in Canadian history.

It comes as a curious fact that in a recent survey, only 39 per cent of Canadians thought that government has done a good job responding to the H1N1 pandemic. After all, there were not enough doses available to treat everyone. It arrived after the onset of infection in Canada. The vaccine was rushed out too soon without adequate testing. There were long lineups to get vaccinated.

The fact is that we are witnessing the largest mass vaccination program in Canadian history. Although the world only learned of the appearance of H1N1 in Mexico in April, although the WHO only declared a pandemic in June, Canadian vaccination began in late October. It is no easy task to isolate the virus, grow it in large amounts, create a huge amount?of vaccine and check the safety?and purity of it,?in such a short?time.

Probably unknown to the public is Ontario’s surge planning for pandemics, which started after SARS. Ontario’s Critical Care Secretariat, in conjunction with our LHINs, developed a database of critical care capacity, systematically enlarged that capacity, and developed the infrastructure to permit hospitals to share capacity. When our ICU was overwhelmed with critically ill, unstable H1N1 patients, hospitals in Sault Ste. Marie, North Bay, and London accepted four of our more stable patients in transfer. Sudbury Regional Hospital has daily morning meetings to ensure that resources are available to deal with the admission of new H1N1 patients. Our public health unit has concentrated its resources on the vaccination program.

As a community we have a lot to be grateful for. Please get vaccinated.

Dr. Peter Zalan is a critical care physician at the Sudbury Regional Hospital.