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B.C. prepares for the next wave of H1N1 swine flu
By Amy O'Brian, Vancouver SunAugust 28, 2009
By the time the next wave of the H1N1 virus hits British Columbia, schools will be back in full swing, temperatures will be dropping, final Olympic preparations will be underway, and the health authorities will be continuing to look for ways to trim their budgets.
Add to the mix the Christmas holidays at the end of December — when doctors and nurses will be taking time off — and the thousands of international visitors who will be here for the Olympics in February, and you have something of a perfect storm for the proliferation of the virus.
Yet public health officials say they’re prepared, even though there is a host of unknowns about the numbers of people who might get sick, how sick they’ll get, and whether the anticipated vaccine will do its job.
Dr. Perry Kendall, chief provincial health officer, is the go-to guy for all things H1N1-related. He has been hard at work planning for the anticipated surge in cases, which is likely to occur sometime in October or November, once kids are back to school and the weather starts to get wetter and cooler.
He and his colleagues have been looking to the southern hemisphere — where winter is coming to an end — to get a sense of what might happen here.
He has been crunching numbers to determine how many people here might get sick, how many might end up in hospital and how many might die.
Kendall says about 85 per cent of his time since May has been devoted to H1N1.
But even though public health officials have been planning for the worst, Kendall maintains that the predicted surge in H1N1 cases is likely to be no worse than a bad year of seasonal flu, which we see on a fairly regular basis.
“We might estimate, based on what they saw in Australia, we could see up to 20 per cent of the population infected,” Kendall said.
People over the age of 55 don’t seem to be affected nearly as much as the rest of the population, so that age group can be excluded from most of the predictive modelling.
So far in B.C., there have been about 800 lab-confirmed cases of H1N1, about one-third of which have been in school-age children, aged five to 19. Of those cases, 42 have been deemed severe by the BC Centre for Disease Control.
But to get an idea of the actual number of H1N1 cases in B.C., Kendall says the number of lab-confirmed cases should be multiplied by 20 or 30 because very few people actually get tested for the virus.
As many as 5,000 people may end up in hospital as a result of the virus, but the death rates are not expected to greatly exceed those we would normally see in a bad flu season.
Each year in B.C., there are 400 to 800 flu-related deaths.
Fraser Health plans
The province is taking the lead on communications and planning, but hospitals and health authorities are doing their part to prepare for the expected surge in H1N1 cases.
At the Fraser Health Authority, Dr. Roland Guasparini says he’s spending about 60 per cent of his time on work related to H1N1.
He and his colleagues are referring to the health authority’s pandemic influenza preparedness plan — a thick document every health authority has on hand — and working out details surrounding ventilator availability, ICU beds, triage and staff education.
At the moment, Guasparini says the planning is being guided by realistic estimates of the number of hospitalized cases.
“I think we still need to do the worst-case scenario,” he said.
“Flu bugs are unpredictable, so we certainly want to be ready in the event this becomes more severe. But the realistic planning we’re doing now is for the existing severity and there’s enough to do just with that.”
In some Canadian cities, such as Edmonton, health officials are planning to use large tents or off-site spaces for triage should the need arise. But Guasparini said there are no such plans for Fraser Health.
Meeting rooms and other lightly used spaces inside hospitals and other health authority buildings can be used as needed if there is an influx of serious H1N1 cases. Fraser Health also has a stockpile of a couple of hundred extra stretcher beds, which can be used as needed.
Pressures on intensive care units — ICUs — will be a real concern if many people become critically ill. Patients with compromised respiratory function may need the aid of a ventilator to breathe, and will need to be stationed in an ICU for regular monitoring and care.
To relieve some of the pressure on ICUs, health authorities will postpone elective surgeries that would require recovery time in the ICU, if it’s deemed necessary.
But as Kendall notes, not all the health authorities will experience these pressures at the same time.
“It will vary from area to area, because that’s the pattern we see with influenzas,” he said. “So the contingency plan is basically, ‘If you start seeing pressures on a hospital to the point where you think you might run out of ICU beds, maybe in that area you start cutting back on elective surgeries. Maybe you refer patients to another region that has capacity.’
“So that’s the planning that’s going to be happening at the hospitals in the regional health authorities. How do we move resources around? And how do we move patients around to ensure people get the care they need, irrespective of where it’s delivered?”
One piece of equipment that’s likely to be in high demand if B.C. sees a spike in serious cases is the ventilator.
The province has taken an inventory of needed equipment and medications and found that there are 976 ventilators, enough anti-viral drugs to treat one million people (or a quarter of the population), and a 26-week supply of personal protective equipment, such as masks, gowns, gloves, and syringes.
But Brian Brodie, president of the B.C. Medical Association, said in an interview that only about five per cent of the ventilators are appropriate for treating people suffering from H1N1. However, the federal public health agency is in the process of acquiring more ventilators, and will distribute them wherever they’re needed.
Brodie said his H1N1 concerns are the number of ICU beds, rather than the number of ventilators.
“The bottleneck is not going to be from the number of ventilators. If you look at the Australian data, it looks like we’re okay,” Brodie said.
“What is a potential bottleneck is the number of ICU and [Critical Care Unit] beds. . . . That’s where the problem is because as you know, these beds are not sitting empty. They’re full.”
Temporary clinics
As for concerns that hospitals will be full to overflowing during the Olympics, however, Brodie has been assured that pressures related to the Games will be mostly absorbed by two large temporary medical clinics set up specifically for the event.
Brodie said the two 10,000-square-foot medical facilities will be “completely decked out” and will be able to handle all kinds of cases, from critical H1N1 situations to ankle sprains.
There are no current plans to cancel Olympic spectator events and Kendall said the only real concern surrounding the Olympics is that people will decide not to come to Vancouver out of fear of H1N1.
“Our major concern is that out of unwarranted fear, people won’t come,” he said.
Visitors coming from the southern hemisphere will have already either been exposed to the virus or had a vaccine. Similarly, those visiting from other northern countries will have had the chance to get vaccinated and, by February, most British Columbians will have been vaccinated or exposed to the virus, too.
An H1N1 vaccine is expected to arrive in Canada in November. But Brodie said it’s possible the vaccine won’t be available to the public until early December, depending on how long the clinical trials take.
A great deal of faith is being put into the vaccine, but there is also the possibility that it will not be entirely effective and could even make people sick, as was the case with the 1976 swine flu vaccine, which was linked to a nervous system disorder called Guillain-Barre syndrome.
“It’s going to be somewhat untested. We really don’t have data on what kind of reactions we’re going to see,” Brodie said.
“This is a vaccine that we just will not have up to the regular standards of screening by the time we need to give it.
“There’s just no long-term data about the safety and reactions.”
And as much as the province and the health authorities plot and plan and adjust their respective pandemic plans to meet the ever-changing information coming from the World Health Organization, other countries and other provinces, it is impossible to say exactly what will happen as the flu season progresses.
“This is absolutely shifting sand. It changes every week. You get a new piece of information that leads you down a different path,”
Seven ways for British Columbians to stay well:
1. Stay home when you’re sick or have influenza symptoms. Get plenty of rest and check with a health care provider as needed.
2. Avoid close contact with people who are sick. If you are sick, keep your distance from others to protect them from getting sick.
3. Cover your mouth and nose with a tissue when coughing or sneezing and throw the tissue away immediately. It may prevent those around you from getting sick.
4.Wash your hands. Washing your hands often will help protect you from getting sick. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers.
5. Avoid touching your eyes, nose or mouth. You can become ill after touching a surface contaminated with germs and then touching your eyes, nose or mouth.
6. Stay two metres (six feet) away from people who are sick.
7. Practise other good health habits. Get plenty of sleep, be physically active, manage stress, drink plenty of fluids, eat nutritious foods, and avoid smoking, which may increase the risk of serious consequences if you do contract the flu.
Source: www.gov.bc.ca/H1N1
B.C. prepares for the next wave of H1N1 swine flu
By Amy O'Brian, Vancouver SunAugust 28, 2009
By the time the next wave of the H1N1 virus hits British Columbia, schools will be back in full swing, temperatures will be dropping, final Olympic preparations will be underway, and the health authorities will be continuing to look for ways to trim their budgets.
Add to the mix the Christmas holidays at the end of December — when doctors and nurses will be taking time off — and the thousands of international visitors who will be here for the Olympics in February, and you have something of a perfect storm for the proliferation of the virus.
Yet public health officials say they’re prepared, even though there is a host of unknowns about the numbers of people who might get sick, how sick they’ll get, and whether the anticipated vaccine will do its job.
Dr. Perry Kendall, chief provincial health officer, is the go-to guy for all things H1N1-related. He has been hard at work planning for the anticipated surge in cases, which is likely to occur sometime in October or November, once kids are back to school and the weather starts to get wetter and cooler.
He and his colleagues have been looking to the southern hemisphere — where winter is coming to an end — to get a sense of what might happen here.
He has been crunching numbers to determine how many people here might get sick, how many might end up in hospital and how many might die.
Kendall says about 85 per cent of his time since May has been devoted to H1N1.
But even though public health officials have been planning for the worst, Kendall maintains that the predicted surge in H1N1 cases is likely to be no worse than a bad year of seasonal flu, which we see on a fairly regular basis.
“We might estimate, based on what they saw in Australia, we could see up to 20 per cent of the population infected,” Kendall said.
People over the age of 55 don’t seem to be affected nearly as much as the rest of the population, so that age group can be excluded from most of the predictive modelling.
So far in B.C., there have been about 800 lab-confirmed cases of H1N1, about one-third of which have been in school-age children, aged five to 19. Of those cases, 42 have been deemed severe by the BC Centre for Disease Control.
But to get an idea of the actual number of H1N1 cases in B.C., Kendall says the number of lab-confirmed cases should be multiplied by 20 or 30 because very few people actually get tested for the virus.
As many as 5,000 people may end up in hospital as a result of the virus, but the death rates are not expected to greatly exceed those we would normally see in a bad flu season.
Each year in B.C., there are 400 to 800 flu-related deaths.
Fraser Health plans
The province is taking the lead on communications and planning, but hospitals and health authorities are doing their part to prepare for the expected surge in H1N1 cases.
At the Fraser Health Authority, Dr. Roland Guasparini says he’s spending about 60 per cent of his time on work related to H1N1.
He and his colleagues are referring to the health authority’s pandemic influenza preparedness plan — a thick document every health authority has on hand — and working out details surrounding ventilator availability, ICU beds, triage and staff education.
At the moment, Guasparini says the planning is being guided by realistic estimates of the number of hospitalized cases.
“I think we still need to do the worst-case scenario,” he said.
“Flu bugs are unpredictable, so we certainly want to be ready in the event this becomes more severe. But the realistic planning we’re doing now is for the existing severity and there’s enough to do just with that.”
In some Canadian cities, such as Edmonton, health officials are planning to use large tents or off-site spaces for triage should the need arise. But Guasparini said there are no such plans for Fraser Health.
Meeting rooms and other lightly used spaces inside hospitals and other health authority buildings can be used as needed if there is an influx of serious H1N1 cases. Fraser Health also has a stockpile of a couple of hundred extra stretcher beds, which can be used as needed.
Pressures on intensive care units — ICUs — will be a real concern if many people become critically ill. Patients with compromised respiratory function may need the aid of a ventilator to breathe, and will need to be stationed in an ICU for regular monitoring and care.
To relieve some of the pressure on ICUs, health authorities will postpone elective surgeries that would require recovery time in the ICU, if it’s deemed necessary.
But as Kendall notes, not all the health authorities will experience these pressures at the same time.
“It will vary from area to area, because that’s the pattern we see with influenzas,” he said. “So the contingency plan is basically, ‘If you start seeing pressures on a hospital to the point where you think you might run out of ICU beds, maybe in that area you start cutting back on elective surgeries. Maybe you refer patients to another region that has capacity.’
“So that’s the planning that’s going to be happening at the hospitals in the regional health authorities. How do we move resources around? And how do we move patients around to ensure people get the care they need, irrespective of where it’s delivered?”
One piece of equipment that’s likely to be in high demand if B.C. sees a spike in serious cases is the ventilator.
The province has taken an inventory of needed equipment and medications and found that there are 976 ventilators, enough anti-viral drugs to treat one million people (or a quarter of the population), and a 26-week supply of personal protective equipment, such as masks, gowns, gloves, and syringes.
But Brian Brodie, president of the B.C. Medical Association, said in an interview that only about five per cent of the ventilators are appropriate for treating people suffering from H1N1. However, the federal public health agency is in the process of acquiring more ventilators, and will distribute them wherever they’re needed.
Brodie said his H1N1 concerns are the number of ICU beds, rather than the number of ventilators.
“The bottleneck is not going to be from the number of ventilators. If you look at the Australian data, it looks like we’re okay,” Brodie said.
“What is a potential bottleneck is the number of ICU and [Critical Care Unit] beds. . . . That’s where the problem is because as you know, these beds are not sitting empty. They’re full.”
Temporary clinics
As for concerns that hospitals will be full to overflowing during the Olympics, however, Brodie has been assured that pressures related to the Games will be mostly absorbed by two large temporary medical clinics set up specifically for the event.
Brodie said the two 10,000-square-foot medical facilities will be “completely decked out” and will be able to handle all kinds of cases, from critical H1N1 situations to ankle sprains.
There are no current plans to cancel Olympic spectator events and Kendall said the only real concern surrounding the Olympics is that people will decide not to come to Vancouver out of fear of H1N1.
“Our major concern is that out of unwarranted fear, people won’t come,” he said.
Visitors coming from the southern hemisphere will have already either been exposed to the virus or had a vaccine. Similarly, those visiting from other northern countries will have had the chance to get vaccinated and, by February, most British Columbians will have been vaccinated or exposed to the virus, too.
An H1N1 vaccine is expected to arrive in Canada in November. But Brodie said it’s possible the vaccine won’t be available to the public until early December, depending on how long the clinical trials take.
A great deal of faith is being put into the vaccine, but there is also the possibility that it will not be entirely effective and could even make people sick, as was the case with the 1976 swine flu vaccine, which was linked to a nervous system disorder called Guillain-Barre syndrome.
“It’s going to be somewhat untested. We really don’t have data on what kind of reactions we’re going to see,” Brodie said.
“This is a vaccine that we just will not have up to the regular standards of screening by the time we need to give it.
“There’s just no long-term data about the safety and reactions.”
And as much as the province and the health authorities plot and plan and adjust their respective pandemic plans to meet the ever-changing information coming from the World Health Organization, other countries and other provinces, it is impossible to say exactly what will happen as the flu season progresses.
“This is absolutely shifting sand. It changes every week. You get a new piece of information that leads you down a different path,”
Seven ways for British Columbians to stay well:
1. Stay home when you’re sick or have influenza symptoms. Get plenty of rest and check with a health care provider as needed.
2. Avoid close contact with people who are sick. If you are sick, keep your distance from others to protect them from getting sick.
3. Cover your mouth and nose with a tissue when coughing or sneezing and throw the tissue away immediately. It may prevent those around you from getting sick.
4.Wash your hands. Washing your hands often will help protect you from getting sick. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers.
5. Avoid touching your eyes, nose or mouth. You can become ill after touching a surface contaminated with germs and then touching your eyes, nose or mouth.
6. Stay two metres (six feet) away from people who are sick.
7. Practise other good health habits. Get plenty of sleep, be physically active, manage stress, drink plenty of fluids, eat nutritious foods, and avoid smoking, which may increase the risk of serious consequences if you do contract the flu.
Source: www.gov.bc.ca/H1N1