Announcement

**Gert van der Hoek** · October 15, 2009, 04:44 AM

Re: Suspected A/H1N1 flu deaths probed- Two Die From Swine Flu

3rd victim suspected

2 DIE FROM SWINE FLU

By Leiselle Maraj and Cecily Asson Thursday, October 15 2009

Health Minister Jerry Narace yesterday confirmed two men have died from the virus at the San Fernando General Hospital on Tuesday night.

?It is indeed difficult and sad for any Minister of Health to report fatalities to the nation. And although on a scientific level we expected this, on the human level, it remains disheartening and frustrating to lose lives to this new virus,? Narace said at a press conference yesterday at the ministry?s head office, Park Street, Port-of-Spain.

Another person also died at the hospital yesterday morning but the minister could not confirm if this was another swine flu victim as investigations were continuing into the cause of death. The sex of the deceased was not disclosed, although a hospital source said the victim was a woman.

The deaths of the two men come as a second wave of the virus hits many countries.

Dr Albert Persaud, executive medical director of the South West Regional Health Authority (SWRHA), said the first case was a 30-year-old man who went to the hospital 24 hours before he passed away. He described the man as being extremely ill because he was in respiratory distress when he was admitted to the Intensive Care Unit of the hospital.

Hospital consultants, specialising in severe respiratory illnesses, attended to the patient.

?The symptoms were so severe that he was placed on a machine to assist with his breathing. Unfortunately the illness proved to be more than the treatment offered and he passed away last (Tuesday) night,? Persaud said.

The second patient was a 42-year-old man who was admitted to the hospital from an unnamed private health institution also in severe respiratory distress. Similar treatment was administered but this patient also died on Tuesday night. Persaud said the fact that both men were admitted at such a late stage of the virus increased their risk of death.

Narace and Persaud said proper protocols were followed at the hospital but a team of ministry and SWRHA officials are conducting an audit into the treatment of the two men.

Narace added the treatment the second patient received at the private institution before being admitted to the hospital is also being investigated. He said based on the findings, the ministry hopes to issue policy statements advising the public to not wait until it was too late to seek treatment for symptoms of the virus. Officials are also conducting surveillance of family members, hospital staff and others who came into contact with the victims.

There have been 158 confirmed cases of swine flu in the country with the two deaths. According to statistics from the Pan American Health Organisation (PAHO) 3,406 deaths have been reported in 25 countries of the Americas.

Narace said PAHO has approved Government?s request for 260,000 doses of the Influenza A/ H1N1 vaccinations and the ministry is expecting delivery next month.

Chief Medical Officer Dr Anton Cumberbatch, who was also at the press conference, warned, ?We have always maintained that even though the presentation of the virus in Trinidad and Tobago is mild, it remains dangerous which is why we keep insisting serious attention be paid to it.? Although when questioned about the names of the dead victims and the areas where they lived, Cumberbatch said this information remained confidential. When asked whether there was a possible link between these cases since both men died within hours of each other, Cumberbatch said deaths in areas where there is a swine flu outbreak are common.

However, a medical source at the hospital said the two men who died were from Princes Town and Penal. The third death which may have been due to the virus was a woman from Princes Town, the source said.

The woman was admitted to the hospital on Monday and was ?extremely ill? the source said. However, because there were no beds available on the medical wards, the woman remained screened off on a gurney in an emergency room in the Accident and Emergency department up until the time of her death. The source said there was great concern among medical staff when a doctor received the X-Ray results of the woman.

?When the results came in, you couldn?t even make out her lungs. It was very bad,? the source said.

?Her condition was deteriorating so quickly she was experiencing severe respiratory problems and had to be put on a ventilator.? The source said the woman died early Tuesday morning, hours before the deaths of the two men. A staff meeting was held on Tuesday and masks were distributed to health workers and the ambulance bay was cordoned off.

A senior doctor told Newsday the virus appears to not be responding to antibiotics. ?It seems to be very vicious, it seems to be very different from what we have seen before,? the doctor said. In the release issued Tuesday night, the ministry said while two patients had died at that time, five more people were hospitalised with respiratory symptoms, four of whom were on respiratory support. The medical officials at the press conference yesterday said they had no additional information about these persons.

Cumberbatch said all necessary precautions are being taken at the hospital. ?We have sanitised the area and distributed masks and personal protective gear to all hospital staff. Although there are no confirmed cases on the paediatric ward, all health professionals are being advised to wear protective gear to prevent the spread of the virus,? he said. As for the Commonwealth Heads of Government Meeting it remains on schedule for the end of November, said Narace, since the vaccinations will be administered strategically to persons and workers in high risk categories.

Also yesterday there were unconfirmed reports that a student of Exchange Presbyterian Primary School had contracted the virus. Parents rushed to the school at Bryce Street, Couva to take their children home from as early as 12 noon when word spread that a student had symptoms of the virus. This latest incident comes after Grant Memorial Presbyterian School in San Fernando was closed for a week last month when three students contracted swine flu.

source: newsday.co.tt

**Shiloh** · October 16, 2009, 07:36 AM

Re: Suspected A/H1N1 flu deaths probed - Two More Die From Swine Flu

Source: http://www.newsday.co.tt/news/0,109260.html

2 more suspected swine flu deaths

By Odette Loney Friday, October 16 2009

There are new reports of two suspected swine flu deaths at the San Fernando General Hospital.

If health officials confirm these two cases the death toll from swine flu, medically referred to as Influenza A/H1N1, will rise to four.

Sources said one of the patients died on Wednesday night and the other yesterday morning.

Health Minister Jerry Narace yesterday said a statement will be issued once there is confirmation of any new deaths due to the virus.

On Wednesday, Narace disclosed two men died of swine flu at the hospital the day before.

Tests were being done to determine if a third patient had died from swine flu. The results are yet to be released. However, Newsday sources identified the patient as a woman from Princes Town and yesterday her family reported she died from pneumonia.

Marina Jattan said an autopsy on her mother Cynthia Jattan, 42, confirmed she died from pneumonia and not swine flu.

?There was nothing about swine flu on the death certificate. Doctors told me that tests came back negative,? Jattan told Newsday.

Jattan was admitted to the Intensive Care Unit of the hospital on Monday with high fever, vomiting and diarrhoea and although doctors attempted to aid Jattan?s breathing by inserting a tube into her lungs her condition worsened and she died on Tuesday.

On Wednesday, Chief Medical Officer Dr Anton Cumberbatch said the hospital had been sanitised and masks and gloves were given to staff. The Ambulance Bay was placed on a two-day quarantine which was lifted yesterday. Ambulances once more parked at the stations and attendants wore masks, gloves and coveralls for protection. Security guards and persons visiting the hospital also wore masks.

Responding to Narace?s disclosure that 260,000 doses of the swine flu vaccine would arrive in the country next month, secretary general of the Medical Professionals Association (MPATT) Balkaran Ramkissoon yesterday advised the ?efficacy of the vaccine is limited? and may have side effects.

?The vaccine may only result in reduced symptoms in some persons. Accordingly, in spite of a vaccine being available and the public being immunized, severe illness may still be caused by the swine flu virus,? Ramkissoon said in a release.

Ramkissoon said there is a need for proper clinical management which includes intensive care and he warned public health institutions may fail to adequately address a swine flu outbreak.

However, staff at several health centres which Newsday contacted said they were prepared to treat cases of the virus and information campaigns are still underway to combat its spread.
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**Shiloh** · October 16, 2009, 07:38 AM

Re: Suspected A/H1N1 flu deaths probed - Two More Die From Swine Flu

Source: http://www.trinidadexpress.com/index...s?id=161544910

Penal man believed to be another H1N1 victim
Aabida Allaham aallaham@trinidadexpress.com

Friday, October 16th 2009

ANOTHER person has died at the San Fernando General Hospital from suspected Influenza A H1N1, the Express has learnt.

The 28-year-old Penal resident, who only got married last month, spent three days warded at the Intensive Care Unit (ICU) with a severe respiratory illness, and hospital officials believe it is directly related to the swine flu. He succumbed to his illness around 10 a.m. yesterday.

Attempts by the Express to get confirmation from the Ministry of Health of the number of swine flu deaths as of yesterday proved difficult, as officials were reportedly in a closed meeting up to late last night.

San Fernando yesterday told the Express "there are no more suspected cases in the ICU". But after lunch yesterday, another patient from the casualty ward was diagnosed with the virus, while two other patients in Ward 2 were also suspected of contracting it. As a result, the hospital started using the ward as a holding bay for patients suspected of having the virus.

While restrictions at the ICU were removed yesterday, the situation at the hospital was still tense. The Express understands that some nurses were refusing to wear their safety gear or masks to guard against the outbreak of the disease.

Meanwhile, in a press release yesterday, the Medical Practitioners Association of Trinidad and Tobago (MPATT) said it is plain to see the health system is not equipped to deal with the second wave of swine flu.

MPATT said Government's failure to increase institutional capacity will no doubt result in its incapacity to cope with the demands of a severe swine-flu outbreak.

"For nearly a decade, MPATT has been repeatedly pointing out that our public healthcare infrastructure has been deteriorating and continues to do so more rapidly now. ... Our public institutions do not have the capacity to manage the basic demands required of our population, and has been struggling to cope with the demand of only the urgent and emergency cases," the statement said.

While addressing members of the media at a news conference on Wednesday at the Ministry of Health in Port of Spain, Pan American Health Organisation (PAHO) country representative, Dr Carol Boyd Scobie, said obese people were on top of the "high-risk list".

Researchers have also said obese people who do not have underlying health conditions and are otherwise healthy, still may be at special risk.

-With reporting by

Louis B Homer

**Shiloh** · October 16, 2009, 08:18 AM

Re: Suspected A/H1N1 flu deaths probed - Two More Die From Swine Flu

Source: http://www.trinidadexpress.com/index...s?id=161544906

Family relives victim's ordeal
Richard Charan Editor South Bureau

Friday, October 16th 2009

Vishraj Maharaj is one of the confirmed victims of the H1N1 Influenza virus-a man who moved from healthy to heart failure within six days.

Maharaj, a 30-year-old truck driver and used-car businessman, died at 7.30 p.m. on Tuesday in the Intensive Care Unit of the San Fernando General Hospital (SFGH).

He was a non-smoker who drank no alcohol and had no history of serious illness.

But in his final days, family said, Maharaj's trembling body was wracked with pain, his lungs collapsed, he bled through the mouth and nose, and was kept alive by a ventilator until a third heart attack killed him.

The death certificate gave the cause of death as broncho-pneumonia.

Maharaj's relatives said yesterday they were never told he was being treated for swine flu.

At least 20 family members were allowed to see him shortly before he died. They said they were allowed into the ICU two at a time, sharing two masks and aprons.

On Wednesday, the SFGH took a decision to restrict access to the facility's ICU to only hospital staff wearing protective gear.

Maharaj's sister, brother, niece and nephew have also fallen ill and suspect they have contracted the virus. Only the nephew is in hospital. The others intend being at Maharaj's funeral today.

Health officials promised to visit the family to test them for the virus.

On Wednesday, Maharaj's home at Realize Road, Barrackpore, was sprayed with a chemical by Health Ministry officials.

Maharaj was one of two people whose deaths from the virus was announced in a press conference by Health Minister Jerry Narace on Wednesday. The identity of the dead were not disclosed by Narace, citing patient confidentiality.

However, yesterday, Maharaj's family insisted that the details of how Maharaj died must get out. It would be, they said, the ultimate public service message for citizens.

Maharaj sister, Pamela Jaganath, 36, said it was last Wednesday that he fell ill while at work at a trucking company at Preysal, Couva.

She said, "He had body aches, pains, fever, a sore throat, the cold. Our brother had to go to his workplace to pick him up because he was shaking, unable to move properly."

That night, she said, Maharaj was taken to a private doctor in Penal, given medication and sent home.

When his condition did not improve, Maharaj was taken back to the doctor, who administered the same treatment and diagnosed him as having a bad case of the flu.

Maharaj fought the illness at home until Monday.

Jaganath said, "He got up about 3 a.m. and filled the water tanks. By 5 a.m., he could not even walk. He asked my mom for help. He said he could not breathe."

At 8.30 a.m. Monday, Maharaj was taken to the Princes Town District Hospital.

One of his sisters said, "They put him on a ventilator. But they could not revive him. He stayed there until 1 p.m. before they took him to the San Fernando General Hospital."

She added, "I reached there to see him hook up (on all the machines), froth coming from his mouth, gasping for breath, doctors all around."

By 9 p.m., doctors were telling the family that Maharaj's condition was grim.

Jaganath said, "Even then, doctors were saying they could not understand how a healthy strong man like this could reach this stage, and begin bleeding internally."

On Tuesday morning, Jaganath said she was given a prescription by a hospital doctor to purchase a drug called flucloxacillin at a Port of Spain pharmacy that could help Maharaj. She said, "We felt good. Here was our chance to save his life. We never found the drug."

At 4 p.m. Tuesday, the family learnt that Maharaj's heart had stopped twice.

Jaganath said, "The doctor came out, told us his third heart failure would be the end. We were asked to come in to see him in twos. We wore an apron and a mask which we all shared, and no gloves. It was not a sight."

The family was told that health officials would come to the home yesterday to test for the swine flu. They had not come up to late yesterday.

Maharaj was unmarried and lived with his mother. He was one of 11 siblings.

**yielddude** · October 16, 2009, 08:42 AM

Re: Suspected A/H1N1 flu deaths probed - Two More Die From Swine Flu

"But in his final days, family said, Maharaj's trembling body was wracked with pain, his lungs collapsed, he bled through the mouth and nose, and was kept alive by a ventilator until a third heart attack killed him."

These symptoms are particularly disturbing to me, reminiscent of 1918. And it appears that it is spreading efficiently. Hopefully these are isolated cases, but bear watching closely.

**Shiloh** · October 16, 2009, 10:12 PM

Re: Suspected A/H1N1 flu deaths probed - Two More Die From Swine Flu

Source: http://www.trinidadexpress.com/index...s?id=161545375

Common bond: H1N1 flu victims were all overweight
Camille Bethel cbethel@trinidadexpress.com

Saturday, October 17th 2009

The Health Ministry yesterday confirmed four deaths from the Influenza A/H1N1 virus. The victims all had a common link-morbid obesity.

The victims-three men and one woman-died in the Intensive Care Unit of the San Fernando General Hospital this week. Another man also died at the facility, but from seasonal flu.

Yesterday, executive medical director of the hospital Dr Albert Persad said the international literature confirms that people who are excessively overweight suffer more severely from the virus. "So that it is now a very strong contender as a risk factor for people with H1N1 illness to progress to a very severe level."

Vishraj Maharaj, 30, one of the confirmed "swine flu" victims who died on Tuesday, was overweight, but in otherwise good health.

Persad said at any stage, the illness can progress to a critical level.

"We have now only started to see the severe forms of the illness... we are only one or two weeks into this and... it is always difficult to tell the extent to which the virus will affect people in the community and how many people will continue into the moderate or severe stage."

The dead are all believed to be from a relatively small area of Trinidad and epidemiologists are trying to find out if the victims made contact.

Persad said all the relatives of those who died or who tested positive for the virus must also be tested.

So far, at least 250 people have been tested in South for the "swine flu" virus, most of whom have come back negative. But there were people throughout the country with H1N1 at a mild level, he said.

Hospital medical director Dr Stephen Ramroop said the first two patients to die the hospital went in on Monday, and their positive tests were confirmed by the Caribbean Epidemiology Centre.

**Gert van der Hoek** · October 17, 2009, 01:35 AM

Re: Suspected A/H1N1 flu deaths probed - Four Die From Swine Flu

4 DIE FROM SWINE FLU

By Richardson Dhalai Saturday, October 17 2009

click on pic to zoom in

In just five days, four persons have died from the Influenza A/H1N1 virus, more widely known as the swine flu.

The South West Regional Health Authority (SWRHA) and the Ministry of Health yesterday announced two more persons died from H1N1 after the first two deaths were reported on Wednesday. All four persons, three men and one woman, died of the disease at the San Fernando General Hospital.

There was one more death which health officials said was not due to H1N1. This patient, a man, died from the seasonal flu virus which has been described as a ?twin? or ?close friend? of H1N1.

San Fernando General Hospital medical director Dr Stephen Ramroop, South West Regional Health Authority (SWRHA) executive medical director Dr Albert Persaud and SWRHA chief executive officer Michael Harris broke the news of the newest deaths and overall swine flu toll during a media briefing at the SWRHA?s human resource building, Lewis Street, San Fernando yesterday.

This was the second media conference on H1N1 called in two days by health officials; the first was held by the Ministry of Health on Wednesday.

Persaud at first reported three new deaths and said the post mortems of the patients showed they had severe lung disease, a condition of persons who die from the H1N1 virus.

?The post mortems done have revealed the same findings as the first two persons in that there was severe lung disease which is the finding internationally with persons who succumb to the H1N1 virus,? said Dr Persaud.

?The three persons came to the institution at a very late stage in the illness with each person not being there for more than 48 hours. They were treated in the Intensive Care Unit...where the usual protocols for illnesses like this was followed very, very closely,? he said. ?Unfortunately we have not been successful in managing their illness at that stage and the three persons succumbed to their illness.?

At this point, Ramroop clarified that two of the three new deaths Persaud referred to were due to H1N1 and the third was caused by the seasonal flu.

?There were four deaths in this hospital due to the pandemic H1N1 virus,? Ramroop said. Ramroop gave an account of the dates of when the four patients, whose deaths have been confirmed as due to H1N1, were admitted to the hospital: October 12, two men; October 13, one man. No date was given for the woman.

Ramroop then explained there are three subtypes of Influenza A: seasonal Influenza A, seasonal Influenza A H3N2 and Influenza A H1N1, which has been classified as a pandemic (worldwide illness).

Once a patient has symptoms of Influenza A, samples are taken and sent to the Caribbean Epidemiology Centre (Carec) to determine which subtype the patient contracted.

?They are extremely close friends, in fact you can?t even make out the difference, you can even call them twins. It?s an influenza A virus,? Ramroop said of seasonal Influenza A and H1N1(swine flu), the subtypes which were the causes of death among the three patients.

As of yesterday, no other patient was being treated for H1N1 at the hospital, Ramroop said, who also raised the issue of ?morbid obesity? as possible risk factor which contributed to the acceleration of the H1N1 virus into a fatal illness.

?Morbid obesity...It is now a very strong contender as a risk factor for persons with H1N1 for the illness to progress to a very severe level,? he said.

He said the symptoms of the four patients who died from H1N1 were ?shortness of breath, severe respiratory distress and a sudden onset illness within five to six days?.

One or two of the patients had other medical problems which Ramroop said could not be disclosed for confidential and legal reasons. The four swine flu patients were between 30 and 49 years old.

In a subsequent media statement, the Ministry of Health confirmed the doctors? reports saying ?based on the latest epidemiological data, four Influenza A/ H1N1 deaths have now been reported in Trinidad and Tobago.?

?Thus far there have been reported 163 laboratory confirmed H1N1 cases in the country and four deaths,? the ministry said.

?It is to be noted that the persons who passed away were admitted at the hospital at a late stage in the course of their illness and they all presented respiratory distress. Moreover, the deceased also had serious underlying risk factors that rendered their management a lot more complicated than the average case of H1N1.?

The ministry also pointed out that apart from the four deaths, other H1N1 cases which have been treated thus far were ?relatively mild and the persons returned to their normal activities within seven to ten days.?

4 DIE FROM SWINE FLU - Trinidad and Tobago Newsday Archives

http://www.newsday.co.tt/news/0,109319.html

In just five days, four persons have died from the Influenza A/H1N1 virus, more widely known as the swine flu.

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Suspected A/H1N1 flu deaths probed - Four Die From Swine Flu

Suspected A/H1N1 flu deaths probed - Four Die From Swine Flu

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