http://www.calgaryherald.com/health/Canadian+hospitals+prepared+pandemic/1798833/story.html
Canadian hospitals are not prepared for pandemic
Our swine-flu plans do not allocate enough money for beds with ventilators
By JARO KOTALIK, Ottawa CitizenJuly 17, 2009
While we continue to observe a daily increase in the number of swine flu cases across the country, we take comfort in the fact that our country has been preparing for a pandemic for years. We have an elaborate, expertly produced national pandemic plan, which in turn gave rise to provincial, territorial, regional and local plans. Canada has even been called a world leader in pandemic preparedness by the World Health Organization.
But there is an inherent weakness in our pandemic planning, a weakness that greatly undermines all the effort put into this enterprise, a weakness that might in the end be fatal.
In 2004, a Canadian pandemic plan was released that did not say a word about the amount of material and human resources that would be required for each of the hundreds of proposed pandemic measures nor about who would provide these resources. When you stop to think about it, it's almost unbelievable: The largest public health program ever proposed was launched without any budget or money.
True, in 2006 the federal budget earmarked $1 billion over five years for this cause. Three years into this budget, we know that the federal government purchased stocks of the antiviral drug Tamiflu and contracted for the production of a vaccine. However, these actions, while important, are far from meeting all the essential requirements. To date, none of the budgeted money seems to have made its way to the front lines where the real war against the pandemic will largely be fought, such as the hospitals I am associated with.
This economic blind-eye approach has resulted in our lack of readiness to care for those sick with the flu. The sudden emergence of an enormous number of sick people is the hallmark of a pandemic. The national plan for a moderate pandemic estimates that of 4.9 million people who will become ill, 109,000 people, about two per cent, will need to be admitted to a hospital. The plan does not suggest how these additional patients could be accommodated given that in Canada we have just over 100,000 beds and that they are full 90 per cent of the time.
Furthermore, it now appears that the demand for hospital beds might be much higher than our experts predicted. On June 12, the Public Health Agency of Canada reported that not two per cent, but five per cent of confirmed cases of pandemic flu had to be hospitalized. And not any kind of hospital bed will suffice.
Because the most frequent serious complication of any flu is pneumonia, and in some cases the inability to breathe, these flu patients will require mechanical ventilation in an intensive care unit. This fact was foreseeable, and it is well known that beds with ventilators are constantly in short supply, yet no provisions were made to at least partially remedy the shortage.
It now appears that at the peak of demand, pandemic flu patients might need almost twice as many beds with ventilators as are currently being used for all patients. To date, no relief of the shortage has been proposed.
A recent situation in Winnipeg highlighted how ill-prepared our hospitals are. In mid-June, at the very beginning of the H1N1 flu outbreak, when the province had only 119 confirmed cases, 31 of them needed ventilators. Winnipeg hospitals cancelled non-urgent surgery, discharged patients earlier and ordered 15 more ventilators.
The health-care-delivery system in Canada is stretched to its limits. Wherever you are, at this very moment there is probably a "discharge planner" going around your local hospital trying to determine which patients could be sent home, because unless someone is discharged, it is not possible to get a bed for a patient waiting for admission. Under these circumstances, how can hospitals engage in serious preparation for increased demand?
So all of us are closing our eyes to the unpleasant reality and hoping that, somehow, we will get through this.
I have recommended to our hospital that we should determine what resources we need to provide care at the height of the pandemic to all patients who can be reasonably expected to rely on us. We should then notify our funding agency and include an estimate of the potential human cost of not having the necessary resources. If funding is not received, our hospital has an obligation to inform the public about the lack of resources.
If we fail to do this we will have an ethical responsibility for the harm or deaths that could have been prevented.
If given a choice, would Canadians want our health- care system to go through the pandemic, the largest threat to the health and life of Canadians in many decades, with no additional resources, scaling down care to what the regular budget provides? Or would they be prepared to pay for the best possible care, knowing that the deaths that will occur will be unavoidable?
Jaro Kotalik is a physician and bioethicist in Thunder Bay, Ont.
? Copyright (c) The Montreal Gazette
Canadian hospitals are not prepared for pandemic
Our swine-flu plans do not allocate enough money for beds with ventilators
By JARO KOTALIK, Ottawa CitizenJuly 17, 2009
While we continue to observe a daily increase in the number of swine flu cases across the country, we take comfort in the fact that our country has been preparing for a pandemic for years. We have an elaborate, expertly produced national pandemic plan, which in turn gave rise to provincial, territorial, regional and local plans. Canada has even been called a world leader in pandemic preparedness by the World Health Organization.
But there is an inherent weakness in our pandemic planning, a weakness that greatly undermines all the effort put into this enterprise, a weakness that might in the end be fatal.
In 2004, a Canadian pandemic plan was released that did not say a word about the amount of material and human resources that would be required for each of the hundreds of proposed pandemic measures nor about who would provide these resources. When you stop to think about it, it's almost unbelievable: The largest public health program ever proposed was launched without any budget or money.
True, in 2006 the federal budget earmarked $1 billion over five years for this cause. Three years into this budget, we know that the federal government purchased stocks of the antiviral drug Tamiflu and contracted for the production of a vaccine. However, these actions, while important, are far from meeting all the essential requirements. To date, none of the budgeted money seems to have made its way to the front lines where the real war against the pandemic will largely be fought, such as the hospitals I am associated with.
This economic blind-eye approach has resulted in our lack of readiness to care for those sick with the flu. The sudden emergence of an enormous number of sick people is the hallmark of a pandemic. The national plan for a moderate pandemic estimates that of 4.9 million people who will become ill, 109,000 people, about two per cent, will need to be admitted to a hospital. The plan does not suggest how these additional patients could be accommodated given that in Canada we have just over 100,000 beds and that they are full 90 per cent of the time.
Furthermore, it now appears that the demand for hospital beds might be much higher than our experts predicted. On June 12, the Public Health Agency of Canada reported that not two per cent, but five per cent of confirmed cases of pandemic flu had to be hospitalized. And not any kind of hospital bed will suffice.
Because the most frequent serious complication of any flu is pneumonia, and in some cases the inability to breathe, these flu patients will require mechanical ventilation in an intensive care unit. This fact was foreseeable, and it is well known that beds with ventilators are constantly in short supply, yet no provisions were made to at least partially remedy the shortage.
It now appears that at the peak of demand, pandemic flu patients might need almost twice as many beds with ventilators as are currently being used for all patients. To date, no relief of the shortage has been proposed.
A recent situation in Winnipeg highlighted how ill-prepared our hospitals are. In mid-June, at the very beginning of the H1N1 flu outbreak, when the province had only 119 confirmed cases, 31 of them needed ventilators. Winnipeg hospitals cancelled non-urgent surgery, discharged patients earlier and ordered 15 more ventilators.
The health-care-delivery system in Canada is stretched to its limits. Wherever you are, at this very moment there is probably a "discharge planner" going around your local hospital trying to determine which patients could be sent home, because unless someone is discharged, it is not possible to get a bed for a patient waiting for admission. Under these circumstances, how can hospitals engage in serious preparation for increased demand?
So all of us are closing our eyes to the unpleasant reality and hoping that, somehow, we will get through this.
I have recommended to our hospital that we should determine what resources we need to provide care at the height of the pandemic to all patients who can be reasonably expected to rely on us. We should then notify our funding agency and include an estimate of the potential human cost of not having the necessary resources. If funding is not received, our hospital has an obligation to inform the public about the lack of resources.
If we fail to do this we will have an ethical responsibility for the harm or deaths that could have been prevented.
If given a choice, would Canadians want our health- care system to go through the pandemic, the largest threat to the health and life of Canadians in many decades, with no additional resources, scaling down care to what the regular budget provides? Or would they be prepared to pay for the best possible care, knowing that the deaths that will occur will be unavoidable?
Jaro Kotalik is a physician and bioethicist in Thunder Bay, Ont.
? Copyright (c) The Montreal Gazette
