Shiloh
Editor, Senior Moderator
Source: http://www.theglobeandmail.com/news...da-to-stock-up-on-ventilators/article1207344/
Swine flu fears spur Canada to stock up on ventilators
Warnings that youth are hit hardest by virus point to shortfalls in strategy for pandemic
Gloria Galloway
Ottawa ? From Monday's Globe and Mail Last updated on Sunday, Jul. 05, 2009 10:28PM EDT
Critical ventilators to help Canada cope with the swine flu outbreak are being ordered by the federal government amid dire warnings about the severity of this fall's flu season.
As the pandemic spreads globally, Canadian public health findings show ? for unknown reasons ? that victims here have been younger and sicker, and have required more ventilators than most other countries, including the United States.
For years, medical experts have been worried about the small number of intensive care nurses who would be available to treat patients during an influenza pandemic. But the first wave of the H1N1 virus, which killed 29 people in Canada and sent 663 to hospital as of Friday, has exposed another shortfall in national pandemic planning: the number of ventilator machines.
One young man arrived at the Mount Sinai Hospital in Toronto more than a month ago with symptoms of the disease, which was subsequently confirmed. He was put on an oscillatory ventilator ? a measure that is used only rarely for patients with a standard type of influenza. Four weeks later, he was still hooked up to the machine.
?It appears that there is a sub-population of relatively young people who very rapidly develop severe illness with this virus. And they are not a large number, but they require very intensive ventilatory support with new advanced ventilators,? said Allison McGeer, an expert in infectious disease at Mount Sinai.
?We have very few oscillatory ventilators. We generally don't need them very often and usually it's for a very short period of time. So these young people are requiring a disproportionate amount of time on ventilators that we have very small numbers of.?
It is a problem that Dr. McGeer said has been quite distinctive to this pandemic and this particular H1N1 virus.
Anand Kumar, an associate professor of medical microbiology and pharmacology at the University of Manitoba, who has been treating hospitalized flu patients in Winnipeg, said he would be surprised if there was a province in Canada that was not trying to buy ventilators right now.
Each jurisdiction has its own stockpile. And the Public Health Agency of Canada owns 130 that are to be distributed to the provinces and territories as they request them. Fifteen of them were recently sent to Manitoba where, a week ago, 38 ICU beds were occupied by patients on ventilators.
The federal agency ?is currently in negotiations to purchase additional ventilators to increase its stockpile to 500,? a spokeswoman said.
That means they're planning to buy 370 ventilators, which, at a cost of about $10,000 each, would mean an outlay of $3.7-million.
Despite its pandemic planning, the agency could not say how many ventilators there are across Canada, how long it would take to make the purchase, and whether it would specifically be looking for oscillating ventilators.
But doctors applauded any effort to increase the numbers.
?I think it would be prudent to review the Manitoba experience and understand where our strengths are and where our weaknesses are. And certainly the issue of ventilator capacity is something that we ought to be paying attention to nationwide,? Dr. Kumar said.
?I think it is very appropriate to be concerned about the amount of resources of all sorts, whether you talk about nursing, or certain groups of medications, or ventilators. You want to make sure that sufficient resources are available should this recur in a bigger way.?
The recurrence he was alluding to has been predicted for the fall when the traditional flu season in Canada returns.
Dr. David Butler-Jones, Canada's chief medical health officer, said in a teleconference from Mexico last week that H1N1 is not going away.
?The one thing, to the extent that you can be certain about anything, is that we will definitely see this [disease] this winter and preparing for that,? Dr. Butler-Jones told reporters.
The Spanish flu pandemic, which killed between 20 million and 50 million people worldwide in 1918, came in two waves, the second far worse than the first. And doctors say they fear the current H1N1 pandemic will mirror its deadly predecessor.
?It could be much worse during the fall so we need to be prepared,? said Dr. Robert Ouellet, the president of the Canadian Medical Association. ?So I think that any move to improve the equipment, to improve the human resources, is a good move.?
In Ontario, there are 8,000 ventilators, about 1,100 of which are attached to critical-care beds. ?If there is a large-scale health emergency, it comes down to the fact that you're dealing with only so many resources,? said David Jenson, a spokesman for the province's Health Ministry.
That's why the Ontario pandemic plan contains a triage protocol that provides guidelines for decisions around optimal use of such things as ventilators, Mr. Jenson said.
The Canadian Pandemic Influenza Plan cites a research paper called Stand on Guard for Thee that was produced in 2005 by the Joint Centre for Bioethics of the University of Toronto. It identifies many of the ethical issues that could arise during an influenza pandemic, including the allocation of scarce resources such as ventilators.
Dr. Ross Upshur, director of the centre and one of the authors of the study, said it was always assumed that ventilators would go to younger people who have not lived full lives, rather than to older people, if tough choices had to be made.
But because this flu disproportionately hits younger people, it has become a choice of giving them to one young person or another young person, Dr. Upshur said. ?This is a scenario that no one had actually anticipated.?
Swine flu fears spur Canada to stock up on ventilators
Warnings that youth are hit hardest by virus point to shortfalls in strategy for pandemic
Gloria Galloway
Ottawa ? From Monday's Globe and Mail Last updated on Sunday, Jul. 05, 2009 10:28PM EDT
Critical ventilators to help Canada cope with the swine flu outbreak are being ordered by the federal government amid dire warnings about the severity of this fall's flu season.
As the pandemic spreads globally, Canadian public health findings show ? for unknown reasons ? that victims here have been younger and sicker, and have required more ventilators than most other countries, including the United States.
For years, medical experts have been worried about the small number of intensive care nurses who would be available to treat patients during an influenza pandemic. But the first wave of the H1N1 virus, which killed 29 people in Canada and sent 663 to hospital as of Friday, has exposed another shortfall in national pandemic planning: the number of ventilator machines.
One young man arrived at the Mount Sinai Hospital in Toronto more than a month ago with symptoms of the disease, which was subsequently confirmed. He was put on an oscillatory ventilator ? a measure that is used only rarely for patients with a standard type of influenza. Four weeks later, he was still hooked up to the machine.
?It appears that there is a sub-population of relatively young people who very rapidly develop severe illness with this virus. And they are not a large number, but they require very intensive ventilatory support with new advanced ventilators,? said Allison McGeer, an expert in infectious disease at Mount Sinai.
?We have very few oscillatory ventilators. We generally don't need them very often and usually it's for a very short period of time. So these young people are requiring a disproportionate amount of time on ventilators that we have very small numbers of.?
It is a problem that Dr. McGeer said has been quite distinctive to this pandemic and this particular H1N1 virus.
Anand Kumar, an associate professor of medical microbiology and pharmacology at the University of Manitoba, who has been treating hospitalized flu patients in Winnipeg, said he would be surprised if there was a province in Canada that was not trying to buy ventilators right now.
Each jurisdiction has its own stockpile. And the Public Health Agency of Canada owns 130 that are to be distributed to the provinces and territories as they request them. Fifteen of them were recently sent to Manitoba where, a week ago, 38 ICU beds were occupied by patients on ventilators.
The federal agency ?is currently in negotiations to purchase additional ventilators to increase its stockpile to 500,? a spokeswoman said.
That means they're planning to buy 370 ventilators, which, at a cost of about $10,000 each, would mean an outlay of $3.7-million.
Despite its pandemic planning, the agency could not say how many ventilators there are across Canada, how long it would take to make the purchase, and whether it would specifically be looking for oscillating ventilators.
But doctors applauded any effort to increase the numbers.
?I think it would be prudent to review the Manitoba experience and understand where our strengths are and where our weaknesses are. And certainly the issue of ventilator capacity is something that we ought to be paying attention to nationwide,? Dr. Kumar said.
?I think it is very appropriate to be concerned about the amount of resources of all sorts, whether you talk about nursing, or certain groups of medications, or ventilators. You want to make sure that sufficient resources are available should this recur in a bigger way.?
The recurrence he was alluding to has been predicted for the fall when the traditional flu season in Canada returns.
Dr. David Butler-Jones, Canada's chief medical health officer, said in a teleconference from Mexico last week that H1N1 is not going away.
?The one thing, to the extent that you can be certain about anything, is that we will definitely see this [disease] this winter and preparing for that,? Dr. Butler-Jones told reporters.
The Spanish flu pandemic, which killed between 20 million and 50 million people worldwide in 1918, came in two waves, the second far worse than the first. And doctors say they fear the current H1N1 pandemic will mirror its deadly predecessor.
?It could be much worse during the fall so we need to be prepared,? said Dr. Robert Ouellet, the president of the Canadian Medical Association. ?So I think that any move to improve the equipment, to improve the human resources, is a good move.?
In Ontario, there are 8,000 ventilators, about 1,100 of which are attached to critical-care beds. ?If there is a large-scale health emergency, it comes down to the fact that you're dealing with only so many resources,? said David Jenson, a spokesman for the province's Health Ministry.
That's why the Ontario pandemic plan contains a triage protocol that provides guidelines for decisions around optimal use of such things as ventilators, Mr. Jenson said.
The Canadian Pandemic Influenza Plan cites a research paper called Stand on Guard for Thee that was produced in 2005 by the Joint Centre for Bioethics of the University of Toronto. It identifies many of the ethical issues that could arise during an influenza pandemic, including the allocation of scarce resources such as ventilators.
Dr. Ross Upshur, director of the centre and one of the authors of the study, said it was always assumed that ventilators would go to younger people who have not lived full lives, rather than to older people, if tough choices had to be made.
But because this flu disproportionately hits younger people, it has become a choice of giving them to one young person or another young person, Dr. Upshur said. ?This is a scenario that no one had actually anticipated.?