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Swine Flu Pandemic Paradox Kills Few, Overwhelms Hospital ICUs
2009-08-20 14:01:00.1 GMT
By Jason Gale
Aug. 21 (Bloomberg) -- Swine flu filled up Geoff Shaw?s
intensive care unit in Christchurch, New Zealand, last month,
forcing some surgeries to be canceled as the hospital struggled
to cope. As winter moves to the Northern Hemisphere, health
officials from Chicago to London brace for a similar overload.
?We have run out of bed space, we have run out of
nurses,? Shaw, 47, said after working in the ICU and being on-
call for 185 hours over 11 days. ?There will be people who die
because they were denied access to other treatments.?
Health officials call it the swine flu paradox. As the new
H1N1 strain spreads, the majority of patients recover within
days and the number of deaths is a fraction of the seasonal flu
toll. Those statistics mask an alarming reality: the pandemic
has strained intensive care units and a resurgence of the virus
in the fall could bring a public health disaster, experts say.
?We have largely been fortunate,? said Simon Towler, an
intensive care specialist at the Royal Perth Hospital and
Western Australia?s chief medical officer. ?If we had a severe
flu of a different type we would be in massive trouble. The
systems really don?t have the capacity to cope with a surge.?
Last weekend, a quarter of Western Australia?s 105 adult
intensive care beds were occupied by swine flu patients who
needed ventilators to breathe, according to Towler.
The experience in Australia and New Zealand offers clues
about what North America, Europe and Japan may see when winter
moves in.
Artificial Lung
?The Northern Hemisphere medical care requirements for the
next six months are a train wreck waiting to happen,? said
Michael Osterholm, director of the University of Minnesota?s
Center for Infectious Disease Research and Policy in
Minneapolis. ?In the fall, even if nothing else changes in
terms of the virus?s severity and our preparedness, it?s going
to be a real challenge.?
While fewer than 0.5 percent of swine flu sufferers may
need hospitalization, those who do can remain in intensive care
for up to three weeks, occupying a bed that could be used for 15
heart bypass patients. Christchurch Hospital, the biggest on New
Zealand?s South Island, postponed non-emergency procedures
requiring an ICU stay such as heart bypass as flu patients --
three-quarters needing mechanical ventilation -- filled up the
12-bed unit and nine other hastily created intensive-care beds,
according to Shaw.
What?s more, a 10th of those critically ill patients needed
their blood pumped through an artificial lung, a procedure known
as extracorporeal membrane oxygenation, or ECMO, that only one
hospital in New Zealand offers.
Life Support
?I?ve seen nothing like this,? said John Beca, head of
pediatric intensive care at New Zealand?s national children?s
hospital in Auckland. Five of Beca?s six ECMO units have been
used simultaneously this winter. He?s ordering three more.
Maquet Cardiopulmonary AG, a subsidiary of Sweden?s Getinge
AB, has received a 50 percent jump in orders for the life-
support system in Australia, Clinical Director Juergen Boehm
said. The German company is doubling production of the units,
which cost as much as 60,000 euros ($85,000) apiece, and plans
to increase its inventory of tubes, artificial lungs and other
disposable ECMO equipment to about 500 sets, from 100 usually.
?We will have to see what comes over the next weeks and
months from other areas,? Boehm said in a July 27 interview.
Orders for ECMO accessories are up about 20 percent in
Australia and New Zealand, said Joseph McGrath, a spokesman for
Minneapolis-based Medtronic Inc., which also makes the devices.
Vaccine Hopes
Sanofi-Aventis SA, GlaxoSmithKline Plc and Novartis AG are
racing to prepare millions of inoculations against the new virus
and test them before the weather turns colder in the hope of
blunting the pandemic. Paris-based Sanofi began vaccine trials
on Aug. 6 and needs ?two to three months? to complete them.
London-based Glaxo has said it began testing this month. The
U.S. expects the first shots to be delivered mid-October.
?Hopefully the vaccines will get out and the Northern
Hemisphere?s experience will be dramatically mitigated,? Towler
said. ?But there will be some people who either won?t get
vaccinated or won?t be protected, and the lessons from the
Southern Hemisphere, particularly countries like Australia and
New Zealand, will be important.?
More than a dozen flu patients were entering intensive care
units daily in Sydney a month ago, compared with five at the
peak of a regular winter flu season, said Tim Smyth, deputy
director general of health for New South Wales.
Health officials in the state, home to one in three
Australians, are equipping a helicopter with the lung bypass
machine to retrieve patients from remote hospitals.
?Stress?
The average age of patients in intensive care is 40 years,
according to Smyth, and most have an underlying condition such
as diabetes or heart disease, or are pregnant or obese.
In some patients, the virus causes such a severe assault on
the respiratory tract that the lungs become inflamed and the
grape-like sacs where gas is exchanged are injured, causing
bleeding and a critical loss of oxygen supply.
?We are all concerned given the severity of this disease
and the significant critical care support and resource
utilization required for the successful treatment of these
patients,? said Lena Napolitano, chief of acute care surgery at
the University of Michigan Health System at Ann Arbor.
Studies in the U.S. show that the group of patients
requiring mechanical ventilation for at least four days is
growing six times faster than the rest of hospitalizations, said
Marya Zilberberg, a scientist with the Amherst EviMed Research
Group at the University of Massachusetts.
The pandemic will only add to that demand, Zilberberg said.
?My sense is that it may stress our capacity to its limit and
beyond,? she said.
Young Victims
Worldwide, the H1N1 virus has killed about 1,800 people as
of Aug. 13, according to the World Health Organization. The
median age of death in Australia is 56 -- compared with 83 years
for seasonal flu fatalities.
?It?s striking young people down,? said Shaw, the
intensive care specialist in Christchurch. ?We are seeing
people largely between the ages of 20 and 50. That really is
quite different from anything else we have ever had.?
Australia shows how the pandemic has confounded
expectations: Intensive care accounts for about a quarter of
hospital stays, Jim Bishop, Australia?s chief medical officer,
said last week. The government had anticipated only 10 percent
of those hospitalized would need critical care, yet expected
more deaths: its modeling predicted 6,000, and 121 have died so
far.
?There is something very different about this virus,?
said Heath Kelly, head of epidemiology at Victoria state?s
infectious diseases reference laboratory in Melbourne. ?In
ICUs, it looks worse? than expected, he said. ?But everywhere
else you look, it looks better. That?s the interesting
paradox.?
Swine Flu Pandemic Paradox Kills Few, Overwhelms Hospital ICUs
2009-08-20 14:01:00.1 GMT
By Jason Gale
Aug. 21 (Bloomberg) -- Swine flu filled up Geoff Shaw?s
intensive care unit in Christchurch, New Zealand, last month,
forcing some surgeries to be canceled as the hospital struggled
to cope. As winter moves to the Northern Hemisphere, health
officials from Chicago to London brace for a similar overload.
?We have run out of bed space, we have run out of
nurses,? Shaw, 47, said after working in the ICU and being on-
call for 185 hours over 11 days. ?There will be people who die
because they were denied access to other treatments.?
Health officials call it the swine flu paradox. As the new
H1N1 strain spreads, the majority of patients recover within
days and the number of deaths is a fraction of the seasonal flu
toll. Those statistics mask an alarming reality: the pandemic
has strained intensive care units and a resurgence of the virus
in the fall could bring a public health disaster, experts say.
?We have largely been fortunate,? said Simon Towler, an
intensive care specialist at the Royal Perth Hospital and
Western Australia?s chief medical officer. ?If we had a severe
flu of a different type we would be in massive trouble. The
systems really don?t have the capacity to cope with a surge.?
Last weekend, a quarter of Western Australia?s 105 adult
intensive care beds were occupied by swine flu patients who
needed ventilators to breathe, according to Towler.
The experience in Australia and New Zealand offers clues
about what North America, Europe and Japan may see when winter
moves in.
Artificial Lung
?The Northern Hemisphere medical care requirements for the
next six months are a train wreck waiting to happen,? said
Michael Osterholm, director of the University of Minnesota?s
Center for Infectious Disease Research and Policy in
Minneapolis. ?In the fall, even if nothing else changes in
terms of the virus?s severity and our preparedness, it?s going
to be a real challenge.?
While fewer than 0.5 percent of swine flu sufferers may
need hospitalization, those who do can remain in intensive care
for up to three weeks, occupying a bed that could be used for 15
heart bypass patients. Christchurch Hospital, the biggest on New
Zealand?s South Island, postponed non-emergency procedures
requiring an ICU stay such as heart bypass as flu patients --
three-quarters needing mechanical ventilation -- filled up the
12-bed unit and nine other hastily created intensive-care beds,
according to Shaw.
What?s more, a 10th of those critically ill patients needed
their blood pumped through an artificial lung, a procedure known
as extracorporeal membrane oxygenation, or ECMO, that only one
hospital in New Zealand offers.
Life Support
?I?ve seen nothing like this,? said John Beca, head of
pediatric intensive care at New Zealand?s national children?s
hospital in Auckland. Five of Beca?s six ECMO units have been
used simultaneously this winter. He?s ordering three more.
Maquet Cardiopulmonary AG, a subsidiary of Sweden?s Getinge
AB, has received a 50 percent jump in orders for the life-
support system in Australia, Clinical Director Juergen Boehm
said. The German company is doubling production of the units,
which cost as much as 60,000 euros ($85,000) apiece, and plans
to increase its inventory of tubes, artificial lungs and other
disposable ECMO equipment to about 500 sets, from 100 usually.
?We will have to see what comes over the next weeks and
months from other areas,? Boehm said in a July 27 interview.
Orders for ECMO accessories are up about 20 percent in
Australia and New Zealand, said Joseph McGrath, a spokesman for
Minneapolis-based Medtronic Inc., which also makes the devices.
Vaccine Hopes
Sanofi-Aventis SA, GlaxoSmithKline Plc and Novartis AG are
racing to prepare millions of inoculations against the new virus
and test them before the weather turns colder in the hope of
blunting the pandemic. Paris-based Sanofi began vaccine trials
on Aug. 6 and needs ?two to three months? to complete them.
London-based Glaxo has said it began testing this month. The
U.S. expects the first shots to be delivered mid-October.
?Hopefully the vaccines will get out and the Northern
Hemisphere?s experience will be dramatically mitigated,? Towler
said. ?But there will be some people who either won?t get
vaccinated or won?t be protected, and the lessons from the
Southern Hemisphere, particularly countries like Australia and
New Zealand, will be important.?
More than a dozen flu patients were entering intensive care
units daily in Sydney a month ago, compared with five at the
peak of a regular winter flu season, said Tim Smyth, deputy
director general of health for New South Wales.
Health officials in the state, home to one in three
Australians, are equipping a helicopter with the lung bypass
machine to retrieve patients from remote hospitals.
?Stress?
The average age of patients in intensive care is 40 years,
according to Smyth, and most have an underlying condition such
as diabetes or heart disease, or are pregnant or obese.
In some patients, the virus causes such a severe assault on
the respiratory tract that the lungs become inflamed and the
grape-like sacs where gas is exchanged are injured, causing
bleeding and a critical loss of oxygen supply.
?We are all concerned given the severity of this disease
and the significant critical care support and resource
utilization required for the successful treatment of these
patients,? said Lena Napolitano, chief of acute care surgery at
the University of Michigan Health System at Ann Arbor.
Studies in the U.S. show that the group of patients
requiring mechanical ventilation for at least four days is
growing six times faster than the rest of hospitalizations, said
Marya Zilberberg, a scientist with the Amherst EviMed Research
Group at the University of Massachusetts.
The pandemic will only add to that demand, Zilberberg said.
?My sense is that it may stress our capacity to its limit and
beyond,? she said.
Young Victims
Worldwide, the H1N1 virus has killed about 1,800 people as
of Aug. 13, according to the World Health Organization. The
median age of death in Australia is 56 -- compared with 83 years
for seasonal flu fatalities.
?It?s striking young people down,? said Shaw, the
intensive care specialist in Christchurch. ?We are seeing
people largely between the ages of 20 and 50. That really is
quite different from anything else we have ever had.?
Australia shows how the pandemic has confounded
expectations: Intensive care accounts for about a quarter of
hospital stays, Jim Bishop, Australia?s chief medical officer,
said last week. The government had anticipated only 10 percent
of those hospitalized would need critical care, yet expected
more deaths: its modeling predicted 6,000, and 121 have died so
far.
?There is something very different about this virus,?
said Heath Kelly, head of epidemiology at Victoria state?s
infectious diseases reference laboratory in Melbourne. ?In
ICUs, it looks worse? than expected, he said. ?But everywhere
else you look, it looks better. That?s the interesting
paradox.?