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Health See other Health Articles Title: Swine Flu Pandemic Paradox Kills Few, Overwhelms ICUs 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.” In the U.K., where swine flu sparked a summer wave of illness worse than the previous 10 winters, about 1 in 10 patients hospitalized for the virus end up in intensive care, according to Liam Donaldson, England’s chief medical officer. In Australia, that proportion is about 25 percent, he said. “They have had a relatively high level of intensive care admissions amongst hospitalized patients,” Donaldson told reporters in London yesterday. “We might end up like that, but we can’t be 100 percent sure.” Bypass Patients 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. “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. Life Support Maquet Cardiopulmonary AG, a subsidiary of Sweden’s Getinge AB, 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. Sales for ECMO disposable equipment in Europe rose about 50 percent during July, Boehm said by e-mail today. “Hardware figures are slightly but constantly increasing in Europe as well during the last months,” he said. 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. 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. Vaccine Hopes “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. 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. Years Lost “If you quantify the impact in terms of the number of life-years lost, then this pandemic could well end up being more severe than a typical flu season,” Neil N. Ferguson, professor of epidemiology at London’s Imperial College, said in an Aug. 13 telephone interview. 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. Stress Capacity 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. 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.”
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#1. To: Brian S (#0)
Hispanics / Amerinds seem more vulnerable. Look out California.
Anti-racism is code for white genocide
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