WHO Issues New Report; Medics Confer on "ChokePoint" of High-Tech Care Shortages

September 1, 2009 (LPAC)—The World Health Organization (WHO) issued its ninth H1N1/09 Briefing Note on Aug. 28, titled, "Preparing for the Second Wave: Lessons From Current Outbreaks." The two-page document reviews the situation in which H1N1/09 is now the dominant influenza strain in most parts of the world; the paper recapitulates the observations made over recent months by physicians and epidemiologists all along: This novel virus moves and infects easily, and for the most part mildly; however, its pattern is to preferentially affect a small number of young (15-40) very severely, and also all those "subgroups" who are in a weakened condition from poverty, obesity and illness.

One feature stands out: Wherever severe cases have been hospitalized, around 15% of these patients require intensive care, especially breathing assistance, often for weeks. This is a logistics chokepoint, given the low ratios of hospital beds and intensive care units (ICU) per 100,000 population in "developed" countries, and near non-existence elsewhere.

Britain's lack of medical infrastructure was highlighted in July, when it had to airlift a 26-year-old, pregnant H1N1 patient to Stockholm, for a month of breathing-support on extra corporeal membrane oxygenation (ECMO) equipment. The patient, who came back home to an ICU in Scotland in mid-August, would have been treated in July at the British ECMO center in Leicester, but it has only five ECMO units, and all were in use.

This week in Canada, critical care doctors and health experts are meeting Sept. 2-3 in Winnipeg, convened by the Public Health Agency of Canada, to brainstorm on how to cope with the Fall wave of H1N1/09, given the shortage of equipment, and pressure of need. In Winnipeg earlier this year, hospital ICUs were strained to the breaking point with flu cases, and nearly had to ship patients out, or requisition equipment, supplies, and staff from another province. E.g. Winnipeg hospitals went through a year's supply of sedating drugs in just two months, since, as one physician explained, "For some reason—and we don't know why yet—these patients are incredibly agitated and require incredibly high doses of sedation." One of the objectives of this week's meeting, is to compare clinical experiences, in order to come up with ways to avert or mitigate lung inflammation, etc.

In the U.S., the very medical center held up as a model by the advocates for the Obama Nazi health care "reform," was barely able to cope with its intensive care H1N1/09 patient load a few months ago. At the Intermountain Medical Center, in Salt Lake City, 60 ICU patients were treated for severe H1N1/09 flu; their median age was about 30; and two-thirds of them developed acute respiratory distress syndrome (ARDS). "One day the hospital nearly ran out of the dialysis machines needed to do the work of failing kidneys. And it came close to having a shortage of ICU nurses" (reported in the Aug. 31 Canada Press).

Nonetheless, the Obama White House program is to cut such "overutilization" of hospital resources.