Vaccine plan nears; equipment in place

A Journal of the American Medical Association (JAMA) study found the H1N1 death rate in Mexico was twice as high as in Canada because of a lack of access to intensive care beds and ventilators. Of those admitted to hospital intensive care units with H1N1 this spring, 72 per cent were women, the average age of patients was 42, 81 per cent needed to be hooked up to a breathing machine, or ventilator and one in six died.

At the height of the H1N1 outbreak in Manitoba this spring, there were 38 patients hooked up to ventilators, according to the Winnipeg Regional Health Authority.

Expecting another surge this fall, Manitoba has nearly doubled its capacity of 69 adult ICU beds and nine pediatric ICU beds.

The adult intensive care unit has 129 conventional-model ventilators plus 11 older machines that are still usable, as well as two high-frequency oscillator ventilators that administer shallow, puffy breaths.

In the pediatric intensive care unit, there are 12 conventional pediatric ventilators for older children, 31 neonatal ventilators for newborns and nine older models that can be brought into use, as well as nine pediatric high-frequency oscillator models.

Even with enough ventilators, they're useless without enough nurses to operate and monitor them.

"The issue is the staffing, which is why we had planned Article 10 -- so we could staff them," said Heidi Graham, WRHA spokeswoman. Article 10 of the Manitoba Nurses Union agreement gives hospitals in emergencies or strikes the power to schedule nurses to work when and where they are needed.

The hospitals used Article 10 to increase staffing during the H1N1 outbreak this spring. If nurses get sick, however, their reduced ranks could mean fewer available ventilators.

Ninety-three per cent of Manitoba's nurses are women and their average age is 47 -- fitting the JAMA study's bill for those who became the sickest.

The news isn't unnerving, say the nurses.

"I don't think they have any more concerns knowing they're more susceptible," said Manitoba Nurses Union president Sandi Mowat.

"We know how to protect ourselves. We're always concerned and we make sure we take all the proper precautions -- we're provided with all that equipment," said Mowat.

And nurses will be among the first to get the H1N1 vaccine, she said.

"We're on the priority list," with health-care workers among the first to receive the H1N1 vaccine, expected by the first week of November, she said.

The acting chief provincial public health officer wouldn't say who else would be on the priority list.

"We're developing plans," said Dr Bunmi Fatoye. "We don't have a final priority list. As time is going by with the H1N1 virus, more research articles are being released and published," said Fatoye. "Planning groups review the document -- if there is any information that is of use or that is relevant."

After Monday's JAMA report, a Canadian Medical Association Journal study on Tuesday said the early and rapid rollout of swine flu vaccine could have a big impact on reducing the number of cases Canada sees this fall.

It suggests the vaccine could have a disproportionately large effect on tamping down H1N1 activity, if it's used early. The impact would be lessened, though, if the vaccine rollout comes later.

Provincial and federal health officials Tuesday would neither deny nor confirm the report that Health Canada will give the H1N1 vaccine a green light Oct. 19 and has advised the provinces to be ready to roll out the first shots on Oct. 26.

"The plans are very flexible to accommodate any changes," said Manitoba's Fatoye.

carol.sanders@freepress.mb.ca

Republished from the Winnipeg Free Press print edition October 14, 2009 A7