An absence of research into how influenza behaves among aboriginals is hindering efforts to curtail swine flu as it ravages native communities in Manitoba and Nunavut.
Even as doctors scramble to fill in those blanks, native leaders are accusing health officials of ignoring their plight.
"It has taken way too long to recognize how bad the situation is," said David Harper, chief of Garden Hill First Nation.
Some researchers are consulting history books rather than medical manuals, casting back to 1918, the last time an influenza virus hit native communities so hard.
In that year, the disease wiped out whole villages, killing off up to 90 per cent of residents in some cases. While public health officials have developed an arsenal to fight the disease since then, they do find the parallels between 2009 and 1918 troubling.
"Such a disease coming at an atypical time of year, in an atypical population, with an atypical severity - this is a big red flag," said Dr. Ethan Rubinstein, head of adult infectious diseases at the University of Manitoba who's been working steadily with flu patients hospitalized in Winnipeg.
Throughout the province, 26 people - more than half of them aboriginal - have been placed on ventilators due to the flu. That figure includes three children, two residents of Nunavut and at least six pregnant women.
Health officials said three or four people were added to the list of severely ill yesterday, but urged the public not to concentrate on numbers.
"The vast majority of Manitobans have not had a serious illness from this influenza," said Dr. Joel Kettner, the province's chief public health officer. "The proportion of people exposed to this virus who are ending up in hospital right now [is]in the order of magnitude of 1 in 1,000."
But while provincial health officials tried to play down Manitoba's growing numbers of severely ill flu patients, the World Health Organization was highlighting them. Acting assistant director-general Keiji Fukuda said the organization is monitoring flu cases among Canada's native population carefully and that the organization is close to calling the swine flu outbreak a full-blown pandemic.
Dr. Kettner said the WHO upgrade wouldn't affect the provincial response, something native leaders questioned yesterday.
"We're not getting the treatment we need," Mr. Harper said. In his community of Garden Hill, 500 kilometres north of Winnipeg, an 18-month-old whose serious flu symptoms had been treated for days with baths and Tylenol was finally flown out on Sunday.
Twenty-seven residents of nearby St. Theresa Point have been flown out after coming down with serious flu symptoms.
"With the overcrowding and lack of running water in these communities, it's no surprise," Mr. Harper said. "Something has to be done to address these core issues."
But infectious-disease experts say environmental conditions don't entirely explain why the flu is so severe among aboriginals. Other factors include genetic predisposition and the legacy of previous outbreaks of respiratory diseases such as tuberculosis.
Any thorough explanation, however, is clouded by a lack of research on the matter.
"I'm not aware of a single vaccine study that's ever been done in native communities," said Dr. Brian Ward, chief of the division of infectious diseases at the McGill University Health Centre. "It's often really hard to include these communities in otherwise routine studies due to the expense."
The worse could be yet to come. Researchers predict this first wave of the outbreak will be followed by a much more severe one in the autumn.
"If it follows the 1918 pattern, that is what will happen," Dr. Rubinstein said. "Which means we have much worse to prepare for."