Saint Theresa Point is 2,000 people – one-five-hundredth of Manitoba's population – and it generated enough critically ill people nearly to swamp the province's critical-care capacity.
The SARS outbreak in Toronto is still a fresh memory for the critical-care community there, and by every estimate, the numbers of critically ill and dying patients that may be anticipated this autumn and winter will exceed the numbers that generated those crises by many orders of magnitude. Overall, there isn't enough ICU capacity in the country to begin to treat the numbers sickened by the great pandemics of the past.
H1N1's predilection for the young bodes ominously, too. Forty-one per cent of U.S. deaths from H1N1 have occurred in the 25-49 age group. The death rate among the Haida and Tinglit in 1918 was so high not solely because of the direct effects of the influenza, but also because the young adults who did the fishing and the hunting and the food preparation were incapacitated. Villages simply starved to death, to the last soul, even though many inhabitants survived the actual pandemic.
Modern cities are even more interdependent, their citizens' skills more specialized and the citizens themselves less self-sufficient. Even if the CFR is within the Australian estimates – up to 10 times the norm – if this is coupled with a high attack rate and a shift of the affected to the young from the elderly and infirm, then the functioning of police services, transportation, utilities and trade throughout cities will be seriously affected.
Dr Bruce Martin, associate dean of the University of Manitoba and director of that institution's Northern Medical Unit, was one of the team that flew to Saint Theresa Point to direct community care. “Just keeping the building open under that kind of work load is incredibly difficult,” he says.
“As bad as the outbreak was, and as sick as the many of the ill were, there is another huge body of people who are less sick, who don't require evacuation, but do need to be assessed and reassured. And then sent home, to stay home, until they are better. Keeping any of the community's basic services working in that situation is very difficult.”
The isolation measures made necessary by an outbreak of such severity will prove just as draconian to interdependent urbanites. SARS infected only 251 in the Greater Toronto Area, yet it collapsed the municipal economy for three months. An influenza attack rate of 30 per cent will affect 1.5 million Torontonians. If the CFR is as high as 0.5 per cent, then 7,000 of those may perish. SARS killed just 43.
A severe epidemic demonstrates the interdependence of humans with unusual concision. Picture a city bedbound by the flu: The image is one of empty markets, neglected shut-ins and unrepaired sewer lines. Humans are communal animals as much as bees or ants. A threat to any is a threat to all from every perspective: epidemiological, civic and moral.
Which is why the desperation of the reservations really is everyone's problem.
Eventually, a pandemic response strategy tailored to the particular challenges faced by first-nations people will be created, if not for this pandemic, then for the next. Hopefully it will be part of a more meaningful strategy to level out the burden of illness known by first-nations people, especially diabetes, which threatens to become a slower-moving smallpox among the people of the boreal forest.
In the meantime, everything I've said concerning the impact influenza will have on cities will play itself out on the reserves this winter, but worse many times over. The Saint Theresa Point experience will be re-enacted so regularly that eventually only the local media will bother even to mention it. However, suffering itself does not localize. It flies around in aircraft and takes over the ICUs and it comes to the Bridle Paths and it affects 1.9 to 2.2 other people, on average, within 2.1 to 3.0 days.
It will begin among the most vulnerable – and it is in the nature of that particular vulnerability that it will encompass us all.
Kevin Patterson is a physician and writer based on Salt Spring Island, B.C.
