Canada is, per capita, the country in the world hit hardest by H1N1, the pandemic strain of influenza formerly known as swine flu.
This may come as a surprise to Canadians. It's not the kind of No. 1 ranking that government or public officials like to draw attention to, let alone brag about.
Alan Davidson, program co-ordinator of health studies at the University of British Columbia, Okanagan in Kelowna, B.C., made the point eloquently in a recent letter published in The Globe and Mail.
There are, he noted, 20 cases of H1N1 per 100,000 population in Canada. By comparison, the rate per 100,000 is 7.1 in Mexico, 7.1 in the United States and 4.6 in Britain. The only country that comes close to Canada is Australia, with 13 cases per 100,000.
It should be noted that these numbers are the tip of the iceberg. A new study estimates that about one million people have been infected in the United States - which suggests that more than 100,000 have been infected in Canada. This is far and above the 7,983 lab-confirmed cases (including 25 deaths) reported to date.
Now it's true that in outbreaks - or pandemics - of infectious disease there will be clusters. But this is a disease that first took root in the southern United States and Mexico.
Why is it that they have managed to contain the spread better than Canada? And why does H1N1 continue to spread in Canada even in the hot summer weather that is not at all propitious to the transmission of the fragile influenza virus?
These are questions that public-health officials need to be asking, especially because if this new flu sticks around until the fall it could really start spreading.
More troubling than the overall number of cases of H1N1 cases in Canada is where the disease is hitting hardest. The hot spots include Saskatchewan, with 61 cases of H1N1 per 100,000 population and Manitoba with 45.
It is no coincidence that both of these provinces have proportionally large aboriginal populations. H1N1, like all infectious diseases, preys on the poor and the marginalized.
There have been vague suggestions that maybe aboriginal people are genetically susceptible to this pandemic strain of influenza.
While this is possible, it is not the likely explanation. Rather, it is the grim social conditions on native reserves that facilitate the spread of H1N1: inadequate housing that sees families living up to 20 to a house; lack of running water; troubling smoking rates; sky-high rates of diabetes, asthma and obesity. (In the months that H1N1 has been circulating, it has become clear that those who get sickest from this new flu are those with underlying chronic health conditions, precisely those that flourish in poor communities: diabetes, asthma and obesity.) It is a travesty that we have not paid more attention to the link between poverty and pandemic influenza (and illness more generally). Instead, we fixate on bizarre and marginal stories, such as the fact that Health Canada delayed sending hand sanitizer to reserves in northern Manitoba because the cleanser contains alcohol. In defence of Health Canada, it should be noted that these are dry communities and aboriginal leaders themselves did not want alcohol-based products sent.
But the sanitizer fiasco points to a much larger problem: There are some gaping holes in Canada's pandemic preparedness plan.
To wit: One should not be looking for alcohol-free sanitizers when an epidemic is already under way in a community. That should be an integral part of planning for dry communities.
Another aspect of the plan that bears reviewing pertains to the distribution of anti-viral medications.
Relenza and Tamiflu are effective in fighting H1N1. But physicians treating patients with the pandemic strain of the flu - and those who want to avoid catching it - have been frustrated by the fact that it is virtually impossible to fill a prescription for these drugs in Canada.
That is because federal and provincial governments have stockpiled about 55 million doses of anti-virals and they are keeping them for treatment of "priority" groups.
This is not totally inappropriate but it is markedly different from the policies in other countries, which have used anti-virals extensively to prevent the spread of H1N1 by giving them routinely to people exposed to the sick.
This has worked well in Britain, where, again, it should be noted the rate of H1N1 is about one-third of that in Canada.
When H1N1 first arrived on the scene - a few months ago - the Public Health Agency of Canada won praise for its response. In particular, it delivered a concise, clear message that was co-ordinated with provincial public-health officials.
But now that the epidemic strain has settled in and the potential panic has abated, it's time to change the messaging and the approach to H1N1.
There needs to be fuller disclosure of the numbers - with hard-hitting analysis such as Mr. Davidson has done - and more thorough discussion of what we have done right, and wrong, in response to the pandemic.
This is not a time for complacency or sheepishness.
Rather, it is the time for critical analysis of our response to the first wave of H1N1 to ensure we are better prepared when and if the second wave hits harder.
The public needs to be a party to that discussion because, ultimately, their lives are at stake.