Is Canada ready for a second wave of H1N1 (swine flu) that may hit in the fall? Britain says it may have 100,000 new cases a day by late August, based on the current doubling each week of the number of people falling ill. If Canada is hit proportionately, that would be roughly 50,000 cases a day.
The Public Health Agency of Canada is now ordering hundreds of ventilators in case the provinces do not have enough. Based on current expectations for the influenza's spread, there may not be enough ventilators.
Andrew Simor, the head of microbiology and infectious diseases at Sunnybrook Health Sciences Centre in Toronto, puts it this way: "If we assume even a moderate type of pandemic, in the number of people and severity of disease, it will definitely overwhelm our health-care system." It is not just a matter of a shortage of ventilators but of doctors, nurses and respiratory technologists trained to care for the patients and to use and maintain the equipment. "I suspect that is the situation we will likely encounter" beginning this fall, Dr. Simor says.
Who, then, would qualify for the desperately needed ventilators? Canadian acute-care facilities may be in the position of the people in the proverbial lifeboat with not enough drinking water to go around. "If there is a large-scale health emergency," says an Ontario health-ministry spokesman, "it comes down to the fact that you're dealing with only so much resources." It is a disturbing prospect, and should wake Canadians from any complacency they may feel.
The first wave of H1N1 has been, mostly, mild; and the mildness has bred complacency. Some of it has been nurtured by public health officials, who refer to "underlying health conditions" among those who have become the sickest. What are those underlying conditions? Pregnancy, diabetes, asthma and obesity are among them. So is smoking. There may be nearly as many households with an underlying condition in them as not.
The outbreak is likely to worsen. Most flus hit hardest at the old, sick and weak; H1N1 strikes people between 20 and 50. Most flus disappear in summer; Canada has five times the flu rate this summer because of H1N1. Of the 29 Canadians who died, several had no other health problems. Canada has a high rate of the disease compared with other countries, but that may be a sign it keeps a closer eye out for it.
What lies ahead? If Britain's plan is an indication, efforts at containment would end. Schools would stay open, no matter how many cases of sick children had been reported, unless staff members fell ill in large numbers. The focus would be on medical treatment, from an overwhelmed system.
Britain already has a national information campaign on swine flu; nothing in Canada thus far compares. Public authorities here need, as a first step, to communicate the importance of knowing the flu's symptoms, of applying common sense - don't go to work and infect colleagues. But more than that, the authorities need to make whatever investments are necessary to ensure that the system is not overwhelmed, and that lifesaving care is available to all.