Thank you for the invitation to be here today.
My name is Anand Kumar. By way of background, you should know that I have some unusual qualifications to speak to you on the subject of the threat of pandemic H1N1 today. I'm an academic intensive care specialist from the University of Manitoba. I'm one of about 12 physicians in Canada trained in both critical care medicine and infectious diseases.
As you all know, Canada is in the midst of a major H1N1 influenza epidemic that represents the leading edge of the first influenza pandemic in over 40 years. During the first wave during the spring outbreak in Manitoba, over 50 mostly young, relatively healthy patients with H1N1 influenza were admitted to the ICUs of Winnipeg with severe viral pneumonia complicated by an exceptional degree of lung injury, kidney failure, and occasionally shock. All were at immediate risk of death, and eight died--that's about 20%.
The strain on ICU and hospital resources during the epidemic was severe. I know this because I was there and, along with several of my colleagues, treated many of the patients stricken during the most severe portion of their illnesses. There is an appropriate concern that the Manitoba epidemic was simply a harbinger of a larger pandemic that we're beginning to see this fall.
The experience of the Manitoba spring outbreak and the subsequent smaller outbreaks across the country during the summer may provide important lessons for the Canadian response to the H1N1 threat going forward. Among the key observations is that relatively healthy adolescents and adults, particularly women, are the primary groups at risk for severe illness and death, which is a tremendously unusual pattern of illness.
In addition, first nations communities, the obese, and pregnant women are at especially high risk. Further experience to date suggests a remarkable degree of illness associated with severe H1N1 infection and an astonishing requirement for ICU resources to support such patients. These observations by me and my colleagues in the Canadian Critical Care Trials Group were published just last week in the Journal of the American Medical Association.
The price for the earliest of these lessons was paid by the citizens of Manitoba, from the severe illnesses and deaths in both Manitoba first nation and non-aboriginal populations to the exceptional strain on our health care workers during the epidemic. Their losses and sacrifices should be acknowledged. In addition, I want to make particular note of the leadership of Brian Postl and Dan Roberts of the Winnipeg Regional Health Authority; the tremendous effort and resilience of ICU and ER nursing and support staff at all of the WRHA hospitals, particularly the Health Sciences Centre and St. Boniface hospital; and the professionalism and dedication of our intensive care and emergency room physicians. I've been honoured to work alongside all of them.
The boundless efforts of my colleagues, particularly Rob Fowler in the Canadian Critical Care Trials Group, should also be noted. Dr. Fowler's foresight and the dedicated efforts of group members are responsible for the collection of tremendous amounts of critical data on the national spread of the spring/summer outbreak. The data the group collected, at their own expense and without any immediate external financial support, has been crucial in formulating our national H1N1 response strategy, from identifying groups at highest risk for early intervention to determining optimal medical therapy for the most severely ill subset of patients.
The efforts of the Public Health Agency of Canada and the scientists of the National Microbiology Laboratory of Canada, headed by Frank Plummer, should be lauded. As the magnitude of the local threat became apparent, they quickly offered their resources and support without precondition. This allowed us to collect important biological samples for analysis early in the epidemic to help determine ideal diagnostic and therapeutic management strategies. Their support has also been crucial in forging relationships between industry, academia, and government, which are leading to the improvement of standard therapies and the development of novel treatments rapidly enough to make a difference to the patients we will see in the weeks and months ahead. Further, the Public Health Agency and NML quickly arranged a national conference of ICU specialists, public health professionals, and other stakeholders to share information about the pandemic H1N1 risk.
Although much has been learned and substantial progress has been made, significant risks remain. Prime among those risks is the persistent skepticism among the public about the utility and safety of vaccination. The potential benefit of influenza vaccination will never be greater than it is this year. Normally the very old and debilitated are the major victims of influenza. This year its victims will look much like the people in this room and like our children. It is imperative that we find a way to transmit to the public the importance of vaccination, which is the single most effective way of limiting potential damage from pandemic influenza. In addition, although ICU resources have been supplemented, we need to remain vigilant in certain areas, particularly in nurse staffing, where systems stresses may be acute in the months ahead.
There is also an immediate need for increased applied research funding on this epidemic. Funds were recently allocated for influenza research. That's a good thing, but a casual perusal of funded projects suggests that most will yield dividends years in the future. The gun is at our collective heads right now, and we should consider additional funds to answer key questions that will inform our management of patients immediately.
l'd be happy to take any questions.