Worst Of Flu Pandemic Behind Us, Experts Say

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Worst Of Flu Pandemic Behind Us, Experts Say

Shot Still Urged

Tom Blackwell, National Post Published: Saturday, November 21, 2009

At times in recent weeks, the number of suspected flu patients showing up at the

B.C. Children's Hospital's emergency department soared to 50 or 60 a day above

usual, prompting it to set up a separate influenza clinic.

In the last several days, however, the arrivals have fallen off so much that the

special area was officially closed down on Wednesday.

" We're not getting the same wave of patients, " said Dr. Ralph Rothstein, a

pediatrician at the Vancouver hospital. " I think we're all taking a breather

this week. "

They are not alone. After a month of intermittent apathy, panic, mixed messages

and controversy -- and hard work by many doctors and nurses -- it seems the

worst of the H1N1 flu pandemic is over in Canada.

Infectious disease experts generally agree that data from the last couple of

weeks shows the epidemic in most of the country has peaked and is on its long

downward slide.

" There are several indicators that suggest we are over the top of the slope, "

said Dr. Gardam, director of infectious-disease prevention with the

Ontario Agency for Health Protection and Promotion. " Trends are looking positive

in a number of provinces. "

The new virus's spread is beginning to wane just as the healthy public gets

access to the pandemic-flu vaccine, and with evidence largely confirming that

the novel bug is a relatively mild flu, though with some disturbing qualities.

At least one public-health official has accused Canadian governments of going

overboard in their response to the pandemic, which is estimated to have cost

more than $1-billion.

Other experts defend the resources thrown at the situation, however, noting that

it was unclear how virulent H1N1 would be when it emerged in April, and that the

disease has provided a sort of dry run for seeing how well pandemic strategies

worked.

" It has given us a real, live opportunity to test all of the things we've done

in planning and all the measures we've put in place, " said Dr. Gerald ,

president of the Association of Medical Microbiology and Infectious Disease

Canada. " Even though we've had some tragic deaths ... it's way less than we

would have had in that worst-case scenario. "

As well, specialists say, the unprecedented wealth of scientific knowledge

accumulated in the last few months will lead to years of study, and a new

understanding of both pandemics and influenza itself.

Meanwhile, the number of cases remains well above the peak of a regular flu

season, and will stay high for weeks, before becoming more sporadic for the rest

of the winter. A third, spring wave is still possible, some experts say. With

only about a third of Canadians protected against the virus -- either because

they were exposed to it or vaccinated -- infectious-disease doctors still

strongly recommend getting an H1N1 flu shot.

Reports of relatively large numbers of deaths are also likely to keep coming --

even as the number of cases shrinks -- since deaths can happen weeks after

someone is infected. There were 84 in the past week, more than in all of the

virus's initial wave this spring.

A number of measures, however, suggest that the first influenza pandemic in more

than 40 years has passed its apex here.

A Public Health Agency of Canada report released late yesterday showed that in

the week ending Nov. 14, the number of regions reporting flu activity, the

number of outbreaks in schools and hospitals, the number of flu-related doctor

visits and the number of influenza cases sent for testing were all down.

In B.C., where the pandemic's second wave seemed to start and peak first, even

the number of flu-linked hospital admissions and deaths has followed the trend.

" We probably passed the peak last week, " said Dr. . " We're on the downslope

of the other side. "

Mathematical modelling that predicted H1N1's second wave would last six to eight

weeks appears " dead on, " he said.

Declaring that the pandemic has peaked is not easy for physicians and public

health officials, though, in the wake of the Severe Acute Respiratory Syndrome

(SARS) crisis six years ago, said Dr. Gardam. With Toronto being pummelled

economically, experts and government authorities were under " tremendous

pressure " at the time to announce the demise of that outbreak, he said. But no

sooner had they predicted the end was nigh than another deadly wave of the virus

unexpectedly erupted inside a city hospital.

There is wide agreement that H1N1, a novel virus for which few people had any

immunity, has infected far more Canadians than does the seasonal flu. It has

proven relatively

benign, however, causing 250 deaths so far, while the vast majority of patients

have suffered relatively mild illness. That compares to estimates of as many as

4,000 deaths from seasonal flu in this country.

Dr. Gardam cautions about reading too much into that comparison, though. The

seasonal flu mortality estimate is based on mathematical modelling and may well

be a " gross over-estimation. " Also, those victims are generally very old and

very ill, while the death toll from H1N1 has included some fairly young and

healthy people, a " traumatic " fact for the ICU staff who cared for them.

A positive side-benefit of the pandemic has been the treasure-trove of

scientific data collected with technology -- such as precise Polymerase chain

reaction (PCR) testing that pinpoints the genetics of flus -- that did not exist

during the last two pandemics in 1957 and 1968.

" This pandemic has advanced our understanding of flu epidemiology a

thousandfold, " said Dr. Gardam. " People will be going through this for years to

come. "

Among the questions that could be answered is how, exactly, influenza is

transmitted from person to person -- by simple contact, inhalation of airborne

particles or otherwise, he said.

Dr. said he would like to see light shed on the origins of such viruses as

diseases that can transmit freely among humans, knowledge that he said might

some day allow scientists to stop a pandemic " in its tracks. "

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