Friday, 21 August 2009

Doctors ignorance is the paradox

Not a paradox, only doctor's ignorance.

In India they are saying that 30,000 in 30 years is worse than 28 in a
month due to Swine Flu. Well , that 28 can become trillion trillions
in 30 years.

Similarly in New Zealand. At 20 times the infectiion rate due to
common flu, working in parallel with flu, i.e. you can get both types
of flu at the same time, and fatality rate approaching 30% if not
treated as in the case of Mexican early days, it is not surprising.

If you get treatment, fatality is low, if you don't get treatment,
fatality is surely much higher. You cannot compare Spanish Flu in 1919
that had no treatment, with Swine Flu in 2009 that is fully treatable.

They have the same fatality rate if not treated, i.e. 0.67% in a
population, as proven in Wales.

If well treated, it will go down to zero, but most fatalities were due
to late treatment and poor medical care. If everyone can get heart-
lung machine, fatality will be much lower as shown by UK vs Malaysia.

Swine Flu Pandemic Paradox Kills Few, Overwhelms Hospital ICUs
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By Jason Gale

Aug. 21 (Bloomberg) -- Swine flu filled up Geoff Shaw's intensive care
unit in Christchurch, New Zealand, last month, forcing some surgeries
to be canceled as the hospital struggled to cope. As winter moves to
the Northern Hemisphere, health officials from Chicago to London brace
for a similar overload.

"We have run out of bed space, we have run out of nurses," Shaw, 47,
said after working in the ICU and being on- call for 185 hours over 11
days. "There will be people who die because they were denied access to
other treatments."

Health officials call it the swine flu paradox. As the new H1N1 strain
spreads, the majority of patients recover within days and the number
of deaths is a fraction of the seasonal flu toll. Those statistics
mask an alarming reality: the pandemic has strained intensive care
units and a resurgence of the virus in the fall could bring a public
health disaster, experts say.

"We have largely been fortunate," said Simon Towler, an intensive care
specialist at the Royal Perth Hospital and Western Australia's chief
medical officer. "If we had a severe flu of a different type we would
be in massive trouble. The systems really don't have the capacity to
cope with a surge."

Last weekend, a quarter of Western Australia's 105 adult intensive
care beds were occupied by swine flu patients who needed ventilators
to breathe, according to Towler.

The experience in Australia and New Zealand offers clues about what
North America, Europe and Japan may see when winter moves in.

Artificial Lung

"The Northern Hemisphere medical care requirements for the next six
months are a train wreck waiting to happen," said Michael Osterholm,
director of the University of Minnesota's Center for Infectious
Disease Research and Policy in Minneapolis. "In the fall, even if
nothing else changes in terms of the virus's severity and our
preparedness, it's going to be a real challenge."

While fewer than 0.5 percent of swine flu sufferers may need
hospitalization, those who do can remain in intensive care for up to
three weeks, occupying a bed that could be used for 15 heart bypass
patients. Christchurch Hospital, the biggest on New Zealand's South
Island, postponed non-emergency procedures requiring an ICU stay such
as heart bypass as flu patients -- three-quarters needing mechanical
ventilation -- filled up the 12-bed unit and nine other hastily
created intensive-care beds, according to Shaw.

What's more, a 10th of those critically ill patients needed their
blood pumped through an artificial lung, a procedure known as
extracorporeal membrane oxygenation, or ECMO, that only one hospital
in New Zealand offers.

Life Support

"I've seen nothing like this," said John Beca, head of pediatric
intensive care at New Zealand's national children's hospital in
Auckland. Five of Beca's six ECMO units have been used simultaneously
this winter. He's ordering three more.

Maquet Cardiopulmonary AG, a subsidiary of Sweden's Getinge AB, has
received a 50 percent jump in orders for the life- support system in
Australia, Clinical Director Juergen Boehm said. The German company is
doubling production of the units, which cost as much as 60,000 euros
($85,000) apiece, and plans to increase its inventory of tubes,
artificial lungs and other disposable ECMO equipment to about 500
sets, from 100 usually.

"We will have to see what comes over the next weeks and months from
other areas," Boehm said in a July 27 interview.

Orders for ECMO accessories are up about 20 percent in Australia and
New Zealand, said Joseph McGrath, a spokesman for Minneapolis-based
Medtronic Inc., which also makes the devices.

Vaccine Hopes

Sanofi-Aventis SA, GlaxoSmithKline Plc and Novartis AG are racing to
prepare millions of inoculations against the new virus and test them
before the weather turns colder in the hope of blunting the pandemic.
Paris-based Sanofi began vaccine trials on Aug. 6 and needs "two to
three months" to complete them. London-based Glaxo has said it began
testing this month. The U.S. expects the first shots to be delivered

"Hopefully the vaccines will get out and the Northern Hemisphere's
experience will be dramatically mitigated," Towler said. "But there
will be some people who either won't get vaccinated or won't be
protected, and the lessons from the Southern Hemisphere, particularly
countries like Australia and New Zealand, will be important."

More than a dozen flu patients were entering intensive care units
daily in Sydney a month ago, compared with five at the peak of a
regular winter flu season, said Tim Smyth, deputy director general of
health for New South Wales.

Health officials in the state, home to one in three Australians, are
equipping a helicopter with the lung bypass machine to retrieve
patients from remote hospitals.


The average age of patients in intensive care is 40 years, according
to Smyth, and most have an underlying condition such as diabetes or
heart disease, or are pregnant or obese.

In some patients, the virus causes such a severe assault on the
respiratory tract that the lungs become inflamed and the grape-like
sacs where gas is exchanged are injured, causing bleeding and a
critical loss of oxygen supply.

"We are all concerned given the severity of this disease and the
significant critical care support and resource utilization required
for the successful treatment of these patients," said Lena Napolitano,
chief of acute care surgery at the University of Michigan Health
System at Ann Arbor.

Studies in the U.S. show that the group of patients requiring
mechanical ventilation for at least four days is growing six times
faster than the rest of hospitalizations, said Marya Zilberberg, a
scientist with the Amherst EviMed Research Group at the University of

The pandemic will only add to that demand, Zilberberg said. "My sense
is that it may stress our capacity to its limit and beyond," she said.

Young Victims

Worldwide, the H1N1 virus has killed about 1,800 people as of Aug. 13,
according to the World Health Organization. The median age of death in
Australia is 56 -- compared with 83 years for seasonal flu fatalities.

"It's striking young people down," said Shaw, the intensive care
specialist in Christchurch. "We are seeing people largely between the
ages of 20 and 50. That really is quite different from anything else
we have ever had."

Australia shows how the pandemic has confounded expectations:
Intensive care accounts for about a quarter of hospital stays, Jim
Bishop, Australia's chief medical officer, said last week. The
government had anticipated only 10 percent of those hospitalized would
need critical care, yet expected more deaths: its modeling predicted
6,000, and 121 have died so far.

"There is something very different about this virus," said Heath
Kelly, head of epidemiology at Victoria state's infectious diseases
reference laboratory in Melbourne. "In ICUs, it looks worse" than
expected, he said. "But everywhere else you look, it looks better.
That's the interesting paradox."

To contact the reporter on this story: Jason Gale in Singapore at
Last Updated: August 20, 2009 10:01 EDT

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