Thursday, October 22, 2009

Bioethics & H1N1

The secondary way of H1N1 has hit. Three more deaths last week, total number of Canadian fatalities = 86.
"As of 17 October 2009, worldwide there have been more than 414,000 laboratory confirmed cases of pandemic influenza H1N1 2009 and nearly 5000 deaths reported to WHO."
WHO has excellent maps indicating its progress as a pandemic.

Geographic spread of influenza activity

Map timeline

Trend of respiratory diseases activity compared to the previous week

Map timeline

Intensity of acute respiratory diseases in the population

Map timeline

Impact on health care services

Map timeline

Laboratory-confirmed cases of pandemic (H1N1) 2009 as officially reported to WHO by States Parties to the IHR (2005) as of 18 October 2009

Map of affected countries and deaths

Now that we (Canada) have the vaccines, they are targeting those under age 65. But the bioethics intrigue me.

The supplementary criteria the triage teams may use to prioritize patients were defined after extensive review of the ethical framework embedded in Ontario's provincial plan, the bioethics literature, and feedback from stakeholders. These criteria include: (1) Does the patient belong to a profession that could help save/care for others? (2) Is it likely the patient became exposed to influenza through their professional duties? (3) Is the patient pregnant or a caregiver for dependents (children under 18, disabled adults or elders)? (4) Is there any evidence the patient is significantly more likely to survive than others? and (5) Is the patient significantly younger than others, thus at risk of losing more years of life?

Here's how the Hamilton Health Sciences protocol will work. The first step will be to triage patients according to the Ontario Ministry of Health and Long-Term Care's clinical guidelines: Does the patient need critical care? Does the patient have underlying illnesses that predict a poor outcome? Is more than one organ system affected? Does the patient improve with critical care? The goal of this triage process is to ensure that everyone who receives critical care survives.

Triage - Globe & Mail
Essential service workers, people exposed to influenza through professional duties, caregivers of dependents, and younger patients will be given priority access.

As of today, Oct. 23, 2009, CBC reports in the  Greater Toronto Area (GTA) 439 hospitalizations to date. As of Oct. 21, 38. Deaths to date: 28, Average age of death: 57, average age of illness: 18.

"In Canada, the median age of those who have become ill with laboratory-confirmed swine flu is 21, and the median age of those who died is 51, Dr. David Butler-Jones, Canada's chief public health officer  said. Last week, about half of the people who died of the flu in the U.S. were teenagers."

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