Swine flu may cause decreased intensive care availability

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If the H1N1 influenza or swine flu epidemic starts in the Greater Helsinki area already within the next few weeks, not all seriously ill patients in need of intensive care will be able to get mechanical ventilation.
      The number of beds at the intensive care units of the Hospital District of Helsinki and Uusimaa (HUCH) is 80. In an emergency this could be increased to 120.
     
If the influenza vaccine is not available in time, the probable number of patients considered for admission to an intensive care unit will be 300 to 600.
      The H1N1 influenza can cause pneumonia, which can prevent the patient from getting enough oxygen. In the most serious cases, the only treatment would be mechanical ventilation. In other words, a medical ventilator would provide the mechanism of breathing for a patient who cannot breathe.
      ”If the patient does not get mechanical ventilation, he or she will die very soon”, says chief physician, prof. Ville Valtonen from HUCH.
      ”If the peak of the epidemic is strong, the number of beds in our hospitals will not be sufficient”, estimates Valtonen.
      A patient who needs intensive care has to get mechanical ventilation for about ten days.
      What is worse, the potential extra beds for the intensive care units will have to be taken from surgical patients, for example. This would mean in turn that some operations would have to be postponed by weeks in the worst case.
     
It may not be possible to arrange additional beds for the intensive care units if the employees at hospitals have not been inoculated against the virus and they contract the infection.
      It is not possible to arrange crash courses in intensive care functions for the staff.
      According to the estimates, one in five HUCH nurses could contract the swine flu infection.
      The nurses are at the top of the vaccine list, in order that they will be able to work. It is also important that the inoculated nurses will not spread the virus further.
     
The epicemic has three stages. The first one will be the acceleration stage, taking around two to three weeks. During this time the situation will still be under control. The subsequent peak period will last for approximately one month, during which time the health care resources will be hard-pressed. At the third stage, epidemic disease levels will gradually drop below observed peak levels.
      The swine flu vaccinations are to be launched in Finland at the beginning of October. The maximum number of people who will be inoculated per week is 250,000.
     
At its worst, around a million people are estimated to contract the H1N1 infection in Finland, while about a thousand of them are predicted to die of the disease.
      However, if the peak of the epidemic hits as hard as it could, the shortage in intensive care could lead to hundreds of additional deaths, nearly one-third of them occurring in the Hospital District of Helsinki and Uusimaa.
      Then again, if the vaccines get off to a good start, the number of deaths could remain at slightly more than 500.
     
At present, two women in their twenties are being treated in the ICU at the Jorvi Hospital in Espoo, one of the HUCH hospitals.
      The patients had contracted the virus while travelling abroad.
      Valtonen said that he believes that these patients will survive. They are now being given mechanical ventilation.
      If the peak of the epidemic hits Finland in full swing, it will not just be Helsinki that suffers: other hospitals across the country could also run out of intensive care beds.
      According to Valtonen, it is likely that the epidemic will gradually spread from the capital region towards the north, hitting for example Rovaniemi a few weeks after it has been observed in Helsinki.
     
The common form of influenza is usually dangerous to old people, but when it comes to swine flu, one of the observed risk groups is young adults.
      The influenza A (H1N1) epidemic has not yet been reported to be spreading in Great Britain, France, and Germany. It is likely to arrive in Finland only after it has been recorded in these countries.
      The first wave of swine flu infestions is expected in Finland in the course of the autumn, and the second one is predicted to arrive in the country in the spring.
      Once the epidemic has started in earnest, thousands of cases will be recorded every day.


Previously in HS International Edition:
  Sweden reports first swine flu death (1.9.2009)
  Swine flu may reduce number of available child-minders in Helsinki area (18.8.2009)
  Health officials say WHO pandemic pronouncement does not alter Finland´s preparations for swine flu (12.6.2009)

Links:
  Ministry of Social Affairs and Health press release 22.7.2009: Finnish health care prepares for an extensive epidemic of influenza A (H1NI)

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