People sit in a waiting area for turn to be injected with the H1N1 flu vaccine at a clinic in Ottawa.FRED CHARTRAND
Provinces are scrambling to accelerate their H1N1 vaccination programs and at least one prominent hospital is redirecting doctors from clinics to emergency rooms as the second wave of the pandemic virus grips the country.
Toronto Public Health said Wednesday it will fast-track its vaccination clinics for high-risk groups, including pregnant women, and make the vaccine available Thursday rather than next week. Alberta, meanwhile, will open 11 new clinics to meet public demand for the vaccine. And the Children's Hospital of Eastern Ontario is restricting patient visitors to parents, while they redeploy staff to cope with an influx of influenza cases.
The virus has sickened thousands and killed close to 100 people across Canada. The latest and most high-profile death occurred Monday when 13-year-old Evan Frustaglio, an aspiring hockey star, collapsed on the bathroom floor of his Toronto home and never recovered, a fatality that health officials called rare but a tragic reminder of how swiftly the disease can kill.
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Anand Kumar, an intensive-care specialist at Winnipeg Health Sciences Centre, warned that the country will see similar illnesses and fatalities as the flu rips through schools and communities.
"You're going to start to see more children dying in the next few weeks," Dr. Kumar said. "And then the numbers are going to get even worse as parents and other adults are hit.
"Unless there's good vaccine uptake, it's pretty obvious that it's going to be somewhere between bad and really bad. I just don't think people get it."
Evan Frustaglio went from bad to worse in a matter of days. He had a fever and was vomiting over the weekend. His father took him to a walk-in clinic Sunday, when he was sent home with advice to continue taking over-the-counter medication. His fever broke Monday morning. But later that day, his father found him passed out on the bathroom floor.
The tragedy follows the death of 10-year-old Vanetia Warner of Cornwall, Ont., who was sick for several days before her condition rapidly deteriorated. She died Saturday in Ottawa. Pediatric deaths in the United States have also been steadily increasing.
"It speaks to the fact that no child has immunity against this virus," said Michael Gardam, director of infectious diseases prevention and control for the Ontario Agency for Health Protection and Promotion. "As opposed to seasonal flu, where a bunch of them have already had it, this is a new virus."
This week, the country embarked on an unprecedented vaccination program.
With doses slowly rolling in from GlaxoSmithKline, Canada's vaccine supplier, jurisdictions have opted for a phased-in approach: First in line are health-care workers and groups that are more likely to develop complications, such as adults with chronic health conditions, young children, pregnant women and those living in remote communities. Healthy Canadians are being asked to hold off, until priority groups receive their shots.
Despite Evan's death, Ontario has no plans to expand the high-risk group to include teenagers. The province should receive enough vaccine for everyone who wants and needs it by Christmas, officials said.
"The sad news of this boy's death is a reminder that while most flu illness is mild, severe illness and death is a part of the picture of this pandemic," David McKeown, Toronto's medical officer of health, told reporters yesterday.
The city will expand operating hours of vaccination clinics to manage demand, he added.
In Alberta, Health Minister Ron Liepert apologized yesterday to residents who have braved long lines to get the shot. Some had to wait between three to six hours. To meet public demand, the province is opening 11 new clinics. "We are doing the best we can," Alberta Premier Ed Stelmach told reporters.
The virus, now in its second wave, has put governments, hospitals and institutions on high alert.
On Monday alone, the Children's Hospital of Eastern Ontario saw 320 patients in its emergency ward, a majority of them with suspected H1N1, said spokeswoman Marie Belanger.
In addition to its new visitor restriction, where only parents or legal guardians can see patients, CHEO is also asking that only one parent come with a child to emergency. It is also in the midst of closing three ambulatory care clinics - gastroenterology, respirology and endocrinology - so it can redirect doctors and other health-care providers to work in the emergency department, due to the large numbers of children with suspected H1N1.
Dr. Gardam said he wonders why people would think twice about getting the vaccine in light of the number of cases - suspected and confirmed - among younger people. The vaccine has been tested for safety, and there is a small, but real risk of being admitted to hospital and dying if people don't get the vaccine, he said.
"In my mind," Dr. Gardam said, "when you balance those two, it's a no-brainer: You would get vaccinated."
With a report from Katherine O'Neill in Edmonton
Caroline Alphonso
Karen Howlett