THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 4: "The End is Near"

“We have learned very little
that is new about the disease,
but much that is old
about ourselves.”

——Frederick C. Tilney, on the polio epidemic in New York in 1916

The epidemic peaks

    The epidemic in Canada peaked at the end of the fourth week, producing the highest number of new cases. From here forward, cases would trend towards zero. For now, however, the country was seeing the worst of the crisis. On the 29th day of the epidemic, the absolute peak, more than 21,000 people sought hospitalization across the country.
    Some epidemiologists studying the Pandemic claim that while the school closings did not have a pronounced effect, they reduced the peak number of cases by an estimated 10 percent. After the peak, the number of new cases would begin to decline, reduced even further by government interventions such as non-essential business and house of worship closings. Unfortunately, while these intervention strategies reduced the peak number of cases, they also extended the length of the epidemic from eight to 10 weeks in many regions.
    By November 16, 3.8 million people had become clinically ill across Canada and more than 380,000 people had sought care in a hospital setting. Despite the life-saving benefits of antiviral drugs, nearly 50,000 people had died due to complications of Avian Flu. By the end of the Pandemic, these numbers would approximately double.
    In Ontario, for example, which represents nearly 40 percent of Canada’s population, about 1.5 million people had gotten clinically ill and more than 150,000 people sought hospitalization by the end of the epidemic’s first month. Most patients were in and out of the hospital in about a week or less, but some required care for weeks. By week 4, demand for acute care hospital beds was about 160 percent of available capacity even with the proliferation of new emergency hospitals. Among flu cases seeking hospitalization, about 15 percent required an ICU bed for an average of 14 days. By week 4, demand for ICU beds was more than 800 percent of capacity in Ontario. In addition, about 7.5 percent of hospitalized patients required a ventilator bed for an average of 14 days. By week 4, demand for mechanical ventilation was more than 550 percent of capacity. These were particularly dangerous shortages; many died from pneumonia and other complications due to the lack of ventilators and ICU beds.

Figure 4-1. Hospital admissions and mortality in Canada over the course of the epidemic.

Fortunately, Ontario had enough antiviral drugs that again proved sensitive to the Flu, although due to logistical problems sometimes they were overly concentrated in some areas, while other areas got none at all. Over time, these problems worked themselves out, but for many flu patients, the antivirals came too late to make any difference.

Figure 4-2. Hospital admissions and mortality in Ontario over the course of the epidemic.

By November 16, nearly 20,000 people died in Ontario, more than one-third of these in the Greater Toronto area alone.
As mortality increased, it became increasingly apparent that there wasn’t enough space for the dead or enough resources to properly put them to rest.