Canada is developing a complex preparation plan for a possible deadly A/H1N1 flu pandemic later this year, with measures focusing on how to distribute limited treatment resources, as well as training more professionals and buying more ventilators and other machines to treat seriously sick patients.

With the A/H1N1 flu continuing to spread at present, the primary fear of health officials here is that a more deadly and serious flu pandemic will return in autumn, rendering an approximate 200,000 people, or 0.6 percent of the total population, seriously ill.

Health experts believe that A/H1N1 flu may follow the same course as the Spanish flu, which arrived in a mild form in the spring of 1918 and then mutated into something far more vicious when traditional flu season returned in the fall of that year.

In the end, an estimated 50 million people were killed worldwide, including 50,000 in Canada, or 0.6 percent of the then population. If the 1918 experiences were replicated this year and 0.6 percent of the Canadian population fell seriously ill, that would be close to 200,000 people.

Although earnest efforts have been taken to produce effective vaccine in time for the possible autumn pandemic, and experts say there is a strong likelihood that a vaccine will be in place by November, they have also warned that the effectiveness of preventive medicine is by no means a certainty.

Production of a vaccine has already hit a snag, with manufacturers reporting a disappointingly low yield when the virus is grown in eggs, according to the World Health Organization.

With the above considerations in mind, health officials at various levels in Canada are earnestly preparing for the worst.

For one thing, the federal and provincial governments are developing a plan which stipulates, among many other things, that guidelines be developed to assist doctors in making tough choices about the allocation of scarce treatments. This means that for the first time in decades, doctors across the country will be given rules to help determine which patients get access to life-saving treatments and which not.

"There may come a point where there is definitely an overcrowding situation where triaging has to occur if you have limited resources," Theresa Tam, director general of infection disease and emergency preparedness for the Public Health Agency of Canada, told national newspaper The Globe and Mail in a recent interview.

Some of the work to develop the rules around triage has already been done, said Dr. Tam. A multidisciplinary group has been pulled together to analyze the potential situations as various issues, including legal issues, clinical issues and ethical issues, will all be involved.

With most diseases, it is the elderly and the infirm who are worst affected. But the H1N1 virus has a predilection for people in their prime.

"We may be faced with two young persons who may be competing for the same health-care resources, and those are some of the questions that we will be facilitating discussions on," Dr. Tam said.

Meanwhile, respiratory technicians say there are not enough members of their profession currently practicing in this country to care for patients during an influenza pandemic. Nor, they say, are there enough critical-care nurses.

The public health agency is looking at ways to bring health professionals out of retirement, getting students fast-tracked into the work force, and allowing credentials to be accepted across jurisdictions.

Some doctors have also suggested the problem of finding enough ventilators and enough isolation rooms.

Dr. Tam estimated that there are about 3,500 to 4,500 ventilators in Canada that could be used in a pandemic. The public-health agency is purchasing 370 of the regular ventilators to add to the federal stockpile of 130 that can be distributed to the provinces as needed.

Dr. Tam said the regulators will be selected with ease of transportation and operation in mind. The agency expects to spend about 10,000 Canadian dollars (US$8,500) per machine. But agencies such as the Respiratory Therapy Society of Ontario have questioned that choice, saying better machines, each costing at least fours times as the regular ones, are needed for the pandemic. Experts expect more debate is coming as the severity of the flu is assessed.

Canada has the third highest number of confirmed A/H1N1 flu cases in the world. There have been a total of 9,717 confirmed patients so far in the country, with 39 deaths, according to the latest figures from the Public Health Agency of Canada.

(Xinhua News Agency July 14, 2009)