Tuesday, July 18, 2017

NSW: Sydney Hospitals `Slammed' By Flu-Like Cases


Unlike Hong Kong and Taiwan (see yesterday's  Hong Kong Hospitals Scramble To Deal With Mounting Flu Surge) - both of which sit in the northern hemisphere - it isn't unusual or unexpected to see influenza begin to ramp up in Australia in July, although their peak doesn't usually arrive until August or September (see NSW Surveillance chart below).

The above snapshot, current as of 9 days ago, shows influenza in New South Wales making its earliest surge since 2012, something we discussed in late June. The most recent (week 27) NSW Health Influenza Surveillance Report summary noted:

  • Surveillance data indicates a marked rise in activity over the last week and it is expected to continue to rise throughout July.
  • The impact of influenza on the health sector is steadily increasing.
  • Influenza A strains were more common than influenza B strains

Overnight Australian media has been filled with reports of over crowded ERs, ambulances `queued 10 deep' outside of hospitals waiting to unload patients, and paramedic response times plummeting as hospital's are being `slammed' by flu cases.

Typical of these reports are the following, first from The Age.

Huge delays as Sydney hospital emergency departments swamped with patients

Kate Aubusson

Paramedics and emergency departments in Sydney's south-west have been inundated by huge numbers of sick patients, causing major delays in ambulance transfers and hospital admissions.

Emergency staff say their emergency departments have been clogged with patients over the past 36 hours, many presenting with flu-like symptoms, causing significant delays in admissions times.
(Continue . . . )

And this from ABC News.

Ambulances queued up 10 deep outside Liverpool Hospital in Sydney
By state political reporter Sarah Gerathy

Ambulances have been queued 10 deep for hours outside some overstretched emergency wards across south-western Sydney, with doctors having to "tuck people in every corner" due to a surge in patients in the past 48 hours.

The acting director of emergency medicine at Liverpool Hospital said the hospital had been "slammed" and it was trying to do everything it could to ease the queue of ambulances and make sure paramedics could get back on the road.
         (Continue . . . )

Although they pale in comparison, these reports should provide some inkling of what hospitals and emergency services would have to deal with during a full fledged pandemic (see Australian Doc: ICU’s Were On `Verge of Collapse’ During Pandemic).
The ability of our medical system to deal with a sudden, possibly overwhelming, surge of patients during a pandemic - or other disaster - remains one of their greatest challenges.   
Two years ago, in COCA Call : Disaster/Emergency Preparedness For Clinicians, the CDC provided some guidance on the management of multiple critically ill patients during a disaster or pandemic. That presentation and supporting materials may be accessed at:
Emergency Preparedness for Clinicians - From Guidelines to the Front Line

Like Hong Kong and Taiwan, New South Wales appears to be dealing with a combination of Influenza A H3N2 and H1N1, and Influenza B.  H3N2 appears to be edging out H1N1, but about 87% of the influenza A positive isolates were not subtyped in the latest report.

Non-influenza respiratory viruses, including Rhinovirus, RSV, Parainfluenza, and Adenovirus are also being reported as part of their winter respiratory season mix, and so while Influenza A may seem the obvious culprit, we'll have to await further word as to exactly which virus has sparked this recent run on Sydney's hospitals.
Influenza seasons can vary greatly in terms of severity and timing, with H3N2 dominant seasons usually hitting the elderly hardest. Even in non-pandemic years, there can be as much as a 10-fold difference in flu mortality. 
While the recent severe flu in Hong Kong, and these latest reports from NSW, can't tell us with any certainty what kind of flu season we will see this fall, we have come off two relatively mild flu seasons in a row (see FluView Chart below).

At some point that pendulum will swing, and we'll see another severe flu season. In When Influenza Goes Rogue we looked back at some of these extreme non-pandemic years, and the overriding lesson is that flu has an enormous capacity to surprise us.

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