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Recent severe cases of H1N1 flu worry health officials

In a teleconference with reporters this afternoon, federal health officials provided an update on the current state of the Canadian government's response to the H1N1 flu pandemic.

Health Minister Leona Aglukkaq -- who has kept a fairly low profile in her time at the helm of Health Canada throughout the H1N1 response as well as the radioisotope shortage crisis -- was in attendance but said little besides mentioning that she'd be traveling to Mexico soon alongside foreign governments' delegates to discuss at a World Health Organization meeting how to deal with the expected resurgence of the H1N1 virus this fall.

Dr David Butler-Jones, the government's Chief Public Health Officer (above right), said that although the vast majority of the 7,775 cases detected in Canada so far (see the map below for a breakdown by province or visit the Public Health Agency's surveillance website) have been mild and have resulted in full recoveries, the anticipated "second wave" of infections this fall has been preceded already by the mysterious appearance in recent weeks of a small number of "severe" infections.

According to Dr Butler-Jones, the reason or reasons for the emergence of this new set of "severe" cases in Canada has not been determined, though epidemiologists with Health Canada and the Public Health Agency of Canada have been dispatched to study the matter. Possible explanations, he explained, could include: genetic variations that result in either too little or too great an immune response in infected patients, a mutation in the H1N1 virus (which would augur potentially very serious consequences in the general population over the months to come, it would seem), or some combination of factors. He warned that we should expect to see more cases in Canada over the coming months, including more severe cases, and more deaths.

At the top of the news lately have been accusations that the federal government's response to the rapid spread of the H1N1 flu virus in aboriginal communities, particularly in Manitoba, has been insufficient. Health Canada's regional director of First Nations and Inuit Health, Valerie Gideon, endeavored to convince reporters that was not the case. The shipments of hand sanitizer, which had been delayed because of concerns that the alcohol-based gels might be abused by First Nations patients, have now been delivered, she said, and nursing stations are open on the reserves 24 hours per day and are stocked with necessary medical supplies.

One interesting item to note about Monday's news conference was the tone that Dr Butler-Jones employed when discussing recommended precautionary measures for pregnant women and people with preexisting health conditions, both of which groups of patients may be at higher risk of experiencing dangerous complications if they are infected with the H1N1 flu. Whereas US Vice-President Joe Biden was mocked not long ago for warning people to avoid crowded places like buses and trains for fear of catching the virus, Dr Butler-Jones said very seriously that pregnant women in Canada should consider staying out of crowds. He refused, however, to cite specific crowded places pregnant women should avoid; he demurred when asked by one reporter if he meant women should avoid shopping malls and public transportation, only mentioning for certain (and this is where things took a brief turn for the surreal) that pregnant women should avoid mosh pits.

Photo: Public Health Agency of Canada

David Caplan aims for better, cheapter healthcare

It's been said that the Canadian model of healthcare insurance promises three things: high-quality care, for everyone, quickly. Reality falls short of the promise, of course. As the saying goes: pick two.

But David Caplan (left), the man selected to follow the controversial George Smitherman as health minister of Ontario a year ago this month, intends to make good on that promise. Universal coverage is a given, of course, but as for quality and efficiency -- well, let's just say that Canada is no . Maintaining a high level of quality has in some cases meant reduced access and longer wait times, and it's likewise assumed that providing all patients with family physicians (and the enviable same-day access patients in some other countries get) would compromise doctors' ability to give patients sufficient attention and deliver appropriate care.

Complicating matters is the fact that the rate at which governments' health spending has been increasing has outstripped growth in GDP for years, and seems likely to do so for years to come.

Mr Caplan's ambitious goal as health minister is to turn that move beyond the quality/wait-times binary and to save money in the process.

He explained his thinking to me in a long interview for the June issue of Parkhurst Exchange magazine:

"What I want to do is raise the quality of the healthcare experience, of healthcare service, because all of the literature I've read says that when you increase quality you increase efficiency and you increase sustainability and cost-effectiveness. That's the real way. The mistake I think governments have made in the past is they've tried to contain costs first and what you've seen is a degradation of quality. If you raise quality, and that's the goal, almost by definition it will logically follow that cost-effectiveness will result."
on the Parkhurst Exchange website, for more on health policy as well as a discussion of following in his mother's footsteps as health minister of Ontario, the decline and future of solo practice, Mr Caplan's struggles with his weight and smoking addiction, and more.