Cases not connected

Nunavut health officials have increased their surveillance for the H1N1 virus – more commonly known as swine flu – now that four cases have been confirmed in the territory.

Three of Nunavut's cases involve children in the pediatric ward at Yellowknife's Stanton Territorial Hospital. The other is not in hospital.

The cases are not connected, and are not from a single community.

And none of the four involve people who have been travelling beyond the North, said Nunavut's chief medical health officer, Dr. Isaac Sobel.

Beyond that, for privacy reasons, he would offer no further information that might identify the patients or their home communities.

Most Nunavummiut who go to Stanton are from the Kitikmeot region, but Sobel would not confirm that either.

One case of swine flu was confirmed in the Northwest Territories at the end of May, and one was confirmed in Yukon earlier in the month.

For at least the next two weeks, the department is asking all health professionals in the territory to take a nasal swab on any patients they encounter with flu-like symptoms.

This would include fever, fatigue, lack of appetite, coughing and sore throat.

Some people with the H1N1 virus have also reported vomiting and diarrhea, according to a public health advisory.

Until now, unless there were additional reasons to suspect swine flu, health workers were only being asked to take a swab on every fifth patient with flu-like symptoms.

The change, Sobel said, is to see if officials can get a better idea of how widespread the H1N1 virus is in Nunavut.

The testing window is being limited to two weeks for now, he said, because "we don't want to burn out our health-care staff or blow our budget."

Sobel has also told health-care workers not to bother checking on whether patients have traveled to Mexico or elsewhere recently because the disease has become widespread in Canada.

"There is no reason Nunavut should be immune to it," he said.

He also noted that some patients have likely gone undiagnosed because people may have had mild cases with familiar flu symptoms, and didn't get in touch with health care workers.

Sobel said all Nunavummiut should be taking standard hygienic precautions against the spread of any strain of influenza, so knowing the location of the communities involved should not make a public health difference.

Those precautions include:

• frequent hand washing, with either soap and warm water, or alcohol-based hand cleanser;
• stay home from work, school or social functions if you are experiencing any flu symptoms – until you are feeling better;
• call your local health centre to let them know you are experiencing flu symptoms;
• get lots of rest and drink lots of fluids;
• cover your nose and mouth when you sneeze, even if you have to use your sleeve to do it; and
• if the symptoms worsen, go to the health centre – but call first so they know you are coming.

Sobel said that about 4,000 people die in Canada each year of other strains of flu, and "at the moment this [H1N1 virus] looks no more virulent than those other strains."

Health officials around the world, and including in Nunavut, are remaining vigilant, however, he said, noting that the infamous Spanish flu epidemic that killed up to 40 million people globally in 1918 and 1919, actually came in two waves.

The first wave was comparatively mild, he said, but then, for reasons that are still not understood, it came back with a vengeance.

According to a Stanford University web site, the Spanish flu killed 25 people for every 1,000 infected, whereas previous influenza epidemics killed less than one in a thousand.

Also unusual was that most of the victims were in the 20 to 40 age range.

As of June 1, Health Canada was reporting over 1,500 lab-confirmed cases of H1N1, including those in the three northern territories.

There have been three deaths, two in Ontario and one Alberta and all involving people with prior health issues.

That would be a mortality rate of two per 1,000 confirmed cases. Only 57 people in Canada have been hospitalized with the disease.

On May 29, the World Health Organization reported 15,500 cases of swine flu worldwide, and 99 deaths, which is a rate of over six per 1,000 confirmed infections.