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Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria

Martin E Lum, Alison J McMillan, Chris W Brook, Rosemary Lester and Leonard S Piers
Med J Aust 2009; 191 (9): 502-506.

Summary

Objective:

Design and setting: Prospective modelling with the tools FluSurge 2.0 and FluAid 2.0 (developed by the United States Centers for Disease Control and Prevention) over 12 weeks from when the pandemic “Contain” Phase was declared on 22 May 2009, compared with data obtained from daily hospital reports of pandemic (H1N1) 2009 influenza-related admissions and transfers to intensive care units (ICUs).

Main outcome measures: The effect on hospitals as projected by the FluAid 2.0 model compared with observed hospital admissions and ICU admissions.

Results: Prospective use of the FluAid 2.0 model provided valuable health intelligence for assessment and projection of hospitalisation and critical care demand through the first 10 weeks of the pandemic in Victoria. The observed rate of hospital admissions for pandemic (H1N1) 2009 was broadly consistent with a 5% gross clinical attack rate, with 0.3% of infected patients being hospitalised. Transfers to ICUs occurred at a rate of 20% of hospital admissions, and were associated with vulnerable patient groups, and severe respiratory failure in 82% of patients admitted to ICUs. Most patients treated in ICUs (85%) survived after an average ICU length of stay of 9 days (SD, 6.5 days). Mechanical ventilation was required by 72% of patients admitted to ICUs, and extracorporeal membrane oxygenation (ECMO) was used for 7%. Pre-existing haematological malignancy accounted for half of all the deaths in patients admitted to ICUs with pandemic (H1N1) 2009 influenza.

Conclusions: Prospective use of modelling tools informed critical decisions in the planning and management of the pandemic. Early estimation of the clinical attack rate, hospitalisation rates, and demand for ICU beds guided implementation of surge capacity. ECMO emerged as an important treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.

  • Martin E Lum1
  • Alison J McMillan2
  • Chris W Brook3
  • Rosemary Lester4
  • Leonard S Piers5

  • State Government of Victoria, Department of Health, Melbourne, VIC.

Correspondence: martin.lum@dhs.vic.gov.au

Acknowledgements: 

We thank the following State Government of Victoria, Department of Human Services staff: Zoe Theodore, Funding and Health Information Policy Branch, and Catherine Lineham, Access and Metropolitan Performance Branch for collating daily hospital demand reports; James Fielding and Joy Gregory, Communicable Disease Prevention and Control Unit for assisting with verification of cases of notified disease; and Alison Markwick, Health Intelligence Unit, for help with epidemiological modelling.

Competing interests:

None identified.

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