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Part Four
Currently, most cases are being seen in school aged children & the elderly. It's hoped with schools being closed, the number of cases among children will decline. Some of the more serious complications being seen are severe respiratory distress & several older patients are experiencing cardiac & renal difficulties. 3 children appear to have meningitis - tests have been done & results are pending.
As to the closure of schools & almost all leisure activities, Dr. Gemmel points out that areas in Asia which did not immediately do this saw a huge increase in cases in very short order. South Korea has over 50,000 cases & most of these developed before the schools were closed. What worries public health are reports from Asia of patients who did not require hospitalization. Some who became asymptomatic six weeks ago, are still too weak to return to work or resume their normal responsibilities. They are unavailable to replace those who are still falling ill, adding to the burden in the countries earliest affected.
The mayor warns that other restrictions on movement by the public may soon apply - some locally mandated & others put into effect at the provincial or federal level. There are plenty willing to say this is a huge over reaction on Canada's part, the province, the city... but the effects overseas where the outbreaks have been raging longer cannot be gainsaid. In the 2 nations which first saw human cases - Vietnam & South Korea, the outbreak shows no sign of slowing down. North Korea is releasing no information & while anecdotal evidence from China indicates they're being heavily impacted, no one is sure. They've closed their borders - as much as they can. In the second tire of Asian countries to contract H5N1, cases are still ramping up quickly.
By Friday, the estimated case load is roughly 950. Few patients are being tested except to rule out secondary infections. The affected age is changing, more & more older teens & young adults are becoming ill. Many seniors are contracting it as well & they're beginning to die. The city on Friday, states that 56 deaths are not presumed to have been caused by the flu. Most have occurred in the past three days.
Increasingly, health care workers are coming down with it - at last count 23 of them are either off sick or hospitalized themselves. Most have no idea how that happened & for most, community exposure of some type is suspected. It's been hectic in the hospitals as the students learn their new duties & ward managers try to put together reasonable schedules. People are working three 12 hour shifts in a row with 1 day off in between stretches of three shifts. So far, staff are holding up under that regime.
The hospital has closed completely to cases from outside the city save for those where alternative hospitals are simply out of the question - severe auto accidents, etc. Those doctors still seeing patients in the community are working long, hard hours & their staffs are constantly on the phone fielding questions from worried patients. Several drug manufacturers have shipped in supplies of 'standard' prescription meds & most people on regular meds have or can obtain two months worth, three for certain drugs not quite in demand.
Grocery stores have begun, of their own volition, limiting quantities of what customers are permitted to buy after rumours spread of profiteering & the marked absence of certain items. One store with an enlightened manager has chained spray bottles to many of the shelves & all the carts - they contain a simple disinfectant mix & customers are urged to spray cart handles, their own hands & their clothing before leaving the store. Other stores pick up on this. Stores reek of different disinfectants - few complain.
By the following Friday, case numbers have risen dramatically to over 2300 - of which 270 or so have been hospitalized. Many small neighbourhood convenience stores have closed for either lack of supplies, lack of customers or fear on the part of owners, forcing more & more to the bigger stores. Public Health thinks these stores, in spite of ample use of disinfectants, are acting as amplification points.
Public transit is also pointed out. Parking in the downtown area is poor & a significant percentage of the population either cannot afford to drive or chooses not to. Public transit is heavily used & people have actually used more public transportation since the outbreak began. Many accustomed to walking to the grocery store, now prefer to begin stocking up & take the bus at least for the return trip home. Many who've made private arrangements for the care of their out of school children are having to bus their child there, then turn around & get on another bus back to work. Most don't have masks to wear & today's bus fleet offers poor ventilation. During the rush hours, the typical bus is packed.
The city convenes a series of working meetings over the weekend to try & figure out ways to slow the spread. Entering the fourth week, the city has already close to being on its knees & for many, matters are becoming critical.
By the end of week five...
3154 cases are recorded with 354 required to date. 113 patients have died, most because their pulmonary system became completely overwhelmed, others due to cardiac, renal & hepatic complications. Several children have suffered terribly with digestive complaints & one two year old essentially bled out through his lower intestine. Of the hospitalized patients, some 20 are showing clear signs of neurological impairment on top of severe respiratory symptoms. Their prognosis is poor.
While the RATE of increase of new cases has dropped, it's too early to tell if this is significant & other countries have experienced this only to find case rates soaring upwards again within a week or two. The one item of what might be considered good news is that both South Korea & Vietnam have announced that for the last 2 weeks, cases have levelled off. China is reporting a similar situation but only in some regions. North Korea isn't talking. Japan is doing comparatively well. The Diet, once informed of the first cases immediately activated the IDF & brought in some severe restrictions on the movements of goods & people. They closed their borders - easy enough as they're an island. Some smugglers had their boats sunk & those aboard were either outright killed or simply not picked up. Japan was in no mood to deal with the stupidity of others. Food was rationed immediately as much today is imported. The nation had previously stockpiled masks & gloves & there items, especially masks are considered essentials during cold/flu season in Japan in any case. The Japanese are serious about 'respiratory manners'
Other nations have had mixed success dealing with their outbreaks depending on plans they already had, speed of execution & 'human' factors. The initial countries hit are being closely watched by other nations. Mistakes are being learned from & 'right' moves are being copied when local conditions permit. Kingston is now experiencing some serious social problems directly attributable to local conditions.
Many seniors live alone & a great many of those have no family in the area. Phone lines across the country have been swamped with the sheer volume of calls. Often, relatives can't get through to seniors & while the local police is trying to check on them, as are some apartment building superintendents, the checks are spotty. Several have been found by police, neighbours & supers having fallen, suffered heart attacks or with other serious medical conditions. A few have died. Seniors living on the same floor of apartment buildings are encouraged to 'buddy up' - to check on each other several times daily for added safety.
For families on low incomes, child tax credit cheques have yet to be deposited - a major bank glitch from the sending bank's end & it's yet to be cleared up. For many, including most on welfare or mothers' allowance, that means food is very scarce or non-existent. Police are reporting higher numbers of attempted & successful break ins. As well as money & some easily transported goods, food items are disappearing.
No satisfactory solution for the possibility that public transit is acting as an amplifier can be found. People still working need to get to work. They're encouraged to limit their time on the bus & all bus windows are opened as far as possible. It's April & wet but not that cold. As the weather improves, may elect to walk. It makes for longer days though & added stress. Many with young children still to be brought to whatever care is available have no option - it's the bus or stay home from work & that's simply not an option.
Local news reports that many have elected to not pay phone or utility bills this month. This is a problem in many other parts of the country as well. Many people are simply not making certain payments. Banks are still open & ATMs working but with an increasing number of glitches & cash deliveries to ATMs are not always done on time. Banks are limiting their hours & operations with deposits & withdrawals being the only functions performed. Clients are encouraged to use ATMs & these are equipped with spray bottles of disinfectant. These are constantly disappearing.
Groceries & other items are still getting into town but deliveries aren't reliable & many customers are growing increasingly irate at store limits on purchases. It's a real problem, especially for those with larger families. Emergency services have increasing concerns about manning. Many personnel have gone down with the flu, leaving fire & police departments short staffed. Ambulance services are reduced to having one qualified attendant or paramedic per crew with a 'warm body' making up the other half of the crew. Most calls are for flu related emergencies.
Of those admitted so far, only 73 have been discharged. Several who appeared ready for discharge have relapsed but this was anticipated as it has been the experience in Asia & has been seen since H5N1 first broke into humans 8 years ago. The military converts 2 more transient barracks - this time into temporary hospitals & quickly trains up reserve infantry soldiers in basic patient care. It's the best anyone can do at this point.
The mood in the city increasingly consists of fear. At this point everyone knows someone who has the flu or knows OF someone who has it - a child's teacher, the young night shift dude from the local convenience store, their neighbour... fear is thick in the air. The military presence at the 2 hospitals in the city as well as the walk in clinics & temporary military hospitals has been beefed up. It's just getting too ugly out there. On one terrifying night, a young corporal had to fire over the heads of an agitated crowd. They'd heard rumours vaccine was now available & were demanding the right to theirs.
That's an unfortunate rumour. Seed stock for this strain has only now been delivered to the 2 vaccine plants in the country who make flu vaccine. It will be 2 months before it's available to anyone & the first to get it will be health care workers, followed by emergency services personnel. Hopes of diluting the vax & still having it work have been dashed. This subtype simply doesn't seem to want to 'co-operate' in this regard.
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