Health experts have warned that an influenza pandemic is inevitable; however, the recent outbreak of the H1N1 influenza strain shifted the public's perception of this risk from theoretical to real and urgent (Garrett et al. 2008; Toronto Academic Health Sciences Network 2006; Vawter et al. 2007). In response to the 2003 outbreak of severe acute respiratory syndrome (SARS), the Ministry of Health and Long-Term Care (MOHLTC) in Ontario accelerated efforts to develop a comprehensive and coordinated plan to respond to with an influenza pandemic. In 2005, MOHLTC asked healthcare organizations to develop a local pandemic plan aligned with the Ontario Health Plan for an Influenza Pandemic (OHPIP). Based on standard modelling (a 35% attack rate), the OHPIP estimates that at the peak of the pandemic, influenza patients will require 170% of available intensive care unit (ICU) beds and 117% of ventilators in Ontario (MOHLTC 2008). The current average occupancy rate in Ontario ICUs is 85% - thus in, a pandemic demand could easily exceed the usual ICU bed capacity. While governments are purchasing more ventilators (Galloway 2009, July 6), this is unlikely to solve the problem. Recent studies predict the attack rate for healthcare providers (HCPs) will be significantly higher than that in the general population (Gardam et al. 2007), perhaps nearing 50%. HCPs may also be prevented from working due to competing priorities, such as caring for sick family members and protecting themselves from infection. This presents Ontario hospitals (and hospitals around the globe) with the following scenario: more than twice as many patients will require intensive care, with less than half the usual staff available to provide it.
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