I guess I was in a bit of denial about it. I was hoping that it would blow right past us until I realized that we are running out of ICU beds and somebody mentioned that we might need to borrow Nitric Oxide equipment. The presentation is quite similar so far. It starts as a flu-like illness with fever (up to 105), myalgias, sore throat etc. Several days later patients develop progressively worsening shortness of breath and cough. Once we see them in ER, they are already quite sick. The chest XR shows bilateral patchy infiltrates consistent with pneumonia. Surprisingly, the rapid swab test was positive in only a few of those patients. It appears that the sensitivity of this test is low. It takes several days to get confirmation on H1N1 from the State lab so the patients are being started on Tami flu empirically. Several patients have already progressed to a full-blown ARDS (click on image above) and multiple organ failure. I had to use high PEEP and FiO2 and yet oxygen saturation was barely in the 80’s. We had to use prone positioning and even Nitric Oxide. Sputum and blood cultures in most cases are coming back negative. The empiric antibiotics are being started to prevent secondary superinfection. Some patients require dialysis for kidney failure.
The H1N1 vaccine is being given to healthcare workers only sporadically so far (I got mine as soon as I could). Apparently, we might have a shortage of respirators and Tami flu. This is only October and I wonder how much worse this is going to get.