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Potential pediatric intensive care unit demand/capacity mismatch due to novel pH1N1 in Canada
David Stiff1, Anand Kumar, Niranjan Kissoon
1Risk Analytica Research, Toronto, ON, Canada.
Insights
Pandemic models predict significant pediatric intensive care unit (PICU) shortages for ventilation and critical care, even with vaccination. Reducing the attack rate through measures like vaccination or social distancing is crucial for maintaining pediatric care capacity.
Area of Science:
- Epidemiology
- Public Health
- Critical Care Medicine
Background:
- The emergence of the swine-origin pH1N1 virus raised concerns about pediatric critical care capacity.
- Pandemic preparedness requires understanding potential shortfalls in pediatric intensive care units (PICUs).
Purpose of the Study:
- To investigate potential pediatric intensive care unit shortfalls using pandemic models.
- To assess the impact of vaccination on pediatric critical care demand during a pandemic.
Main Methods:
- Simulation modeling was used to predict pediatric intensive care demand based on pH1N1 pandemic predictions.
- Canadian data from the first pH1N1 wave informed models for potential second-wave scenarios.
Main Results:
- Significant PICU shortages are expected in Canada, even with low attack rates (15%).
- Vaccination strategies targeting 50% of the population reduced demand but did not eliminate potential shortages.
- Ontario and British Columbia may face the most significant supply-demand differences.
Conclusions:
- Reducing the attack rate in children is critical for ensuring adequate PICU capacity.
- Vaccination and non-pharmaceutical interventions like social distancing are vital for pandemic preparedness in pediatric critical care.
Objective:
To investigate the possibility of pediatric intensive care unit shortfalls, using pandemic models for a range of attack rates and durations. The emergence of the swine origin pH1N1 virus has led to concerns about shortfalls in our ability to provide pediatric ventilation and critical care support.
Design:
Modeling of pediatric intensive care demand based on pH1N1 predictions using simulation techniques.
Setting:
Simulation laboratory.
Patients:
None.
Interventions:
None.
Measurements And Main Results:
Data collected during the first wave of the pH1N1 in children in Canada were applied to several second wave pandemic models to explore potential pediatric intensive care unit ventilatory demands for Canada and to investigate the impact of vaccination upon these demands. In almost all cases studied, even for relatively low attack rates of 15%, significant pediatric intensive care unit shortages would be expected to occur. Vaccination strategies targeting 50% of the population significantly reduced demand, but shortages may still be expected. Although shortfalls can occur in all provinces, Ontario and British Columbia may experience the greatest supply-demand difference, even at low attack rates.
Conclusion:
Reducing the attack rate among children, whether through vaccination or additional measures, such as social distancing, will be critical to ensure sufficient pediatric intensive care unit capacity for continued pediatric care.
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