CIHI study finds impact of H1N1 pandemic on Canadian hospitals

While the H1N1 global pandemic may not have resulted in as many severe cases as originally predicted, a new study released today by the Canadian Institute for Health Information (CIHI) shows that more than 15,000 Canadians were admitted to hospital for H1N1 in Canada between April and December 2009. This is about 6,500 more patients than the number of lab-confirmed hospitalization cases reported at the end of last year, as it includes the number of both confirmed and probable H1N1 acute care hospitalizations.

The Impact of the H1N1 Pandemic on Canadian Hospitals uses the combined total of probable and confirmed H1N1 cases to assess the impact on Canada's acute care hospital system because many hospitalizations for unspecified influenza are assumed to have been H1N1. The number of cases released last year followed the World Health Organization's guidelines and focused on lab-confirmed H1N1 only.

"As the first global pandemic in more than 40 years, the response to H1N1 from public health authorities was unprecedented," explains Jeremy Veillard, Vice President of Research and Analysis at CIHI. "While there have been suggestions this response may have been exaggerated, our study shows that, in fact, the impact of the virus on hospitals was significant and much higher than originally estimated. The good news is that Canada's acute care facilities were able to weather the storm."

At pandemic peak, H1N1 hospitalizations outnumbered those for heart attack or stroke

Two-thirds of H1N1 hospitalizations occurred over a five-week period beginning at the end of October 2009. During this time, H1N1 accounted for 3.4% of all hospitalizations. This exceeded hospitalizations for many common conditions, such as heart attacks (2.5% of hospitalizations) and strokes (1.6%) over this same five-week period.

CIHI's study also shows large increases in the volume of emergency visits during the second wave of H1N1. In Ontario, about one in four emergency department visits during October and November was for patients with flu-like symptoms, compared to about one in seven patients in previous years.

Hospitals minimized disruption for other types of patients while managing H1N1 influx

During the five busiest weeks of the pandemic, almost 10,000 more flu patients were hospitalized than in a typical year. Hospitals accommodated the influx of patients using various strategies. In some cases, patients who would have typically been treated in intensive care units (ICUs) were moved to ward rooms with increased monitoring. This included newborns with minor health problems and people admitted with cardiac conditions such as angina or chest pains. Hospitals also reduced the number of planned admissions for care, such as elective surgery.

"Hospital pandemic plans are designed to handle a surge in patient admissions while maintaining essential services and minimizing disruption to patients," says Kathleen Morris, Head of Emerging Issues at CIHI. "Our study shows that Canada's hospitals were able to build on what was learned during SARS in 2003 and effectively cope with the high number of H1N1 patients."

Hospital cost of caring for H1N1 patients spiked during pandemic peak

The estimated cost of H1N1 for hospitals was approximately $200 million, and about $128 million was spent over the five busiest weeks of the pandemic.

The H1N1 total is based on estimated total inpatient costs of $146 million for H1N1 and influenza patients combined with emergency department costs of approximately $50 million across the country. These estimates cover the costs of acute patient care, excluding physician fees. The average cost was about $9,600 per admission.

Overall costs of the pandemic include items such as the purchase and administration of vaccinations and antivirals, emergency responsiveness, surveillance and public education. A full analysis of the costs of responding to H1N1 has not yet been produced.

Quick facts

• There were more than 15,000 cases of confirmed and probable H1N1 between April and December 2009. This is about 6,500 cases higher than the number of lab-confirmed cases last year.
• Probable H1N1 cases consisted of patients hospitalized for influenza; lab results show that almost all influenza in 2009 was H1N1.
• The majority (65%) of H1N1 hospital admissions occurred over a five-week period starting at the end of October during the second wave of the outbreak.
• Hospitals accommodated the large volume of H1N1 patients by modifying care for patients hospitalized for other reasons.
• During the peak of hospital activity during the second wave of the outbreak, H1N1 accounted for 3.4% of all hospital discharges; this was greater than the number of people discharged for heart attacks or strokes during that time.
• In Ontario, one in four emergency department visits in October and November 2009 was for influenza symptoms, which was almost double the number of influenza-related visits in this time period in a typical year.
• H1N1 cost hospitals close to $200 million, and $128 million was spent over the five busiest weeks of the pandemic.