15 flu deaths might be tip of the iceberg

At least 15 people have died from the flu in Ottawa this winter, but public health officials say that is likely just a fraction of the actual number.

Given changes to the way flu is being tracked and reported in the province this year, more timely numbers are not available.

The deaths were among hundreds of people who became ill with flulike symptoms during outbreaks at long-term care homes, retirement homes and hospitals across the city.

There have been 37 influenza outbreaks in Ottawa acute-care, long-term care homes and retirement homes since September. Fifteen of the 407 people who became ill during those outbreaks died — a death rate of 3.7 per cent.

Only the first four fatal cases were confirmed as influenza by a lab, said Ottawa Public Health program development officer Jason Haug. Under Ministry of Health guidelines, only the first few cases in an outbreak need to be tested to confirm the outbreak. The remaining people died with influenza-like symptoms, but flu was not confirmed as their cause of death.

Measuring flu cases and, especially flu-related deaths, is a relatively inexact science at best. Not all people receive treatment for the flu, and not all flu-related deaths are measured as such. Recent research found that people are at higher risk for heart attacks in the weeks after the flu, deaths that would unlikely be considered part of a seasonal flu outbreak, but arguably should.

But this year in Ontario it is tougher for local public health officials to measure the severity of the flu season in a timely way. Changes in the way flu is being tracked means less immediate information is available. And that is causing frustration.

Shad Qadri, the Ottawa councillor who chairs the city’s board of health, said he hopes the message goes out to the province that “this system isn’t working.”

In previous years, public health units were mandated, and funded, to follow up on 20 per cent of all laboratory-confirmed flu cases to determine whether the patient was hospitalized or had died.

“Doing this allowed public health units to estimate the proportion of laboratory-confirmed influenza cases who had been hospitalized and the proportion who had died based on the total cases in Ottawa,” Haug said.

That followup is no longer happening. Instead, provincial flu-related death rates will be reported in a seasonal summary published at the end of the year, according to Ministry of Health spokesman David Jensen.

In addition, Jensen said, public health units have access to the province’s acute care enhanced surveillance system, which records influenza-related hospitalizations and deaths, among other things.

The province describes the system as “a real-time syndromic surveillance system … that enables public health to be better informed on the health of the community, which can help improve public health prevention and protection initiatives.”

One of the aims of the system is to help prepare for a flu pandemic. But the information available is as much as six weeks out of date, which makes it less useful as a preventive tool.

“It has made it a little more difficult for us,” Qadri said. By the time the information is available, “either the season is passing by or the issue we are reporting on has happened.”

Qadri said he’s sure Ottawa Public Health officials will make it clear that the system isn’t working.

Jensen said the province is reviewing influenza reporting mechanisms “to determine if they can be strengthened to provide more robust, publicly available data regarding future influenza seasons, including the reporting on influenza deaths in institutions.”

Ontario has had a busier than usual, but not overwhelming, flu season this year that appears to have peaked.