Eerily familiar

What is now happening in Nunavut and Northern Manitoba is all too sad and eerily familiar. The outbreak of H1N1 influenza in northern aboriginal communities is similar in many ways to the plight of Inuit and natives during smallpox outbreaks in the 18th and 19th centuries, the 1918-19  Spanish Flu and the polio epidemic that struck in the north in 1949.

What is so familiar about today’s outbreak and the 1949 polio epidemic is that a number of aboriginal people have had to be placed on ventilators in order to breathe. 

In the 1940s and 1950s, patients with “bulbar” polio remained encased in iron lungs — sometimes for months or years on end — because their muscles controlling breathing had been paralyzed by the disease.

The World Health Organization, or WHO, has noted the severe H1N1 influenza outbreak among Manitoba aboriginals. The community of St. Theresa Point First Nation has been singled out by WHO as needing to be carefully observed, since during past pandemics (world-wide outbreak of a disease to which no one has an immunity and is not previously known), native populations were severely affected. So far, 27 residents have been hospitalized with suspected cases of H1N1. 

An 18-month-old toddler is now in a Winnipeg hospital as the first individual to test positive for the H1N1 virus from Garden Hill First Nation.

Throughout Manitoba, there have been 53 confirmed H1N1 influenza cases, but more than 200 people from St. Theresa have been ill with flu-like symptoms.

Of the 26 people now in intensive care in Winnipeg, more than half are aboriginals. A spokeswoman for the Public Health Agency of Canada reported the average  age of those diagnosed with the virus and in intensive care as 22, with the most common patients being children and young adults.

Dr. Keiji Kukura, assistant-director general for Health Security and Environment, WHO, said at a recent news briefing that the flu virus has been reported in 73 countries and 26,563 cases have been confirmed, including the death of 249 people.

WHO reported Canada has had 2,446 confirmed cases and four deaths.

“We are, as we have pointed out ... at the beginning of the spread of the virus,” said Dr. Kukura. “Unless this virus suddenly disappears overnight, it is likely that the spread of this virus will continue ... 

“Now we know from past pandemics that in these kinds of situations, we can expect potential changes as we go through populations over time ... if we see spread of this virus into populations which are particularly vulnerable, it means we may see more severe disease than we would see in populations which are relatively well off. I think the current reports coming from Canada about what has been seen in some Inuit villages is a good example of this.”

Dr. Kukura told Canadian reporters the lessons of past pandemics show that native populations “were very severely hit, and this is why these reports raise such a concern with us.”

Sixty years ago, when an Inuit hunter named Tutu became infected with the polio virus while trading at an army base in Churchill, Manitoba, he returned to Chesterfield Inlet and spread the disease to the community. It was the first recorded instance of polio affecting Inuit in Northern Canada, although polio outbreaks had occurred in the south since at least 1910.

The Winnipeg Free Press on Monday,  March 7, 1949, reported 13 Inuit polio victims, including six children, were transported to Winnipeg where they were placed in quarantine at King George Hospital.

“The 13 victims — all serious cases — were picked up by an RCAF ski-wheel equipped Dakota (DC-3) along with five members of a medical mission who were sent to combat a plague of paralysis which has taken the lives of 13 Eskimos, and affected 60 others during the last three weeks.”

At first, the type of disease causing sickness and death in the north was a mystery, but doctors soon recognized that as Tutu travelled to tiny outposts around Chesterfield Inlet he was spreading the polio virus. 

“Although Tutu didn’t have the disease himself, he was a carrier of the germ, obviously having contracted it from white men who had been taken from Churchill to Winnipeg’” reported the Free Press  on March 6, 1949.

“When two deaths occurred late in December, through the efforts of Dr. J.P. Moody, medical superintendent of Indian Eskimo health  services at Chesterfield Inlet, (there) began a thorough investigation into the disease.”

Later, Dr. W.J. Wood, the head of the medical mission to Chesterfield Inlet and  regional supervisor of the Dominion Indian Eskimo health services, declared a 40,000-square-mile quarantine area.

Between February 14 and March 7, there had been 14 deaths and 39 cases of paralysis among the 278 Inuit in the Chesterfield Inlet area. Another 13 deaths were recorded in the Eastern Arctic region.

A report from the federal health department said: “if an epidemic of the same destructiveness were to attack Greater Winnipeg (population in 1949 was an estimated 350,000), more than 50 per cent of the people would be laid up. There would be in the course of 10 days 15,000 deaths and 42,500 people would be left paralyzed.”

The “explosiveness and devastation” of the epidemic was described as “unprecedented” and “unlike the usual course of poliomyletis in white communities.”

Today, most Manitobans contracting the H1N1 virus have experienced relatively mild cases of influenza, but severe respiratory illness has been a pattern in many aboriginal cases.

The Winnipeg Regional Health Authority is “taking steps to provide enough support in intensive-case units and priorizing patients for personal-care home beds,” according to a recent Manitoba government bulletin. “There are also 15 additional ventilators that have arrived and will be put to use as needed.”

If the H1N1 virus follows the pattern of past disease outbreaks in northern communities, health officials warn that aboriginal people will face a worsening situation.