ICU Resource Limitations During Peak Seasonal Influenza: Results of a 2018 National Feasibility Study

Rapid data sharing is the basis for public health action. The report from the 30 January 2020 International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (COVID-19) stressed the importance of the continued sharing of full data with the World Health Organization (WHO). The information disseminated through peer-reviewed journals and accompanying online data sets is vital for decision-makers. 1 – 3 For example, the release of full viral genome sequences through a public access platform and the polymerase chain reaction assay protocols that were developed as a result made it possible to accurately diagnose infections early in the current emergency. Deficiencies in data-sharing mechanisms – highlighted during the 2013–2016 Ebola virus disease outbreak in west Africa – brought the question of data access to the forefront of the global health agenda. 2 In September 2015, agreement was reached on the need for open sharing of data and results, especially in public health emergencies. 2 Subsequently, the International Committee of Medical Journal Editors confirmed that pre-publication dissemination of information critical to public health will not prejudice journal publication in the context of health emergencies declared by WHO. 4 Furthermore the committee stated that information critical for public health is to be shared with WHO before publication 5 – a commitment echoed by several leading journals in the context of the COVID-19 response. Efforts for expedited data and results reporting should not be limited to clinical trials, but should include observational studies, operational research, routine surveillance and information on the virus and its genetic sequences, as well as the monitoring of disease control programmes. To improve timely access to data in the context of the COVID-19 emergency the Bulletin of the World Health Organization will implement an “COVID-19 Open” data sharing and reporting protocol, which will apply during the current COVID-19 emergency. On submission to the Bulletin, all research manuscripts relevant to the coronavirus emergency will be assigned a digital object identifier and posted online in the “COVID-19 Open” collection within 24 hours while undergoing peer review. The data in these papers will thus be attributed to the authors while being freely available for unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations license (CC BY IGO 3.0). Should a paper be accepted by the Bulletin following peer review, this open access review period will be reported in the final publication. If a paper does not meet the journal’s requirements after peer review, authors will be free to seek publication elsewhere. If the authors of any paper posted with the Bulletin in this context are unable to obtain acceptance with a suitable journal, WHO undertakes to publish these papers in its institutional repository as citable working papers, independently of the Bulletin. The choice of a pre-print platform remains the sole discretion of the author. This early access to research manuscripts at WHO builds on examples of other rapid information access platforms such as PROMED and F1000Research. 5 , 6 Given the many unanswered questions on the reservoir, transmission, consequences and manifestations of COVID-19 infection and associated disease, our goal is to encourage all researchers to share their data as quickly and widely as possible. With this protocol for immediate online posting, we are providing another means to achieve immediate global access to relevant data. By submitting their studies to “COVID-19 Open,” researchers can share their data while meeting their need to retain authorship, document precedence and facilitate international scientific cooperation in the response to this emergency.

Between March and July 2009, the largest number of confirmed cases of 2009 influenza A(H1N1) infection occurred in North America. To describe characteristics, treatment, and outcomes of critically ill patients in Canada with 2009 influenza A(H1N1) infection. A prospective observational study of 168 critically ill patients with 2009 influenza A(H1N1) infection in 38 adult and pediatric intensive care units (ICUs) in Canada between April 16 and August 12, 2009. The primary outcome measures were 28-day and 90-day mortality. Secondary outcomes included frequency and duration of mechanical ventilation and duration of ICU stay. Critical illness occurred in 215 patients with confirmed (n = 162), probable (n = 6), or suspected (n = 47) community-acquired 2009 influenza A(H1N1) infection. Among the 168 patients with confirmed or probable 2009 influenza A(H1N1), the mean (SD) age was 32.3 (21.4) years; 113 were female (67.3%) and 50 were children (29.8%). Overall mortality among critically ill patients at 28 days was 14.3% (95% confidence interval, 9.5%-20.7%). There were 43 patients who were aboriginal Canadians (25.6%). The median time from symptom onset to hospital admission was 4 days (interquartile range [IQR], 2-7 days) and from hospitalization to ICU admission was 1 day (IQR, 0-2 days). Shock and nonpulmonary acute organ dysfunction was common (Sequential Organ Failure Assessment mean [SD] score of 6.8 [3.6] on day 1). Neuraminidase inhibitors were administered to 152 patients (90.5%). All patients were severely hypoxemic (mean [SD] ratio of Pao(2) to fraction of inspired oxygen [Fio(2)] of 147 [128] mm Hg) at ICU admission. Mechanical ventilation was received by 136 patients (81.0%). The median duration of ventilation was 12 days (IQR, 6-20 days) and ICU stay was 12 days (IQR, 5-20 days). Lung rescue therapies included neuromuscular blockade (28% of patients), inhaled nitric oxide (13.7%), high-frequency oscillatory ventilation (11.9%), extracorporeal membrane oxygenation (4.2%), and prone positioning ventilation (3.0%). Overall mortality among critically ill patients at 90 days was 17.3% (95% confidence interval, 12.0%-24.0%; n = 29). Critical illness due to 2009 influenza A(H1N1) in Canada occurred rapidly after hospital admission, often in young adults, and was associated with severe hypoxemia, multisystem organ failure, a requirement for prolonged mechanical ventilation, and the frequent use of rescue therapies.