Several weeks after the first case of secondary transmission in Canada, and a few hundred hundred “mild” cases of flu later, the Ontario government issues new guidance for clinicians. Key changes:

– health care workers now to wear N-95 mask and eye protection when examining all patients with influenza-like illness (ILI); last guidance (April 28) only recommended this for patients will Mexico travel history

– specimens for laboratory testing now mandatory for patients with moderate to severe ILI; previously, no testing was required for patients without travel history.

– However, they’d rather not know about every case of novel H1N1, thank you very much… there is no mandatory reporting and no mandatory testing of those with “mild” influenza. The basic message: we got it — it’s spreading like wildfire. There’s no way to control it, so let us know if you notice anything weird.

Comparing the April 28th guidance with the May 19 guidance provides a pretty good indication that the new flu has been, most likely, underreported in Ontario. While 284 cases were confirmed by lab testing by yesterday, and the majority of those had no connection to Mexico, it’s just a fluke that most of those cases were tested, since there was no guidance suggesting doctors should do anything other than pat patients on the head.

Many will argue that, with this illness being so mild and all, neglect can only be benign. I don’t agree. For one thing, the “mild” flu knocks many people out for weeks. For another, the less accurate the guidance, and the more laissez-faire the treatment advice, the more cases like this. And this.