A new study published in the Canadian Medical Association Journal paints a vivid picture of how the influenza pandemic played out in Manitoba, which has experienced the highest incidence of severe H1N1—181 patients were hospitalized, and 45 patients were admitted to the intensive care unit because of the virus. The researchers identified a pattern: the longer the time period between the onset of symptoms and the treatment with antivirals such as Tamiflu, the more likely patients were to wind up in ICU. In fact, the patients who waited the longest for treatment had the worst outcome; some even wound up on life support. The researchers found that while many infected people didn’t require treatment because they were able to overcome the virus on their own, recognizing the importance of prompt medical care for serious symptoms is essential. They also identified another key trend in severe H1N1: First Nations people were at higher risk for serious infection than other ethnic groups. This happened in New Zealand and Australia too, and was also witnessed during the 1918 Spanish flu. The researchers attribute this to the fact Aboriginals have experienced “social inequities that have led to significant health disparities.” They conclude that identifying the at-risk populations and risk factors associated with severe H1N1 is critical to combating future waves of the disease.