The number of official deaths from swine flu in Canada nudged closer to a dozen Tuesday with two reported in Quebec and two in Manitoba.
Manitoba Medical health officer Joel Kettner said the H1N1 virus killed a man in his 40s from Winnipeg who did not have any known underlying health conditions. The second victim was a woman from northwestern Manitoba -- also in her 40s -- who did have "significant" health problems when she was hospitalized.
In Quebec, health officials said a man and a woman from Montreal -- both between 30 and 50 years old -- had underlying medical conditions when they died that made them susceptible to infection.
Six Quebecers have now died from the swine flu, while the deaths in Manitoba were the first two in that province. At least 11 people have died across the country.
They are not likely to be the last, Kettner said.
While the majority of swine flu cases are mild, there were still at least 31 people in Manitoba's intensive care units with severe symptoms, he said.
"These are very critically ill people. They're on ventilators. They cannot sustain their lives without very, very active life-support help ... It is not unreasonable to expect that we will have more deaths to announce as this epidemic goes through this phase of its course."
Manitoba also announced another spike in swine flu cases -- 74 new cases to push the total to 226.
"We fully expected that we would have deaths, as we do every year from influenza," Kettner said. "It's particularly concerning, of course, when they occur in people in their 40s because this is a premature death by anyone's test."
He would not say whether the victims were aboriginal. Of Manitoba's most severe cases of swine flu, the majority of patients have been native.
Many patients have been airlifted from a cluster of reserves in a remote area 500 kilometres northeast of Winnipeg that has fewer than 10,000 residents. Aboriginal leaders have said poor living conditions, including cramped housing and lack of clean water, have made some reserves a "breeding ground" for the virus.
Federal and provincial health officials have said they are working as quickly as they can to send more nurses and doctors to the remote communities, along with hand sanitizers and masks.
"We are working with the communities to make sure all the pieces get in place," said Jim Wolfe, regional director for First Nations and Inuit Health. "This will be a continuing piece of work for some time to come."
Still, health officials from both Manitoba and Quebec said there is no reason to panic. Kettner said schools can remain open and people shouldn't avoid travelling or meeting publicly.
Michel Dore, a Quebec civil security spokesman, also urged parents not to overreact ahead of the busy summer season.
"There are no reasons for anyone to cancel any of the plans they have made so far for summer camps or summer activities, be they festivals or youth camps," Dore said.
"What is more important is that we maintain our hygiene and hand-washing."
Cases in Canada's North are also growing. Nunavut confirmed 25 more illnesses on Tuesday to bring the provincial total to 189. Sixteen people have been hospitalized in the last few weeks, but 11 have recovered and been released, health officials said.
