The sudden death of a young athlete from swine flu, just four days after he started showing symptoms, has stunned the boy's family and friends.

Evan Frustaglio died Monday night. He represents an extremely rare case, but his father says all parents should take the H1N1 virus seriously.

"He was my best friend," Paul Frustaglio told CTV News Channel on Tuesday, fighting to keep his composure. "My 13-year-old son was my best friend."

Frustaglio's first symptoms were a cough, and he told his father he felt slightly ill on Friday. On Saturday, the avid hockey player was in two games.

"Evidently the last game he played on Saturday evening, he was excellent," said Paul Frustaglio, who did not attend the game himself.

Throughout the night, Frustaglio developed flu-like symptoms, including a fever. The family took him to a walk-in clinic in Toronto.

"A doctor checked his lungs and said, 'Everything is fine, it's just the flu, go home and monitor it,'" said the father.

Back at home, the family cared for Frustaglio throughout the night. The father said it all happened within 10 minutes. He started to perform CPR but it was too late. His son had stopped breathing. Paramedics also tried to revive him but they were unsuccessful. Evan died as his father watched on.

"I guess this disease already attacked his heart, that fast," Paul Frustaglio said.

On Monday afternoon, the boy was rushed to St. Joseph's Hospital in west-end Toronto, but he died soon afterwards.

A rare case

Dr. David McKeown, Toronto's medical officer of health, said the boy's death is an extremely rare case.

"People with severe illness have the same virus as people with mild illness," he told a Tuesday news conference that reacted to the case of Evan Frustaglio.

And Dr. Arlene King, Ontario's chief medical officer of health, also told a Tuesday news conference that such deaths are a "very, very rare occurrence."

Those most likely to die are older with a pre-existing health condition, she said.

Since April 1, six young people have died after contracting the virus. There have been 28 confirmed deaths.

However, McKeown said because swine flu is a "novel virus," it is more likely than seasonal flus to cause severe illness. "We must build society's defences to protect the population," he said, adding that swine flu cases are on the rise in Toronto.

For that reason, the city will be opening up vaccination clinics for those deemed to be in priority groups starting Thursday instead of next Monday, McKeown said. The priority groups include:

  • people with chronic medical conditions under the age of 65
  • people in remote, isolated communities
  • healthy children from six months to five years old
  • care providers and household contacts of persons at high risk who cannot be immunized or may not respond to vaccines
  • health care workers
  • pregnant women

Toronto Public Health will issue information on the number and location of the advance clinics on Wednesday.

Vaccination for health-care workers began on Monday.

The city and province are also running clinics to inoculate seniors against the seasonal flu virus. Those started last Thursday and run through to Sunday.

Frustaglio's death

The boy's mother is a nurse and the whole family was planning on getting the flu shot, his father told CTV Toronto. Evan's mother, father and 10-year-old brother are now on Tamiflu medication that has been prescribed by their family doctor.

Dr. Neil Rau, a Toronto infectious diseases specialist who is nursing a daughter with swine flu, told CTV News Channel that Evan Frustraglio's death can be likened to the boy being hit by lightning.

"Here's a kid who is otherwise healthy, who doesn't fit any of the risk group profiles ... it sounds like in this case it was a very rapid progression to a heart infection known as myocarditis," he said. "This is an incredibly rare complication of flu."

When a child does become ill, in most cases the duration becomes significant. If they don't get better after 48 to 72 hours, there might be a bacterial complication, Rau said.

"If things are starting to get better, even if it goes on for more than 48 to 72 hours, I don't think there's the same alarm," he said.

Generally speaking, only the people in the at-risk groups need early medical intervention, Rau said, adding, "We have to ... accept that unfortunately, there is the rare person out there that is otherwise healthy who is going to succumb to a really bad fate like this."

Statistically speaking, however, your life is in more danger from a ride in your car than it is from the flu, Rau said.

Proper precautions

Evan, who resided in Etobicoke with his family, is the second child in a week to have died from a virus believed to be swine flu.

A Cornwall, Ont. girl died in Ottawa on Saturday after exhibiting symptoms of the swine flu. She was being treated in hospital for mild symptoms but doctors said her condition rapidly deteriorated.

She had no pre-existing health condition.

The Frustaglio family is related to long-time Vaughan Regional Councillor Joyce Frustaglio.

The politician told that she is furious with health officials for not giving the family enough instructions after they brought Evan to a walk-in clinic over the weekend. She said she wants health officials to lay out what precautionary steps the family should take next, especially as they plan for a large funeral.

She said the responsibility should not fall on the boy's mother, a registered nurse who is overwhelmed with shock and grief over her son's unexpected death.

"This is a tragedy of mammoth proportions," she said. "You don't expect your son to have a fever, a cold and then without any indication, to have him die like that."

The councillor, whose sons grew up with Evan's father as cousins, said the boy was a "bright" young man who was extremely loved by his family.

"He was the most respectful," she said. "I was always Auntie Joyce. He was a real leader in his school and a great hockey player."

Evan was a student at Hill Academy in Vaughan, a small, tight-knit school that fosters young athletes. He had celebrated his 13th birthday last month.

The flag outside the school was at half-mast Tuesday morning and classes were cancelled for the day as friends of the boy poured messages of grief on an online tribute sight on Facebook.

"Wow, I'm stunned," wrote one person. "Evan, you were a great kid and we will all miss you."

Meanwhile, some players on Evan's team had to be quarantined after exhibiting flu-like symptoms.

Hockey coach Al Reisman told CTV Toronto that Evan's teammates are shocked and saddened. The team's next two hockey games have been cancelled as a result of the tragedy.

"We were all shocked, we still are," he said.

With reports from CTV Toronto's Galit Solomon and John Musselman