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Unready for the next wave
Canada must prepare for another swine flu outbreak this fall
From Saturday’s Globe and Mail Last updated on Saturday, Jul. 04, 2009 12:17AM EDT
http://www.theglobeandmail.com/news/opinions/editorials/unready-for-the-next-wave/article1206214/
Is Canada ready for a second wave of H1N1 (swine flu) that may hit in the fall? Britain says it may have 100,000 new cases a day by late August, based on the current doubling each week of the number of people falling ill. If Canada is hit proportionately, that would be roughly 50,000 cases a day.
The Public Health Agency of Canada is now ordering hundreds of ventilators in case the provinces do not have enough. Based on current expectations for the influenza’s spread, there may not be enough ventilators.
Andrew Simor, the head of microbiology and infectious diseases at Sunnybrook Health Sciences Centre in Toronto, puts it this way: “If we assume even a moderate type of pandemic, in the number of people and severity of disease, it will definitely overwhelm our health-care system.” It is not just a matter of a shortage of ventilators but of doctors, nurses and respiratory technologists trained to care for the patients and to use and maintain the equipment. “I suspect that is the situation we will likely encounter” beginning this fall, Dr. Simor says.
Who, then, would qualify for the desperately needed ventilators? Canadian acute-care facilities may be in the position of the people in the proverbial lifeboat with not enough drinking water to go around. “If there is a large-scale health emergency,” says an Ontario health-ministry spokesman, “it comes down to the fact that you’re dealing with only so much resources.” It is a disturbing prospect, and should wake Canadians from any complacency they may feel.
The first wave of H1N1 has been, mostly, mild; and the mildness has bred complacency. Some of it has been nurtured by public health officials, who refer to “underlying health conditions” among those who have become the sickest. What are those underlying conditions? Pregnancy, diabetes, asthma and obesity are among them. So is smoking. There may be nearly as many households with an underlying condition in them as not.
The outbreak is likely to worsen. Most flus hit hardest at the old, sick and weak; H1N1 strikes people between 20 and 50. Most flus disappear in summer; Canada has five times the flu rate this summer because of H1N1. Of the 29 Canadians who died, several had no other health problems. Canada has a high rate of the disease compared with other countries, but that may be a sign it keeps a closer eye out for it.
What lies ahead? If Britain’s plan is an indication, efforts at containment would end. Schools would stay open, no matter how many cases of sick children had been reported, unless staff members fell ill in large numbers. The focus would be on medical treatment, from an overwhelmed system.
Britain already has a national information campaign on swine flu; nothing in Canada thus far compares. Public authorities here need, as a first step, to communicate the importance of knowing the flu’s symptoms, of applying common sense – don’t go to work and infect colleagues. But more than that, the authorities need to make whatever investments are necessary to ensure that the system is not overwhelmed, and that lifesaving care is available to all.
A(H1N1) : Health Ministry ready to face mitigation stage
by Karen Arukesamy
http://www.thesundaily.com/article.cfm?id=35475
PETALING JAYA (July 7, 2009) : In the wake of the fast-spreading A(H1N1) virus which has raised global concerns, the question now is how various sectors can respond to the pandemic in order to migitate its effects.
According to reports, influenza pandemics have occurred every 20 to 30 years around the world; in 1918 the Spanish Flu pandemic known as H1N1 caused some 40 to 50 million deaths globally, in 1957 the Asian Flu/H2N2 caused about a million deaths, and the Hongkong Flu/H3N2 of 1968 recorded a similar casualty.
“The influenza virus can keep changing and after a certain period it will develop into a new virus. Due to this, in 1995 the World Health Organisation (WHO) called on all the countries to develop a pandemic preparedness plan,” said the Health Ministry’s Disease Control Division director Datuk Dr Hasan Abd Rahman.
Malaysia came up with the National Influenza Pandemic Preparedness Plan (NIPPP) in 2005 and implemented it the following year.
Hasan explained that the pandemic can be tacked in various ways, such as
» medical intervention – antiviral drugs, vaccine, medical care and treatment;
» non-medical intervention – personal hygiene, quarantine, social distancing, risk communication and travel restriction; and
» for service sectors like security, food water supply, power supply, transportation, telecommunication, other essential services to have business continuity plans to protect their staff.“The new strain is a mix of human, avian and swine genes and is transmitted from human to human; and everyone is at risk due to absence of immunity,” he said.
He said the current containment phase approach in the country is effective; nevertheless the Health Ministry is ready to face the mitigation stage if the need arises.
“The transition from containment to mitigation phase is when there is clear evidence of beginning of widespread community transmission where there are a number of unlinked cases with no known epidemiological link to any known case,” Hasan said.
“It is a shared responsibility and we should not wait for the pandemic to impact everyone before we act,” he said.
About 80% of Malaysia’s cases are imported but this may change if there is an outbreak in the country, Hasan said.
“The aim now is to delay the spread of the virus in the community because if there is an outbreak and about 10% of the population is affected, there will not be adequate medical services to treat everyone,” he said.
Malaysia has not officially imposed travel restrictions to or from infected countries although WHO has declared that the pandemic is in phase six.
“In the mitigation stage the aim will be to reduce morbidity and mortality, to slow the spread of disease although it cannot be controlled completely and to minimise disruption to essential services,” Hasan said.
During this stage, there will still be disease surveillance conducted to identify the area of the outbreak, look out for clustering whether in particular communities, schools or groups.
“We would then establish the extent of spread to see whether the outbreak has only affected one street or others as well, or in a school whether only one classroom is affected or several others as well,” Hasan explained.
He said there will be constant monitoring of the changes in the natural history of the disease including severity as the virus can mutate and become more virulent.
“The medical laboratories will conduct random sampling for confirmation instead of testing case by case which is what we are doing currently,” he said