Flu pandemic
McGill University Montreal, Canada; Email: martin.dawes{at}mcgill.ca
A flu pandemic is inevitable. What is not known is how many will be affected, and when it will happen. We are currently in pandemic alert period phase three of the six international phases for a pandemic outlined by the World Health Organization (http://www.who.int/csr/disease/avian_influenza/phase/en/index.html). Once cases begin to occur in each country it will take only a few weeks before influenza is widespread. The scientific debate about whether it will be possible to stop a pandemic has not reached any real conclusions.1,2
An additional uncertainty is how we will react as health professionals. In their article Shaw et al. explored the reaction of GPs to the problems of providing primary care during an influenza pandemic.3 During such an event as many as 30% of the population may be temporarily incapacitated and there will be an excess number of deaths over and above those seen during normal influenza epidemics. It is estimated that a GP may expect to see 50 new cases per week for an average list size, which would rise to 100 at the height of the pandemic. As 30% of other GPs may be sick the actual volume might be several times higher.
In response to this potential humanitarian health crisis, the authors found that Tasmanian GPs were committed to providing primary care even though they would be putting themselves and their families at risk. The key role in primary care will be reassurance of well patients, the assessment and management of patients unwell with influenza, continuing care of unaffected patients and looking after the psychological consequences of the disaster. They acknowledged the risk to themselves and were anxious that governments were not providing the resources to minimize that risk. A number of practices felt that they had not adequate supplies of masks, gloves, gowns and antiviral medication.
The most important conclusion from this study is that, as health professionals, it is up to us to organize the care in our own practices so that when the epidemic does come we will know what to do. The differing contexts in which each of us practice means that national and even local plans cannot really help us prepare for the day-to-day management of care during a pandemic. It is the government's responsibility to make sure that practices can have access to the medical supplies that we need but we should be drawing up our own practice plan. In addition to supplies we need to have organized various elements of practice such as methods of contacting each other and other health services. Do you have a system for seeing patients suspected of influenza that minimizes the risk of transmission to other patients? Do your staff know what the assessment criteria are for a potential avian flu case (Box 1)?
BOX 1 Clinical assessment criteria for suspected avian flu, whether bird to human or human to human
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Information about preparing a practice is still fragmentary but several national websites, for example http://www.rcgp.org.uk/default.aspx?page=3908, are very helpful. They contain most of the elements that are important but not immediately obvious; for example making sure we have enough cleaning fluid to wipe down surfaces.
There is much discussion on various medical discussion forums and journals about whether we would continue to practice during an epidemic with many individuals declaring that they would not do so. The last word on this part of the debate should go to this GP ‘Caring for patients is a moral imperative during a pandemic influenza outbreak. I wouldn't be much of a human being if I closed up and headed for thehills.’
Notes
Dawes M. Flu pandemic. Family Practice 2006; 23: 265–266.
References
1 Ferguson NM, Cummings DAT, Cauchemez S, et al. (2005) Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature 437:209.[CrossRef][Medline]
2 Pandemic Influenza: Report with Evidence, House of Lords Science and Technology Committee, 4th Report of Session 2005–06. London: Stationery Office Limited; 2005.
3 Shaw KA, Chilcott A, Hansen E, Winzenberg T. (2006) The GP's response to pandemic influenza: a qualitative study. Family Practice 23:267–272.
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