Health system may not be up to the challenge of a swine flu pandemic

The ability of the system to cope with a large-scale outbreak of swine flu must be in serious doubt given the problems it has in coping with demand for normal health services. Doctors and nurses will be put under severe stress to cope and will have to protect themselves from contracting the illness as well, not just for their own sake but so they don’t spread it further.

IF the Government manages to get just one thing right during the rest of the year, then let’s hope it is in the management of the anticipated largeiscale outbreak of the swine flu.

The possibilities are scary. The Department of Health has estimated that one million people in this country could be affected by an outbreak of the virus before the end of the year.

Many deaths could result, even though there have been just 450 reported deaths worldwide to date as a result of the outbreak, a very small proportion given the 94,500 confirmed cases of the A (H1N1) virus that have been reported by the World Health Organisation.

Already, there have been 146 confirmed cases in this country, but only 10 have been suffered by people who had not travelled abroad to one of the originally infected areas and who picked it up in Ireland. While there have been no fatalities here, thankfully, there have been deaths in Britain in the past week, most poignantly of a six-year-old schoolgirl in London and of a family doctor.

These deaths have brought home to us the potential seriousness of the flu. Most people regard the illness as an unpleasant inconvenience that most of us get over after a week or so of misery. However, to anyone with an underlying medical condition it can be fatal. And what is really terrifying for many parents is that children appear to be very vulnerable to this particular strain of the flu virus, not just those under-five but pre-teens and teenagers too. There seems so little people can do except hope the illness does not visit them, especially as vaccinations are not available as yet and their efficacy remains unproven.

That the number of deaths so far has been so low has given hope that we will not suffer the experience of previous generations where strains of the flu have killed tens of millions. However, it is known that flu strains tend to mutate, meaning they can become more difficult to treat, thereby leading to many more deaths if it becomes stronger.

A fine balance has to be struck between being prepared and being paranoid. Human nature being what it is, many will worry excessively but others will disregard the possibilities or not even give thought to them. Some people have become somewhat blasé, believing the regularity of warnings about potential pandemics or epidemics shows excessive caution on the part of world health authorities and even a need to justify their own existence by talking up potential crises. The fears raised about SARS for example, just five years ago, were not realised but for a time it seemed as if a dreadful epidemic of biblical proportions was about to hit us. Although HIV and Aids have proven to be dreadful illnesses that have killed millions, most of the deaths have occurred in Africa and Asia and fears of an epidemic in the western world have proven unfounded.

In a non-health related sphere, even the threat of a computer virus at the turn of the century, the so-called Millennium Bug, proved to be exaggerated, with the result that many people now regard each scare they hear about as being merely the latest that should be disregarded.

However, there is no doubt the Department of Health and the HSE have taken this particular scare very seriously indeed and have prepared accordingly. Having done a good job in containing the spread of the illness, the authorities have decided that preventing its spread is no longer possible. Instead the new official policy is to try to “mitigate” it as it spreads.

No longer will efforts be made to try to find out how somebody contracted it — so as to try to identify and isolate the original source — but instead it will be treated as it arises.

Treatment with anti-viral drugs such as Tamiflu will be restricted in future to those who are regarded as being part of high-risk groups, such as those who suffer from illnesses already or who have underlying predispositions towards certain illnesses, particularly of a respiratory nature. The pregnant and the overweight are regarded as particularly suited to whatever resources are available.

The state has ordered 7.7 million doses of the vaccine that is being prepared to fight the flu. However, there is no guarantee it will be available in time. There had been hopes the first batches would arrive before the end of August, but that may be optimistic. The WHO has admitted that sufficient clinical trials to establish a vaccine’s safety will not have been completed by that time; it could take up to three months. Some people may be reluctant to take a vaccine when its side-effects are not known or to allow their children take it. Yet the HSE has already paid over €41m as a down payment against delivery of the vaccines and will pay the balance on delivery. Given the state’s financial condition, and especially the demand on HSE budgets, this is an expensive statement to make; it suggests the Government has decided to purchase an expensive insurance policy.

It is easy enough to guess as to why. The ability of the existing system to cope with a large-scale outbreak of swine flu must be in serious doubt given the problems it has in coping with demand for the provision of normal health services at present. Doctors and nurses will be put under severe stress to cope and will have to protect themselves from contracting the illness as well, not just for their own sake but so they don’t spread it further. For those so seriously ill that they have to be hospitalised the demand for ventilators and other facilities is going to be immense and hard to manage. If we have problems coping with numbers in our hospitals as it stands, how will the system be able to cope with a major influx, especially of people who, in optimum circumstances, might be better kept isolated.

AN enormous burden is going to fall on general practitioners in the event of a serious outbreak, even one that falls far short of the worst predictions.

It will be important that people do not start going in numbers to GP clinics to get prescriptions and sick certs for work; that is how infection will move more quickly. However, GPs are likely to be reluctant to engage in large-scale home visits and many people would struggle to pay for them if they do take place.

The Department of Health is hopeful that many people can be diagnosed over the phone and given details of what medication, if any, they can collect from pharmacies. However, it seems that for most people, until more serious symptoms emerge, the advice will be to just take plenty of hot drinks and paracetamol.

The economic consequences of an outbreak could be terrible: imagine the costs if there have to be extensive closures of factories and other workplaces. Schools and universities may have to be closed too if there is a widespread outbreak. No wonder the HSE has authorised the large spend on the vaccine. It might prove unnecessary if a major outbreak does not take place, but it could prove a worthwhile investment if it prevents the economy from shutdown and unmanageable strain on the health services. It is undoubtedly a major worry. Some people think the media is always looking for bad news and for reasons to attack officialdom. Not here. For all sorts of reasons, not least the health of the nation, we must hope sincerely that the Government’s investment in the vaccine works and that the vaccine does too.

The Last Word with Matt Cooper is broadcast on 100-102 Today FM, Monday to Friday, 4.30pm to 7pm.