The World Health Organization (WHO) earlier this week officially declared an end to the pandemic concerning the influenza H1N1 virus, popularly known as swine flu.
However WHO Director-General Margaret Chan recognised that here in New Zealand we’re still experiencing the effects of a second wave of H1N1.
“In the post-pandemic period, localised outbreaks of different magnitude may show significant levels of H1N1 transmission. This is the situation we are observing right now in New Zealand,” Mrs Chan said.
The outcome of this for some has been particularly tragic. However, as recently reported in NZ Dr, this year’s weekly rate of flu consults is well down on last year.
Communications before, during and after were to my mind a great example of how to get it right. Unfortunately not everyone has seen it that way. As the predicted apocalypse did not occur, many people say the whole thing was a money-making venture by pharmaceutical companies. While these theories make for great headlines they also significantly diminish the genuine efforts of public health protection teams globally, who potentially saved hundreds of thousands of lives.
We will never know how bad it could have been had the level of alarm not been raised. After all only 450 people died in the UK compared to the predicted 65,000 which surely proves it all an unnecessary scaremongering exercise? Shame on the health experts for saving some lives. When dealing with statistics it is easy to forget that only one number matters to people – the one that affects them.
Closer to home our own public health protection specialists implemented a textbook case of how to effectively contain a highly contagious and potentially deadly disease. You can read about it in the BMJ’s May 21st edition.
Dr Craig Thornley, Medical Officer of Health at Auckland Regional Public Health Service shared with us a brief overview (below) of the basics of the response in New Zealand which highlights the complexity behind some very simple messages.
• The pandemic response in New Zealand had several partly-overlapping strategic phases, all of which had been previously laid out in the New Zealand Influenza Pandemic Action Plan.
• The first phase was termed ‘keep it out’, and was about delaying introduction of the virus into New Zealand to give healthcare services time to mobilise their plans. This initially seemed critically important as reports were being received from Mexico that suggested that the illness had a high mortality.
• We were concurrently running a ‘stamp it out’ phase: when people with swine flu were diagnosed in the community we launched a rapid response to “ring-fence” spread by distributing antivirals (mainly Tamiflu) to those they had been in contact with. Again, this strategy was also intended to try to delay spread.
• We moved into the ‘manage it’ phase when it became clear that swine flu was widespread in the community. During this phase a range of groups mobilised to support those who were unwell to ensure that those with mild-to-moderate illness could be managed away from the hospitals; hospitals re-allocated capacity to deal with the increased workload, particularly in intensive care units (who experienced high demand with sick young people requiring very aggressive life support); public health units focused attention on outbreaks in residential institutions; and a variety of strategies were applied in primary care to help cope with the influx of swine flu patients.
• Throughout each of these phases, there were intensive health education campaigns on ways to prevent flu spread, protective equipment was distributed to healthcare workers (the healthcare workforce being one of the most-exposed groups), and systems for testing and making treatment available were streamlined.
• All of this was designed to “flatten the curve” to try to delay the peak of the outbreak, reduce the overall number of cases and spread the caseload across a period of time instead of having a massive early epidemic peak that could have jeopardised provision of healthcare and many other services. As the nature of the illness caused by swine flu became clearer, strategies were tailored around protecting those that were most vulnerable.
Communicating risk so people take action to protect themselves appropriately is a tricky thing, and when people are protected from the risk it can be tempting for people to think the risk wasn’t there in the first place. Unfortunately even one untimely death is one too many though. Best we not get complacent about the next infectious threat that comes our way.
There are two things I ponder about the swine flu. Can the precautions we take make any real difference? How long will our media sustain the almost-hourly case count, particularly as later today our overburdened health authorities’ switch from their containment strategy to a management strategy?