=
<B><font size=+1 color=red><center>Preparing for a pandemic </font>
12 March 2006 By Aileen O'Meara
<A href="http://www.thepost.ie/post/pages/p/story.aspx-qqqid=12541-qqqx=1.asp">www.thepost.ie</a></center>
"It’s like predicting an earthquake” is how the country’s top public-health expert describes the build-up to a global flu epidemic. Everyone knows it’s coming, but nobody is sure when it’ll happen and how widespread it’ll be.
‘‘We all know it’s going to come, we just don’t know when. It could be within the next three months, or the next five years,” said Dr Darina O’Flanagan, director of the new Health Protection Surveillance Centre. As she spoke, in Belgium, a man had been placed in quarantine after returning with suspected bird flu from China, while a nine-year-old girl died in China.</b>
Migrating birds have brought the bird flu as far as domestic ducks in France.
More than half of the 175 people who have contracted bird flu to date have died, most of them young people and children.
But then, it is likely that O’Flanagan knew all this before most of the public. She’s the person who knows more about this and other infectious diseases than anyone else in this country.
She became the first director of the-then National Disease Surveillance Centre when it was established in 1998, and has been a tireless proponent of vaccination and public health matters since then.
As the threat of an epidemic moves closer, her surveillance systems will be keeping people informed of the spread of any infection here.
When the Oireachtas Committee on Health called in the experts two weeks ago to tell them about the health service response to a potential epidemic, the department’s chief medical officer quickly handed over to O’Flanagan.
She gave them a meticulous and comprehensive presentation, explaining what a pandemic was, and unafraid to give figures for the numbers of Irish who could die if it hit here.
She said the calculation of 5,000 Irish deaths was based on the numbers of deaths in Ireland from a combination of the three flu epidemics in 1918, 1957 and 1968, two of which were ‘‘mild’’ epidemics.
That’s why it is so frustrating for her that the health authorities do not seem interested in properly resourcing the public health infrastructure in the Republic.
Over the border in the North, there’s a 24-hour public health infrastructure, as there is in Britain.
But in the Republic, there are vacancies for public health specialists around the country.
The jobs have not been advertised, and the vacant positions put existing personnel under greater pressure, especially in high-demand times, such as during an epidemic or outbreak of infectious illness.
But despite a decade of campaigning - including a strike three years ago, in which she was publicly criticised by the minister for being involved - public health doctors still have no agreement on out-of-hours cover in the event of a major outbreak of infectious disease.
With the vaccines in place, rapid identification of the virus will be a key element of any plan to minimise the spread of the highly-infectious virus.
She gives credit to the Department of Health for agreeing to purchase antiviral drugs needed for key staff, should bird flu spread here.
‘‘In this country, we have been fortunate enough - and you can applaud the Department of Health on this one - to have secured agreement to buy more antivirals.
‘‘I think we are as advanced as any other European country in terms of the plans we have put in place.
‘‘We have plans to cover 25 per cent of the population for Tamiflu, and we have plans to cover another 20 per cent of the population with an alternative antiviral drug, Relenza.
“The initial stocks are with us, we will be getting more in by September, and the Relenza will be coming in next year,” said O’Flanagan.
The antivirals will play a key role in reducing the severity of the illness. It is estimated that 25 per cent of those who contract the flu will have clinical symptoms.
‘‘So if the 25 per cent who are sick start on immediate Tamiflu within 24 hours, this reduces by 50 per cent the amount of complications that could occur from it, and the amount of hospitalisations and the amount of people who would get secondary complications, like bacterial pneumonia.”
The authorities have joined those in Britain in an advance purchase agreement with the vaccine manufacturers to provide a vaccine for a human flu strain within six months of an outbreak.
‘‘Epidemics usually occur in waves and, in the first wave, we will have to rely on the antivirals.
“Hopefully, by the second and third waves, we will have vaccines available,” said O’Flanagan.
But the key will be getting those medicines out to people as quickly as possible should an outbreak occur. Experts are considering separate flu clinics or pharmacies so that those with fever and cough can be kept away from family doctors and hospitals.
‘‘The reality is that GPs will be overloaded with people who are seriously ill. A lot of people who get it will get fever and cough, but if they get the antivirals, they will manage without being seriously ill. What we want to try and avoid is those people going into the health system if possible,” she said.
There could be 14,000 ‘‘excess hospitalisations’’ if the pandemic spreads widely. She sighed as she considered the effect this could have on the country’s hospitals.
‘‘The difficulty, as always, will be the stresses and strains on hospital capacity and the reality is that you know hospitals are stretched at the moment,” she said.
Public health experts are discussing using alternatives to hospitals for those with bird flu, including private hospitals or orthopaedic hospitals.
‘‘There’s no doubt that, if we had a pandemic, there would be some cases that would be admitted to acute general hospitals, for the severe complications associated with it,” she said.
‘‘There would be people who would need ventilator support and all that. So you would have to use some of your acute general hospitals, designated flu wards.”
But everything is dependent on the severity of the pandemic. ‘‘It may be as mild as the 1968 or the 1957 [pandemics]”, so it would not be necessary to seek alternative hospital sites.
A practical person, O’Flanagan is keen to communicate the simple messages that will help reduce the risk of spreading any infection: wash your hands frequently, cover your mouth and nose when sneezing, and stay at home if you are sick.
‘‘All the extra time we gain will slow down the rate of infection.
“These are important messages. Sometimes the simple ones are the ones that people rubbish,” she said.
But, while all these scenarios are being discussed, Ireland has had no cases of bird flu - or human cases. O’Flanagan has great confidence in the ability of the Department of Agriculture to combat any outbreak in poultry.
‘‘It will be an animal disease matter mainly, and it is not inevitable that we would get human cases. But the plans are there to manage it if we do. I would hope we would not get any.”
