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Flu plan laid out in chilling detail
Canada
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Feb. 26, 2005. 08:16 AM
Flu plan laid out in chilling detail
ELAINE CAREY
MEDICAL REPORTER
It is a long and chilling document. It lists the names of every embalming fluid and casket supplier in Canada, discusses mass graves and temporary morgues and who should get the small, precious supply of drugs that would be available.
The 400-page report details how the federal government would prepare for and respond to an influenza pandemic. When one hits the world — most experts don't say "if" anymore — health officials estimate it will kill 58,000 Canadians and hospitalize 138,000 others. Five million more will require outpatient care and 10.6 million will be sick enough to miss work.
These days, most experts believe a strain of the avian flu, which has already decimated poultry stocks in Southeast Asia and killed at least 39 people there, is the most likely candidate to become that global killer.
This week, the head of the U.S. Centers for Disease Control called it the single greatest threat to the world today and "a very ominous situation for the globe."
On Wednesday, Canada's federal budget provided $34 million to develop a mock vaccine against the strain of the virus called H5N1, which is spread from bird to human, but which experts believe could quickly mutate to be spread easily from person to person.
"It's infected cats, mice, pigs, people," said Dr. Donald Low, chief microbiologist at Mount Sinai Hospital. "If you're a betting person, you'd have to say this virus is the one we have to be most concerned about."
Both Canada and Ontario have developed lengthy plans outlining how and what should be done to prepare for a pandemic of this magnitude.
The federal plan spells out who should get antiviral drugs and vaccines if they are in limited supply, guidelines for controlling it in hospitals, how health officials will communicate with each other and the public, and exactly who will be in charge of each area.
Since local health authorities will likely be the first to detect an influenza outbreak, "it is essential that the lines of communication within the community and up the line to the provincial and federal levels are clear and established in advance of a pandemic," it says.
But experts like Low warn it isn't enough.
"Many municipalities probably haven't even thought of this, let alone hospitals and businesses," he said. "The Toronto Stock Exchange should be writing a pandemic influenza plan. They have to continue to have people working. How are they going to ensure that? Are they going to stockpile drugs for their employees?"
Pandemics — worldwide epidemics — occur every 30 to 40 years. The last one was the Hong Kong flu in 1968, so health experts say we're overdue. They believe the most likely place it will originate is in Southeast Asia because animals and people co-mingle there.
A pandemic would likely hit Canada about three months after it hit Southeast Asia and would come in waves of six weeks, returning two to three months later, said Dr. Karim Kurjee, Ontario's associate chief medical officer of health, who has been heavily involved in drawing up the province's own pandemic plan, released last May.
"Many people think it would be a little like a flash flood, a large number of deaths in a few weeks," he said. "It certainly is quite a scary situation."
When the pandemic hits, two measures will be most effective against it — expensive anti-viral drugs and a vaccine. But there are problems with both. Only one anti-viral drug, oseltamivir or tamiflu, can be used to both treat the seriously ill and prevent the virus but it's expensive and in short supply. Only one company, Hoffman LaRoche, holds the patent to produce it and every country that can afford it wants it.
This month, Canada announced it has spent $24 million to stockpile 9.6 million doses of the drug, which will be topped up to about 16 million doses with contributions from the provinces and territories.
Ontario already has 1.5 million doses, but a single course of treatment takes 10 doses and costs about $60. It also has to be taken within 48 hours of showing symptoms. The drug can also be used for prevention, but it takes 42 doses over six weeks to be effective.
Dr. David Butler-Jones, Canada's medical officer of health, says that even if Canada could get a large enough supply, it would cost $3 billion to provide anti-virals to everyone in the country. But the drugs don't make people immune, so three to six months later when it returned, they would have to take them all over again.
"It really doesn't make sense to rely on anti-virals," he said, "plus the virus could turn out to be resistant to them, and then you've spent $3 billion for nothing."
Under the federal and provincial plans, the drugs would be made available to treat seriously ill patients in hospital, and as a preventive measure for frontline health-care workers and those in other essential services, including government decision makers. The aim is to use the drugs to ward off the virus while workers scramble frantically to produce enough vaccine for everyone.
"The general strategy, when we actually get a pandemic, will be to throw everything at it to try to delay its speed," said Kurjee. "The more time you can buy, the closer you are to getting a vaccine. It's a little like a military strategy."
Canada prides itself on being the only country in the world that has a long-term contract with a vaccine manufacturer, Vancouver-based ID Biomedical, to produce a vaccine for every Canadian when a pandemic hits.
The company has to stockpile all the raw materials and supplies needed to begin rapid production. Since vaccines are grown in eggs, enough egg suppliers have to be contracted so that enough chickens of the right age are on hand to produce enough eggs in which to grow vaccine for 32 million doses.
But even with that in place, it would take six to nine months to produce enough vaccine, said Butler-Jones.
Unlike the U.S. Centers for Disease Control, which has chosen to develop and stockpile 2 million doses of a real vaccine against H5N1, Canada is choosing a different route because officials believe the virus will change before it becomes more deadly, and the exact strain of a virus must be identified before a vaccine can be created.
That's why Ottawa has decided to invest in producing trial batches of a vaccine, which will speed up the production process once a pandemic strikes, Butler-Jones said.
Stockpiling vaccine against the current virus doesn't make sense because it "quite likely won't be effective anyway. We think it's much better to have a responsive system, whatever the virus, to get to manufacturing quickly."
The Ontario plan contains ominous numbers. If a pandemic affected 25 per cent of the population as predicted, that would lead to 14,000 deaths in the province and 46,000 hospitalizations, Kurjee said.
Another 2.3 million would require outpatient care and 3 million more would get mildly sick.
Canada has SARS to thank for the level of preparedness it has against that threat.
"In terms of influenza, Canada's been planning for many years now," said Butler-Jones. "The WHO (World Health Organization) tells other countries to look at Canada to see what they should be doing.
The U.S. looked at our plan and said `why would we re-invent this?' So they adapted it."
As well as the federal plan, Ottawa has just opened a $3 million emergency operations centre in Winnipeg that includes a five-metre-wide video screen along with computers and a bank of telephones.
It will allow health officials across the country to hold video conferences and share data with the WHO, the U.S. Centers for Disease control and other international groups.
Ottawa has also just revamped the Quarantine Act to give the chief public health officer power to divert planes and take temporary possession of buildings to quarantine planeloads of visitors .
http://www.thestar.com/NASApp/cs/Co...id=970599119419
__________________
Canada
--------------------------------------------------------------------------------
Feb. 26, 2005. 08:16 AM
Flu plan laid out in chilling detail
ELAINE CAREY
MEDICAL REPORTER
It is a long and chilling document. It lists the names of every embalming fluid and casket supplier in Canada, discusses mass graves and temporary morgues and who should get the small, precious supply of drugs that would be available.
The 400-page report details how the federal government would prepare for and respond to an influenza pandemic. When one hits the world — most experts don't say "if" anymore — health officials estimate it will kill 58,000 Canadians and hospitalize 138,000 others. Five million more will require outpatient care and 10.6 million will be sick enough to miss work.
These days, most experts believe a strain of the avian flu, which has already decimated poultry stocks in Southeast Asia and killed at least 39 people there, is the most likely candidate to become that global killer.
This week, the head of the U.S. Centers for Disease Control called it the single greatest threat to the world today and "a very ominous situation for the globe."
On Wednesday, Canada's federal budget provided $34 million to develop a mock vaccine against the strain of the virus called H5N1, which is spread from bird to human, but which experts believe could quickly mutate to be spread easily from person to person.
"It's infected cats, mice, pigs, people," said Dr. Donald Low, chief microbiologist at Mount Sinai Hospital. "If you're a betting person, you'd have to say this virus is the one we have to be most concerned about."
Both Canada and Ontario have developed lengthy plans outlining how and what should be done to prepare for a pandemic of this magnitude.
The federal plan spells out who should get antiviral drugs and vaccines if they are in limited supply, guidelines for controlling it in hospitals, how health officials will communicate with each other and the public, and exactly who will be in charge of each area.
Since local health authorities will likely be the first to detect an influenza outbreak, "it is essential that the lines of communication within the community and up the line to the provincial and federal levels are clear and established in advance of a pandemic," it says.
But experts like Low warn it isn't enough.
"Many municipalities probably haven't even thought of this, let alone hospitals and businesses," he said. "The Toronto Stock Exchange should be writing a pandemic influenza plan. They have to continue to have people working. How are they going to ensure that? Are they going to stockpile drugs for their employees?"
Pandemics — worldwide epidemics — occur every 30 to 40 years. The last one was the Hong Kong flu in 1968, so health experts say we're overdue. They believe the most likely place it will originate is in Southeast Asia because animals and people co-mingle there.
A pandemic would likely hit Canada about three months after it hit Southeast Asia and would come in waves of six weeks, returning two to three months later, said Dr. Karim Kurjee, Ontario's associate chief medical officer of health, who has been heavily involved in drawing up the province's own pandemic plan, released last May.
"Many people think it would be a little like a flash flood, a large number of deaths in a few weeks," he said. "It certainly is quite a scary situation."
When the pandemic hits, two measures will be most effective against it — expensive anti-viral drugs and a vaccine. But there are problems with both. Only one anti-viral drug, oseltamivir or tamiflu, can be used to both treat the seriously ill and prevent the virus but it's expensive and in short supply. Only one company, Hoffman LaRoche, holds the patent to produce it and every country that can afford it wants it.
This month, Canada announced it has spent $24 million to stockpile 9.6 million doses of the drug, which will be topped up to about 16 million doses with contributions from the provinces and territories.
Ontario already has 1.5 million doses, but a single course of treatment takes 10 doses and costs about $60. It also has to be taken within 48 hours of showing symptoms. The drug can also be used for prevention, but it takes 42 doses over six weeks to be effective.
Dr. David Butler-Jones, Canada's medical officer of health, says that even if Canada could get a large enough supply, it would cost $3 billion to provide anti-virals to everyone in the country. But the drugs don't make people immune, so three to six months later when it returned, they would have to take them all over again.
"It really doesn't make sense to rely on anti-virals," he said, "plus the virus could turn out to be resistant to them, and then you've spent $3 billion for nothing."
Under the federal and provincial plans, the drugs would be made available to treat seriously ill patients in hospital, and as a preventive measure for frontline health-care workers and those in other essential services, including government decision makers. The aim is to use the drugs to ward off the virus while workers scramble frantically to produce enough vaccine for everyone.
"The general strategy, when we actually get a pandemic, will be to throw everything at it to try to delay its speed," said Kurjee. "The more time you can buy, the closer you are to getting a vaccine. It's a little like a military strategy."
Canada prides itself on being the only country in the world that has a long-term contract with a vaccine manufacturer, Vancouver-based ID Biomedical, to produce a vaccine for every Canadian when a pandemic hits.
The company has to stockpile all the raw materials and supplies needed to begin rapid production. Since vaccines are grown in eggs, enough egg suppliers have to be contracted so that enough chickens of the right age are on hand to produce enough eggs in which to grow vaccine for 32 million doses.
But even with that in place, it would take six to nine months to produce enough vaccine, said Butler-Jones.
Unlike the U.S. Centers for Disease Control, which has chosen to develop and stockpile 2 million doses of a real vaccine against H5N1, Canada is choosing a different route because officials believe the virus will change before it becomes more deadly, and the exact strain of a virus must be identified before a vaccine can be created.
That's why Ottawa has decided to invest in producing trial batches of a vaccine, which will speed up the production process once a pandemic strikes, Butler-Jones said.
Stockpiling vaccine against the current virus doesn't make sense because it "quite likely won't be effective anyway. We think it's much better to have a responsive system, whatever the virus, to get to manufacturing quickly."
The Ontario plan contains ominous numbers. If a pandemic affected 25 per cent of the population as predicted, that would lead to 14,000 deaths in the province and 46,000 hospitalizations, Kurjee said.
Another 2.3 million would require outpatient care and 3 million more would get mildly sick.
Canada has SARS to thank for the level of preparedness it has against that threat.
"In terms of influenza, Canada's been planning for many years now," said Butler-Jones. "The WHO (World Health Organization) tells other countries to look at Canada to see what they should be doing.
The U.S. looked at our plan and said `why would we re-invent this?' So they adapted it."
As well as the federal plan, Ottawa has just opened a $3 million emergency operations centre in Winnipeg that includes a five-metre-wide video screen along with computers and a bank of telephones.
It will allow health officials across the country to hold video conferences and share data with the WHO, the U.S. Centers for Disease control and other international groups.
Ottawa has also just revamped the Quarantine Act to give the chief public health officer power to divert planes and take temporary possession of buildings to quarantine planeloads of visitors .
http://www.thestar.com/NASApp/cs/Co...id=970599119419
__________________
