THE PUBLIC health management of influenza A (H1N1) in the Republic changes significantly today. Instead of attempting to contain the disease, the Department of Health and the Health Service Executive have decided to adopt a policy of mitigation. Rather than vigorously identifying contacts of proven cases of the pandemic flu and routinely pursuing a laboratory diagnosis of the virus, the new policy means the diagnosis of most cases will be made on clinical grounds.
And treatment with anti-viral drugs such as Tamiflu will be confined to those at high risk from the virus. These include pregnant women, the severely obese and people with severe asthma. Based on the 94,500 laboratory confirmed cases and some 430 deaths reported to the World Health Organisation (WHO), it appears the new virus is particularly affecting children and young adults under 30. And severe lung damage has been a major factor in those who have become seriously ill or died.
To date, there have been 145 confirmed cases of influenza A (H1N1) in the State; five people have been hospitalised but, as yet, there have been no deaths. These numbers are low compared with the US and the UK and reflect the relative success of the previous containment policy. However, the pandemic, described as moderate by the WHO, will continue to grow. The chief medical officer, Dr Tony Holohan, has said some 1 million people here could be infected by the new virus. In such a scenario, continuing a policy of containment would threaten the viability of laboratory services and place severe pressure on health care professionals. As it is, the numbers falling ill will put “significant strain on family doctors, hospitals, ventilation equipment and intensive care facilities”, according to the Department of Health.
From today, patients diagnosed with pandemic flu will no longer routinely receive anti-viral medication. People who suspect they have the flu should not visit their doctor’s surgery; they should telephone their family practice or out-of-hours service in the first instance.
It is likely that a surge in cases will occur in the autumn as schools reopen and the winter conditions needed for the transmission of the virus become more prevalent. The extent of spread will depend on whether the virus becomes more virulent and on how soon the pandemic vaccine becomes available. With two separate doses required, a major logistical exercise will be needed to protect the population. Essentially, we face a race between the rate of vaccination and the rate of spread of the new flu from October onwards.
Thus far, the public health management of the outbreak has been a success; continued hard work allied to a modicum of luck should help minimise the effects here of the world’s first influenza pandemic in 40 years.