Conference hears details of pandemic response plan

A second Admissions and Emergency Department would be set up at St Luke's Hospital during an influenza pandemic so that flu patients do not mix with other patients.

Attempts would also be made to keep other flu patients admitted to hospital separate from others, National Influenza Pandemic Standing Committee chairman Tanya Melillo said yesterday.

She explained that these patients would be admitted to a designated ward, from where both entrance and exit would be limited.

The need to separate flu patients from other sick people is not restricted only to hospital. Speaking during the Fifth Maltese Conference on Infection Control and Antibiotic Therapy, Dr Melillo said general practitioners would not be able to see their patients in a small clinic, where all the patients wait together in a small area.

This was not the only hurdle that private doctors would have to overcome. Because local GPs tend to operate on their own, the likelihood is that when they fall ill during a pandemic period, there would be nobody to take care of their patients.

However, Dr Melillo explained, doctors have already accepted to work together so that they can continue giving a service to their patients.

Speaking about the national pandemic response plan, Dr Melillo said that since it would not be fair for just one group of health care workers to take care of influenza patients, rosters will be prepared.

The 13-chapter plan points out that there is a limited number of Intensive Therapy Unit nurses and stresses the need to train other nurses to do the same job.

"We all need to work together," Dr Melillo emphasised.

She said antiviral courses for 25 per cent of the population have been ordered and a priority list has been prepared in case the attack rate is higher.

Nigel Lightfoot, the director of Emergency Response within the UK's Health Protection Agency, said the World Health Organisation states that the UK is the most prepared country. But Malta was not far behind, he added. He also emphasised the importance of not mixing up avian influenza with the influenza pandemic, stressing that although millions of poultry have been infected, there were only few human cases reported.

Dr Lightfoot said if the virus starts in South East Asia, it would take between two to four months before it spreads to Malta, giving the authorities time to prepare. Moreover, he said, once the virus arrives on the island, it will take another two weeks for it to spread.

He pointed out that closing borders was not the answer because it would lead to "economic suicide" and pointed out that entry screening would not work since the virus has an incubation period of three days, and therefore perfectly healthy people might be infected.

He also said that the pandemic might not be as bad as is expected.

More than 400 delegates took part in yesterday's full-day conference which, perhaps unsurprisingly, dealt with the influenza pandemic, the talk of town from medical circles to people in the street.

Institutional Health director John Cachia, who chaired the conference, reminded those present that all experts were saying that a pandemic was due to strike, but nobody knew when this would be or where it would start.

Those present were taken on a trip to the future, shown fictitious news bulletins telling people that an influenza pandemic has struck.

Although a simulation, the videos, compiled by the Centres for Disease Control and Prevention in Atlanta, mentioned a number of possible scenarios: dwindling supplies of antivirals being sold on the black market for $600, parents protesting because they believed their children should be given the vaccine against the virus first and others protesting that the elderly were being discriminated against and not getting the best treatment. The fictitious news bulletins said waiting times to see a doctor had gone up to 15 hours.

In another video, the chairman of the European Scientific Working Group on Influenza, Ab Osterhaus, said a pandemic can start anywhere but all the factors indicated that it is most likely to start in southeast Asia, particularly China, mainly because the people have close contact with animals.

Once they got into humans, there was the threat of adapting and then spreading easily from human to human.

Although nobody knew when the next pandemic would start, British expert John Oxford said he would be very surprised if it did not happen within the next decade.

Health Minister Louis Deguara said plans are underway to start a series of lectures and workshops at the various hospitals and health care facilities, as well as within the private sector, to disseminate information on the local pandemic plan.

He said that although the permutations of a global influenza pandemic as modelled by experts were a truly formidable challenge, they could be managed effectively "as long as we all remain professional in our attitude".

"Our worst enemy is fear itself. Panic and irrationality have no place in our response to the influenza threat," he said.

He pointed out that whatever the World Health Organisation has recommended "has been and will be done". He mentioned the procurement of protective equipment as well as orders for antiviral drugs and the pre-booking of the specific vaccine against the virus causing the pandemic, which has yet to be developed.

Dr Melillo said the assumption is that the vaccine will arrive six months after the manufacturing company gets hold of the virus sample. She said if the vaccines arrive during the peak of the local epidemic, the whole population will be mass vaccinated over four days, but if it arrives at the end of the first wave, people will be vaccinated over a few weeks.

She stressed the need to educate the public on health measures: washing hands, covering mouth when sneezing and coughing and disposing of tissues immediately.

Dr Lightfoot said the virus can survive on the hands for 24 hours and on surfaces for up to 48 hours, but can be removed by washing with soapy water.