Australia provides latest glimpse at pandemic "what-ifs"
Scott McPherson
in influenza and infectious diseases
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Make no mistake: Australia is reeling under the weight of one of the worst seasonal flu epidemics in the past twenty years. And this provides an excellent glimpse at what a pandemic -- even a mild, 1968-ish pandemic -- can and will do to a nation in the globalized, 21st century.
First, let us get up to date. The seasonal infections are both H3N2 and H1N1. The WHO vaccine targets for the 2006-07 Northern Hemisphere and the 2007 Southern Hemisphere flu season were identical. It may be too early to know if these targets were on the money, or were off. It is not known how many Australians took their flu shots this year. If fewer Australians took their shots, it would help explain why the virus has hit the island nation so hard this year. Or perhaps new substrains emerged Down Under, and drifted beyond the ability of the seasonal vaccine to intercept and destroy them.
But look at the parade of daily news articles streaming from the beleaguered nation. First came the revelation that adults were dying of the seasonal flu. Australian deaths include three otherwise-healthy adults - a 37-year-old Queensland man, a 48-year-old woman from South Australia and a 33-year-old Queensland mother-of-two.
"These figures are growing proof that we're having a heavier season this year than we have in previous years," said Professor Anne Kelso, director of the Melbourne-based World Health Organisation Influenza Centre.
http://news.ninemsn.com.au/article.aspx?id=97550
Flu cases are running three times the five-year average, so the morbidity spike is quite pronounced. It is an epidemic that is much more serious than normal -- so much so that none other than Professor Graeme Laver has called for the dispensing of Tamiflu, without prescription, directly from chemists (pharmacists). In case you did not know, Professor Laver is one of the bona-fide Influenza Rock Stars, and he is right up there with his friend and peer Dr. Robert Webster. Laver's research led to the creation of Tamiflu, although how they ever settled on Chinese Star Anise as the extract is beyond me.
Anyway, Laver contends that Tamiflu is safe enough to be sold over-the-counter. I am not sure the Japanese would agree with that statement, based on the research showing Japanese youths who took the antiviral attempting and occasionally committing suicide and showing other bizarre behaviors. This was a major reason for Roche introducing smaller, 30 mg and 40mg Tamiflu capsules, made especially for younger children (the adult dose remains at 75mg). The smaller doses are now EU and FDA-approved.
This Tamiflu over-the-counter release would be fine, well and dandy, if Australia had enough Tamiflu to distribute. But the Aussies run their economy the same way the rest of the world does, via the Just-in-Time supply chain, which we all know is as doomed as doomed can be in a pandemic. Worried and panic-stricken moms across the nation are driving around, desperately trying to find Tamiflu to buy for their flu-stricken children. So last week the Australian government, under considerable pressure from those moms, agreed to release part of their pandemic stockpile for sale -- but still via prescription. An article, posted by fellow flu blogger and all-round nice person SophiaZoe, can be found at http://www.goldcoast.com.au/article/2007/08/10/1471_gold-coast-news.html and here is a short excerpt:
10Aug07
PANIC-STRICKEN mums yesterday scoured the Gold Coast searching for anti-flu drug Tamiflu for ailing children hit by the crippling influenza epidemic.
Many were forced to drive across the city to get their hands on the drug, with some pharmacies running out and wholesalers struggling to meet the demand.
Some blamed the shortage on widespread government stockpiling for a future pandemic like bird flu.
The Gold Coast Bulletin was inundated with calls from mothers concerned they could not find a pharmacy with the drug or its liquid form, Tamiflu Suspension.
"I've got one hand on the wheel and my other hand on a phone trying to find a chemist that has it," said one mother. "I'll probably get booked, but I need to find a place that has it because that's what my GP prescribed."
Following the calls, The Bulletin contacted a number of pharmacies across the city and received mixed responses.
Some had run dry while others were holding on to stocks.
Finally, we can learn about how hospitals will not be able to handle surge capacity. This comes as no surprise to those of us who study influenza and public health shortcomings, but it is amazing how many authorities still believe we are performing some dastardly disservice every time we mention there is no surge capacity in modern health care today, and none to be seen in the distant future, let alone the near-term. Like we should keep this a secret or something?
As first posted by my buddy and fellow flu blogger Mike Coston, aka FLA_MEDIC, http://www.news.com.au/dailytelegraph/story/0,22049,22262072-5001021,00.html
Private patients in The Hills district are now being shunted into the overloaded public system, which is already buckling under more than 3000 extra suspected flu cases flooding emergency departments in the past week alone.
The crisis comes as yet another person, a South Australian health worker, has died after being infected with the killer influenza A virus sweeping the country.
The Daily Telegraph can also reveal that a Sydney doctor is in intensive care at North Shore Private Hospital after catching influenza A.
Adding even further to the health system's woes, there has been an outbreak of a superbug at Bankstown Hospital's intensive care unit.
The Hills Private Hospital is now being investigated by the State Government to determine if it has breached its licence by failing to keep its emergency department open amid one of the worst flu epidemics in more than 20 years.
Documents obtained by The Daily Telegraph reveal that the hospital asked ambulances to bypass its emergency department on Monday because they did not have enough staff.
It is understood ambulance service CEO Greg Rochford told the hospital's CEO Stephen Tameren ambulances had cancelled all emergency services to the hospital until further notice.
The Hills emergency department was crippled after a doctor called in sick and the hospital was unable to find a replacement for him.
The hospital claims the department is now fully staffed and operational but the ambulance service refuses to take patients there because it does not consider the emergency department reliable.
Meanwhile, NSW Health data released yesterday reveals the flu infection rate has skyrocketed by more than 50 per cent from 5.5 people per 1000 presenting symptoms to 8.7 per 1000 in the past two weeks, with 23,400 presentations in the past week.
At Bankstown Hospital, five people have been quarantined after contracting a superbug in the ICU, causing a critical bed shortage.
So let us review. We have a major flu epidemic in Australia, which is infecting and killing in larger numbers than normal. We have a populace that is aware of what it needs to keep children healthy, and they are exerting pressure on government to solve a problem. The supply chain does not have enough Tamiflu, so the government is releasing part of its stockpile. And we have hospitals that are in violation of law, despite all protestations to the contrary. Hell, I'll bet a quid the same hospital ran a "drill" and proclaimed themselves "ready" to face a pandemic! So how did that work out for them?
And all this from a nation that is very aware of the fact it is only a short flight away from H5N1's hottest spot, Indonesia (which lost a maid over the weekend to H5N1). So if you read this and decide America is about as ready for an influenza pandemic as it is for an alien invasion, you'd be about right.
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