A few years ago and the country was in the grip of Bird Flu Fever, so to speak. The Health sector was dusting off the plans from 1918 and sales of Geoffrey Rice’s excellent account of that earlier pandemic soared. It seemed like every organisation and business in the country was developing its own pandemic preparedness plan.
Now we’re seeing some of those plans in action, underlining the often overlooked fact that any virus is going to produce a different pattern of infection and different demands on health and other services.
One of the key features of New Zealand’s plan is the establishment of Community-Based Assessment Centres (CBACs). The idea of these is to provide facilities at a local level (handy to where people are), but separate from other health services, so that people with flu symptoms can be assessed and treated while minimising the risk of cross-infecting other people who may be particularly vulnerable (old, very young or immuno-compromised).
It’s a really sensible idea, and built directly from 1918 experience. At the time of writing some CBACs have been set up, while others are in preparation, and others not at all, suggesting the trigger mechanism needs some work.
So what do you do about controlling the spread of ordinary flu? Surely if I have common or garden flu (which, by the way, is still a potentially serious illness) then it’s a pretty undesirable thing for me to be transmitting that (or any other casually transmissible disease) to others in a primary care waiting room or retail pharmacy too?
We’re caught right now in precisely this situation. H1N1 flu has heightened concerns about the flu. The availability from today of Tamiflu from pharmacists without a prescription, but at a substantial cost, creates a real dilemma: it’s important that we don’t waste the nation’s stocks of Tamiflu on the worried well or to create stockpiling (with attendant risk that people will use sub-optimal doses at some point with the risk of encouraging drug-resistant strains), so we have set up rules to require pharmacists to eyeball patients and be satisfied that they actually have flu symptoms. But to do this patients with flu symptoms need to come into a pharmacy, bringing them into contact with others and potentially spreading the disease.
A solution isn’t obvious. The drug is available direct from pharmacies to relieve pressure on GPs dealing with the tide of Winter ailments, but maybe we need to go back to prescription-only access to Tamiflu, with separate clinic days in general practices for people with casually-transmissible disease symptoms.
Maybe we need to have district nurses visiting people with suspected flu in their own homes, able to diagnose, prescribe and dispense.
Maybe we should suspend the regular Winter direct access to Tamiflu programme while H1N1 is about. And maybe it’s time to initiate CBACs in all centres with suspected H1N1.