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Pandemics and Infection Control: Meeting Tomorrow’s Threats and Challenges Today
A report from Katie Tomkins FAAPT
The well lit and nicely air conditioned room was a comfortable setting for a well structured Symposium. Placing “reserved” signs on the back tables was a fantastic ploy by the organiser, forcing us delegates to sit on the front tables and interact with each other.
The symposium was split into two sessions, in the morning session;
“Infection Control and Emergency Planning-Preparing for the Challenge of Pandemic Influenza”
Began with Marc Bevridge, (Strategic Emergency Preparedness Manager, Corporate Resilience Team Public Health England) (formally HPA)
Opening question from Marc.
When did you last look at your pandemic plans?
To be honest I don’t know. You do feel that little bit of shame, or well at least I did. And from the mumbles that came from the other delegates I guess we all felt the same.
Have they been reviewed since the swine flu pandemic of 2009?
Are they still valid and current?
The delegate’s mumbles got a louder, but that’s why we are all here. To give us the shaking up we need to think about revisiting and reviewing our plans and those three questions were all it took to get me thinking.
“As a very basic consideration the austerity measures that the NHS and local authorities are currently working under could impact on the plans that were written well over 4/5 years ago. Just our ability to stock pile equipment not to mention our budget constraints and reduced staffing levels.”
This is a very valid point and one that we should all consider. In the lead up to the Olympics there seamed to be an abundance of money for mass fatality planning. But that was last year and the games are over and the money pot is looking empty.
So we turn to look at the lessons we learned from the swine flu pandemic in 2009.
Did the plans work?
"Well yes they did on a whole but there is always room for improvement, but that’s the thing, with the best will in the world we can never fully plan for something that is essentially out of our control.
The pandemic flu plans were all worked around Avian Flu (H5N1), coming from Asia into the South East of the United Kingdom via Heathrow and Gatwick…
Instead we got Swine Flu (H1N1) from Mexico and it arrived in Scotland first. So already the best laid plans were thrown out of sync by this organic virus"
Sentiments echoed by Dr Lydia Drumright, (Department of Medicine, Division of Infectious Diseases and Immunity, Centre for Infection Prevention and Management, Imperial College London.)
The normal triggers that signal an outbreak of any infectious disease are children and the current measles outbreak in Wales is a perfect example. Children interact in closer proximity to each other than adults and are the first to pick up any cold or flu illnesses. Anyone with children will know that a cold brought home from school by your little darling will spread through your household within a week.
Head teachers in schools (not all of them mind) will in general, report if they have a large number of children absent from school with the same symptoms. Thus giving some early warning of an impending outbreak.
But with swine flu the (H1N1) virus behaved differently, affecting young adults and fit healthy younger people in the first instance; throwing the triggers completely off. Students who don’t turn up for lectures are generally not chased by their lecturer or any of the university staff. Giving a big information gap among 17-24 year olds.
This meant we were six weeks into the pandemic before the World Health Organization declared phase 6.
(Phase 6 is a pandemic, according to the WHO definition) http://www.who.int/csr/disease/swineflu/phase/en/index.html
So why did H1N1 affect a different age group compared to our normal seasonal flu?
Why did some people only have a mild disease?
Well there not sure, so MOSAIC was established. (Understanding Pathogenesis Through A Multidisciplinary Approach) The results from this study should be available Summer 2013.!!
Now for the maths…. I won’t lie a lot of what Thomas House Assistant Professor, Mathematics, University of Warwick spoke about sent me brain in a spin.
Our natural immunity built up towards seasonal flu and the season.
Annual vaccination programs mean that our herd immunity to the influenza virus is strong RO2 meaning that every single infected person will go on to infect 2 other people. When you look at measles in comparison we have a herd immunity of RO20 meaning every single infected person would go on to infect 20 other people.
Our herd immunity will always offer some form of protection to the influenza virus but as the virus mutates and crosses with other variations the ability to predict pandemic trends becomes increasing difficult. Placing more importance on the early warning signs from sickness reporting in schools, universities and workplaces.
The morning session came to a close with a chance to ask questions or just share thoughts and experiences in relation to this morning’s session.
I raised an experience in relation to Dr Lydia Drumright’s presentation.
During the H1N1 pandemic every deceased that came into the Mortuary who had a history of flu like symptoms in the lead up to their death was treated as high risk and a good selection of samples were collected and sent for analysis.
But once the pandemic was over we no longer did this. So how accurate are the death figures from the winter 2010/11 showing a confirmed 602 deaths from H1N1, the Mortuaries were no longer testing for H1N1?
The answer was a shrug. Dr Drumright agreed, if everyone with flu like symptoms are not tested we won’t have an accurate picture. I can’t see my Coroner or Trust wanting to pay for the added expense of influenza testing.
The afternoon session “Minimising the Implications of a Pandemic-Strengthening Resiliencies Nationally and Locally” Began with Malcolm Fuller (Business Contingency Manager, Metropolitan Police Service.)
Some comparisons can be drawn between the Met Police and the NHS. We are an essential service that the public rely on. But how would your service cope with 25% of your staff absent? What about 60% of your staff absent?
When I look at that solely in terms of my Mortuary department, 2 Sites, 2 PM rooms and 4 staff.. Just one member of staff off sick has an impact let alone 2 or 3. We are such a specialist profession that it’s imposable to draft in staff from other areas of the hospital to assist. So that urgent call to the locum agencies.. Only to find the locums are all working or also off sick. But of course we all have our Flu vaccination every winter so are immunity levels are good…!!! It all about knowing your tipping point, understating your service and knowing what activities can be scaled down to minimise impact.
But then what also is the impact on our service when undertakers are off sick so unable to collect the deceased, the registrars unable to register deaths due to staff absence. More pressure on a pressurised service due to the already increased mortality rate associated with a flu pandemic.
I know in my trust every weekend the trust declares a Black alert. Operation stack for the incoming ambulance is triggered and the silver command sits every Monday morning to assess the bed pressures and how to proceed. This covers live patients and I’m sorry to be selfish but my concern is with the deceased patients. Every Monday morning I declare my own Black alert on capacity. What colour can I use in a Pandemic??
Jason Wright (Emergency Planning Manager and Local Security Management Specialist, Royal Surrey County Hospital NHS Foundation Trust)
Many points Jason made echoed Malcolm Fuller, with regards to redeployment of staff. Jason spoke solely about the plans at Royal Surry Hospital. The trust has done away with ten plans for ten eventualities. There is one big emergency plan, whether its snow, or pandemic it all about maintaining a service with a reduced member of staff and an increaded number of patients. The NHS like a lot of frontline services relies a lot on the good will of staff, working later and longer hours. “That’s why we all love what we do”
So how can we prepare for the next pandemic and one thing we can be sure of is that there will be another one… In essence; go back to basics. Coughs and sneezes spread diseases. Good personal hygiene, sneezing into a tissue and putting that tissue in the bin. Washing our hands with warm soapy water. These basic things will help prevent the spread of influenza. As frontline staff it is our duty to ensure our inoculations are up to date giving us a stronger immunity to the disease. For us as a profession it’s making sure we have our own departmental emergency plans because if you are included in the trust level plans I bet it’s only a line or two at the most. Maintaining good working relationships with other local Mortuaries so that in the event of a Pandemic, workloads could be shared, staff could be shared stress levels could be reduced.
You know your Mortuary; you know the service you provide. Now just sit for five minutes and think how would you continue if 60% of your staff, Coroners staff and undertaker staff were all off sick with Flu.