Avian Influenza: Presentations.
Deputy Gormley: The problem is that once the big hit arrives, many people will descend on accident and emergency units. Mr. Tom Clonan, who carried out an analysis recently on the coping abilities of our accident and emergency units, estimated that real problems would arise within 20 minutes. How well can the units cope and will people be refused admission to them?
Dr. Kelleher: Our aim is to conduct a major communications campaign in order that people understand that their first point of contact should be a telephone helpline, which they can ring to learn where they should go. They will then be diverted for treatment either to a general practitioner or to a flu clinic. We will be advising people against presenting at accident and emergency departments and that the only people who should go to hospitals will be referred there by doctors and admitted directly. We recognise the issues raised by the Deputy and are trying to avoid them by putting a system in place whereby people are diverted away from accident and emergency departments. We are currently looking into the details of the content and method of transmission of the communication campaign because the front end elements are important in terms of keeping as many people as possible away from the hospital system.
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Deputy Gormley: …This is a huge imponderable because, while I understand the surveillance unit is speculating in the dark, I would hate to think that we will only get our act together when a flu pandemic hits. At present, I do not see the vigilance at ports and airports, which obtained for foot and mouth disease. Will the matter become serious only when a pandemic breaks out? In other words, is the unit making a distinction between a flu pandemic and avian flu? We need to understand whether a significant difference exists in terms of the approach because I believe the message is that it may not become a pandemic. On the other hand, the literature I studied suggests that is inevitable. Will the delegates agree that a flu pandemic is inevitable at some stage?
Dr. Kiely: Deputy Gormley talked about the inevitability of this. All the evidence and intelligence on this issue indicates it is a question of “when” rather than “if” a pandemic will occur. The question is when and what will cause it. It is not inevitable that the bird flu will cause it. Although it is the most likely candidate because of its prevalence in the areas where it occurs and the fact that it can be transmitted to humans, there is no certainty that if and when a pandemic comes it will be the H5N1 virus. The only certainty is that there will be a pandemic some time.
The only intelligence we have on the validity, accuracy and sustainability of figure from other countries, for example, Vietnam, is that the WHO and the international public health organisations, including the veterinary public health people, have been involved closely over recent years in such countries. They have helped these countries implement improved and enhanced surveillance systems and continue to help. We do not know if these figures are reliable and valid but we must depend on the figures as validated to the greatest extent possible by the WHO. These are the only figures we have on which to base our assumptions and it would be invidious of me to suggest that countries were not being upfront. I would not want to do that.
The Department has entered into agreements to stockpile many hundreds of thousands of doses of antivirals, enough to treat 25% to 26% of the population in the event of an emergency. This figure is generally recognised around Europe as being sustainable and credible. Our colleagues from the Department of Agriculture and Food might have an answer to the question about poultry imports.
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Deputy Gormley: Many reports have stated it [Tamiflu] is not as effective as assumed. How true are those?
Dr. O’Flanagan: There have not been many but there has been a number of isolated reports of resistance, especially among people treated with it prophylactically who then became ill. The treatment dosage is double that for prophylaxis. If a person develops symptoms it is important they go on the larger treatment dose. Given the isolated incidents, we are seeking additional supplies of an alternative drug [Relenza or Zanamivir].
Deputy Gormley: Is Relenza [an alternative] more reliable?
Dr. O’Flanagan: As it must be inhaled, it is not suitable for young children or for the very elderly. Widespread resistance to Tamiflu is not inevitable. Although recent viral isolates from Turkey have shown no resistance, it is possible that there will be pressure. The more people receive Tamiflu, the more likely it is that resistance will emerge.
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Deputy Gormley: People who are relatively healthy will survive, as if it were ordinary flu. Only the most vulnerable will be badly affected.
Dr. O’Flanagan: That is not necessarily true. Most of the deaths from avian flu so far have been of young and healthy people. In this country most deaths occur in the elderly who had some predisposing illness such as chronic heart disease but avian flu has heretofore occurred in either healthy children or young adults.
Dr. Kelleher: That was the same in 1919.
Deputy Gormley: Do we know why that is?
Dr. O’Flanagan: No. It is one of the questions on which the European Centre for Disease Control has set up scientific panels. They will look at why there has been predilection so far for young and healthy adults and children.