BY TRACEY DUGUAY
A medical state of emergency has been declared. The Sudbury Regional Hospital?s emergency room is overflowing. Children with blazing fevers and aching bones are home from school. Seniors in long-term care facilities are dying. Morgues and funeral homes are backlogged and refrigerated trucks are brought in to warehouse the dead. Local businesses suffer or close due to employee absenteeism. People with even the smallest cough are glared at suspiciously.
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Emergency planners, Jennifer Amyotte and Tim Beadman, are just two of the many people working on Greater Sudbury pandemic planning initiatives. |
Panic, fear, chaos...predicted outcomes if the deadly Avain flu, or another pandemic, makes its way to Greater Sudbury.
While this hasn?t occurred, according to many experts, it?s only a matter of time before it becomes a reality. So, it begs the question, is Greater Sudbury prepared to deal with a global pandemic?
According to Tim Beadman, director of emergency management for the City of Greater Sudbury, city officials have been working with the Sudbury and District Health Unit, which would take the lead during a medical crisis, for the past two years on pandemic planning strategies.
The city already had an ?all hazards? plan, which is designed to get key decision-makers in the community together to form a ?control and command?
team.
?The Sudbury health unit has just formalized its local plan and now the city has a copy of the health unit?s plan,? Beadman says. ?We?re now integrating their plan and concepts with the city?s plan.?
While there?s no immediate threat to the Greater Sudbury community, various agencies are keeping an eye on the spread of Avian influenza overseas in order to prepare for the worst.
?What we?re doing right now, the World Health Organization and all the disease specialists globally, are watching closely what?s going on with the Avian influenza, which is now not only in Southeast Asia but up in Pakistan,? says Jennifer Amyotte, chief of professional standards for Greater Sudbury Emergency Medical Services.
What has experts so worried about is the Avian flu meets the criteria for a pandemic in the sense it?s a new influenza stream - one that?s very different and very virulent, which means the potential is there for severe disease and death.
Amyotte says the estimated death rate is in the 60 percent range.
?This particular virus is showing some potential of being similar to the Spanish Flu of 1918-1919, which killed, some estimates are between 20 to 30 million, but I?ve heard as many as 50 million people in the world,? Amyotte says.
The threat to Greater Sudbury will remain low as long as there are no signs of the disease spreading through unrelated human contact. Experts agree it?s much more likely to occur in Southeast Asia because of crowded and poor living conditions there.
?What is occurring is there are potential cases of limited human-to-human transmission of people who were very close caregivers to those who were sick with the H5N1 or the bird flu. That?s where it ended though, it hasn?t spread from that person to another person,? said Amyotte.
If the disease ever progresses to that level, the likelihood of Avian flu jumping from country to country increases and the threat of an actual pandemic grows.
?SARS taught us that communicable diseases are only a plane ride away,? Amyotte says.
Even if the disease does spread through human contact, there?s about a four-month window of opportunity before it would reach North America.
?That?s why all levels of government are on high alert and preparing plans,? said Amyotte. ?This is the first time we?ve been able to prepare for a
potential.
?With SARS, it was a new disease process and people didn?t know what it was. But we do know what influenza is, we do know how it spreads, we do know that it?s coming. We can look historically at previous pandemics that occurred in the 19th century and develop some potentials of what may occur.?
Beadman says if the pandemic crosses the pond the federal or provincial governments may declare a state of emergency and at that point, the pandemic plans of various agencies (ie. health unit, hospital, long-term care facilities, funeral directors, etc.) would be implemented.
?What that would do is trigger a number of provincial activities to occur, and then it would trigger a number of municipal activities to occur with the local heath care agencies,? Beadman says.
The challenge for the city would be to maintain essential services - like hydro, water, heat, wastewater, and police and fire - while dealing with a predicted 35 percent employee absenteeism due to flu-related illness. The number would also jump slightly when factoring in staff who would need to be away from work in order to care for sick family members.
While the health unit is in full planning mode, its associate medical officer of health, Vera Etches, stresses it?s important not to get overwhelmed by the doom and gloom prophecies.
?We?re preparing for a pandemic, but it?s not something that should consume us,? says Etches. ?We need to put it into perspective, because it?s not helpful to play on public fears.?
She explains the average person can help prevent and reduce the spread of influenza, Avian or otherwise, by following three simple rules: wash your hands regularly, cover your mouth when you cough, and stay home when you?re sick.
Another way of preventing the spread of influenza is getting an annual flu shot, Etches adds. However, she admits, the vaccine being used now won?t work against the Avian flu.
Currently there is no vaccine available for the Avian flu because health experts don?t know the specific strain yet.
Vaccines, which take four to six months to make, are made from ?killed pieces of the virus,? Etches says. The dead pieces of the virus are used to help the body build antibodies to fight the bug.
The only recourse for the Avian flu at the moment is anti-viral medication, which is taken orally.
Oseltamivir, also known as Tamiflu, is the most widely distributed anti-viral. It can be used to prevent people from catching the flu and also to treat people who are already sick.
There are 14.7 million pills available in Canada right now, Etches says, but this amount isn?t enough to treat everyone.
In the case of a flu pandemic, the pills, which will be heavily guarded by security teams, would be distributed according to strategic planning and need.
For example, front-line health care workers, people who are already infected, essential workers, high-risk populations, and those with a high risk of
complications, like severe illness or death, would receive the pills first.
?The (distribution) plan is constantly being updated. We?re not sure how fast down the priority list it will go,? Etches says. ?But, anti-virals are only one tool we have to prevent influenza.?
The other tools she refers to are reinforcing the concept of personal hygiene practices, decreasing public gatherings and co-ordinating services to identify people who are ill.
These practices are already in place to deal with the annual garden-variety influenza, and would be stepped-up in the case of Avian flu. The health unit keeps an eye on trends to determine when a flu bug is ramping up in the city. This is done by tracking visits to medical clinics, emergency rooms,
school attendance rates and illnesses in long-term facilities.
This monitoring takes place over a period of months, since the flu progresses in consecutive ?waves.? It can take months or even a year for a bug to work its way through a community, as seen with the SARS outbreak a few years ago.
?Influenza comes in waves. Even with your annual outbreak, you get people who get sick in November, and then people who get sick in February and March,? Amyotte says.
?You have a wave that lasts about eight weeks and then it seems to decrease in new occurrences, then the second wave hits. This is just part of the disease process.?
Given this information, and the potential deadly impact of Avian flu, the health unit and hospital are working on a variety of strategies and plans to minimize the impact within the community.
Alternative-care facilities may be set up to handle the overflow from medical clinics and the emergency room. Elective surgeries may be rescheduled. Clinic hours may be extended and triaging efforts may be altered in order to assess and treat people quickly.
If the number of deaths overwhelm morgues and funeral homes, refrigerated trucks may need to be brought in to keep bodies cool until burial.
However, Etches doesn?t think this will be needed, because even if the casualty rate is high, ?flu deaths would be slow.?
Even with the best intentions and the best planning, a pandemic raging through the city would undoubtedly stress, if not overwhelm, already fragile health-care sectors.
?Emergencies are emergencies because they overwhelm us,? Etches says. ?The planning won?t stop the pandemic from coming but it will decrease the impact on the community.?
She hopes education and communication help prevent the major social and economic upheaval seen in the wake of SARS. The lessons learned from SARS have helped everyone prepare better for the next health-related disaster.
?We need to empower people, not create fear,? Etches says.
While the true test of any pandemic planning by government and city officials won?t happen until the community is in the middle of a crisis, Amyotte?s not worried.
?I feel very comfortable with where the city of Sudbury sits in their planning. We?ve got good networking established and the decision makers are
working well together.?
