KNOWING RESPONSES: The Case of Swine Flu. Dr Jacky Chambers Dr Andrew Rouse

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1 KNOWING RESPONSES: The Case of Swine Flu Dr Jacky Chambers Dr Andrew Rouse

2 When lives are at stake, it is better to err on the side of over reaction than under reaction

3 Basic principles for managing pandemic Isolate and provide early treatment Work with professional autonomy Educate family and communities Timely epidemiological data Small independent advisory groups Open culture - educated understanding of situation Good intelligence and informed judgement Retain pubic health perspective Assess opportunity costs

4 Expect the unexpected : it will always happen Welford School outbreak begins: 94cases 36 schools 258 affected: 2500 swabs taken: 1 st June Containment policy ends Guidance on antiviral Rx centres National phone line: ACP clinics open Schools -start of summer break 1 st case of H1N1 in West Midlands HPA algorithms X 9 Tamiflu arrives from national stockpile 1 st H1N1 Vaccines delivered to GPs HPA first cascade message 27/04/09 30/04/09 12/05/ May 09 22/05 30/06/0 9 02/ / /07/ July 09 27/10/09

7 Isolate and provide early treatment In the past epidemics of infectious diseases have been countered by mass vaccination, never before by mass chemotherapy. Detailed instructions that are modified daily on testing, prophylaxis and treatment have come from the HPA..via the internet. This strategy could not have been attempted without the internet. Dr Chris Ellis, Editorial BMJ 2009;339 :b2639

8 HoBT PCT TAMIFLU TAMIFLU Single delivery point, secure not on red route, able to receive delivery from 17.5 tonne lorry and access to internet

Andrew Rouse, Consultant in Public Health HoBtPCT Thursday, Nov 12 2009 How I lost my GPs to get bigger bonuses if they meet swine flu jab targets By Daniel Martin

25 that GPs already get per injection. The extra payments are being offered by Heart of Birmingham primary care trust, according to Pulse magazine.

10 Andrew Rouse, Consultant in Public Health HoBtPCT Thursday, Nov How I lost my GPs to get bigger bonuses if they meet swine flu jab targets By Daniel Martin Last updated at 8:15 AM on 11th November 2009 my professional integrity & Managers at a major health trust are offering extra payments on top of the 5.25 that GPs already get per injection. The extra payments are being offered by Heart of Birmingham primary care trust, according to Pulse magazine. surrendered local health autonomy. It is not known whether the bonuses, which would be worth thousands of pounds per practice, are available elsewhere in the country. From Welford Road to the DOH

11 My view is that.. SUMMATION: The profession surrendered What should I have done? Did I do right? If so, Why have local Specialists? 3-4 years when it allowed without discussion Tamiflu to become the basis of H1N1 planning.

12 Basic principles for managing pandemic Isolate and provide early treatment Work with professional autonomy Educate family and communities Timely epidemiological data Small independent advisory groups Open culture - educated understanding of situation Intelligence/communication channels up and laterally Retain pubic health perspective Assess opportunity costs

14 18/05/ /05/ /05/ /06/ /06/ /06/ /06/ /07/ /07/ /07/ /07/ /08/ /08/ /08/ /08/ /08/ /09/ /09/2009 No of consultations per 100,000 GP Consultations Per 100,000 Population in HoB HoB Consultation Rate Normal Seasonal Activity Above Average Epidemic Activity Week Number

15 Basic principles for managing pandemic Isolate and provide early treatment Work with professional autonomy Educate family and communities Timely epidemiological data Small independent advisory groups Open culture - educated understanding of situation Intelligence/communication channels up and laterally Retain pubic health perspective Assess opportunity costs

17 Basic principles for managing pandemic Isolate and provide early treatment Work with professional autonomy Educate family and communities Timely epidemiological data Small independent advisory groups Open culture - educated understanding of situation Good intelligence and informed judgement Retain pubic health perspective Assess opportunity costs

18 Intelligence not information overload

19 Basic principles for managing pandemic Isolate and provide early treatment Work with professional autonomy Educate family and communities Timely epidemiological data Small independent advisory groups Open culture - educated understanding of situation Good intelligence and informed judgement Retain pubic health perspective Assess opportunity costs

21 Rates of consultations for flu like illness

22 EMERGING THEMES Risk assessment is key - real data, not modelling Risk management separate, devolved, timely Public health policy NOT biosecurity evidence based, transparent, lead time Command and control complex system,leadership National emergency?whistleblower Intelligence 2 way channels up and across Political courage policy change and PR 000

23 The battle of swine flu Battles are sometimes won by generals, wars are nearly always won by sergeants and privates P E Alcock In critical and baffling situations it is always best to return to first principles and simple action Sir Winston Churchill

Dosage of oseltamivir in children under 6 months of age in the swine flu pandemic

Gateway ref: 13032 20 November 2009 CAS ref: CEM/CMO/2009/32 Richmond House 79 Whitehall London SE1A 2NS Dear Colleague Dosage of oseltamivir in children under 6 months of age in the swine flu pandemic