1. Dealing with the Swine Flu Alert in Australian General Practice Dr Chris Hogan Provost Victoria Faculty RACGP Member Pandemic Preparedness Planning C’te Royal Australian College of GPs Chair Central Highlands GP Network www.racgp.org.au

2. The Disaster Plan Adage “A good disaster plan is written in pencil so that it may be adapted to rapidly changing circumstances. What informs those penciled words is written in blood, sweat & tears”

3. What is an influenza pandemic ? An influenza pandemic ONLY means the virus is spread easily between humans, and affects a wide geographic area. The virus may cause –mild, –moderate –or severe disease

4. The Public Health Dilemma Yes it’s a difficult knife-edge to be on in public health f..ed* if you do f...ed* if you don't. By the time you know for sure, well it’s too late; so you gamble for safety and if you are wrong it costs lives This pithy quote is from a NSW GP *f…ed= ?failed, not a word administrators like to use

5. We do not have the luxury of certainty We must be neither alarmist nor complacent Until we have more experience with the pandemic strain we can only make informed guesses as to its clinical behaviour GPs are used to uncertainty

6. Preparing for a Pandemic For centuries, on an almost regular basis, the world has experienced pandemics. These widespread outbreaks of contagion cause considerable infection, morbidity, mortality & disruption. Influenza has been a major cause of such outbreaks.

7. What do GPs Need to know? A.Prevention Phase A.How to handle the worried well who present demanding services & information B.How to identify patient zero B.Containment Phase A.How to identify & quarantine & treat cases who are identified C. Mitigation A.How to deal with mass causalities

8. What do GPs Need to know? How to pencil in a response before we have access to definitive supplies The worried well have exhausted current commercial access to masks, NMIs anti-influenza drugs & even hand washes are scarce

9. RACGP Role in Pandemic RACGP’s responsibility is to provide resources and support to maintain standards of quality care, education and training as they apply to influenza pandemic Provide easily accessible evidenced based support and resources to ensure standards Many other organisations will be responsible at the local level for implementing such plans, such as Divisions All players aim to deliver consistent messages

10. Provide information Provide general education to all & specific information to those who need it. We need to spend a lot of time on the justification for & techniques of quarantine & basic hygiene. Use website www.racgp.org.au

11. Communication strategy Communicating with general practitioners/general practice –The aim of an external communication strategy is to quickly update general practice about changing epidemic status. –The external communication strategy aims to: have a wide coverage needs to be responsive needs to be consistent with messages at all levels of general practice, and consistent with messages from other stakeholder organisations –In reality, communications will come from a wide variety of organisations through a wide variety of media” letters, email, fax and websites. Hence, the importance of a consistent, co-ordinated messages and standards

12. Communication strategy Regardless of the level of the epidemic, the communications strategy remains essentially the same No system of communication with GPs is perfect; the College is in contact with General practitioners active in clinical practice RACGP has a system for disease alerts; Current reach is about 13,000 weekly which will increase to about 20,000 Current state of email/Fax to general practitioners The role of SMS and voicemail alerts is still under investigation

13. The RACGP website www.racgp.org.au acts as one reference point where general practitioners can access tailored information for general practice, access resources for quality clinical care Assists general practitioners seeking advice on standards of clinical care.

14. Potential resources include: Disease alert/breaking news Educational programmes for upskilling; currently developing educational needs assessments of General practitioners and practice staff Educational resources addressing attitudes of fear of infection and epidemic Surveillance Access to downloadable posters, patient information clinic resources etc Links to appropriate organisations e.g. govt, divisions, AMA etc.

15. Provide information Website- handouts, overviews & FAQs Regular mass faxes to those registered with our organisation Public meetings for GPs Phone calls- logging of all calls Targeted communication with other organisations

16. Reinforce Co-operation Without the active support of the community our efforts will be futile Australia has done this before We must do it again.

17. Use Communication networks Utilise national & state communication networks for the health system We are VERY happy to communicate what we are discovering from our members

18. Aid Vaccine Development Case identification Detect & report new cases as early as possible to state PHUs Aid the collection of seed virus to develop an effective vaccine

19. Play for Time Institute an effective quarantine, aided by basic hygiene, PPEs & targeted use of antivirals to delay the spread of the virus long enough to allow time for the production, dissemination & administration of vaccine. Quarantine worked in Australia in 1918

20. How will general practice cope? Take Home Messages Basic measures of hygiene are very effective Read Federal,State & Municipal Plans Decide how general practice needs to respond if the situation escalates Absenteeism will be a major challenge There had been a considerable loss of corporate knowledge in disaster planning but Y2K, SARS & the bushfires have had a positive effect.

21. How will general practice cope? Take Home Messages We will do what we do best We will do what we can with the resources available Disasters bring out the best & worst in people. In Australia we tend to pull together for the common good.

22. The 1957 Flu Pandemic If there are any who doubt that GPs would be central to a pandemic response, here are some recollections from Dr John North, a GP who lived and worked in Thomastown through the 1957 Influenza Pandemic. More than a million died world wide from Asian Flu A H2N2-1957

23. “It was the last weekend in July and the Sunday started to get quite busy. “The patient improved slightly with oxygen and they then took her to a hospital. She died. An autopsy showed a fulminating staph pneumonia. I did not have time to get upset, as I attended in excess of 100 patients that day, some 60 at their homes.” The 1957 Flu Pandemic

24. “The place was in darkness, cold and smelly. I made for the bedroom and found Mum and Dad feverish, vomiting, decidedly unwell and unable to get up. After checking them I looked at their 3 children who were much the same. I cleaned things up, found water and ice cubes gave them some aspirin. I could see medicines would not stay down nor was there anybody to fetch same, so I hurried off to the next victim. They survived” The 1957 Flu Pandemic

25. “We had a fever hospital then, but they couldn’t take any more patients. Their corridors were full. The ambulances wouldn’t come and so we had to cope on our own.” “We two GPs saw approximately 2000 patients with flu related illnesses during the epidemic. I have never experienced anything like it. It went through like a bushfire and spared few.” The 1957 Flu Pandemic

26. The Influenza Virus

27. We do not envy your tasks - I am relieved I retired from disaster response when I did. All I can do now is to offer you our full support & cooperation I hope this is just another rehearsal Thank You