My First Swine Flu Patient
I saw a patient from flight NZ1 at 4pm today. She was complaining of mild sore throat and runny nose which she thought initially was due to the aircraft air conditioning. She heard the news about the swine flu and so rang Healthline who, like the clueless people they usually are, immediately sent them to a doctor. A doctor with plenty of people in his waiting room that were just excited to be unnecessarily exposed to swine flu. Not to mention admin staff, nurses and the lucky doctor, me.
As I am not working in public hospitals at the moment, I did not have access to the much vaunted “plan” that DHBs are supposed to have. The MoH have released some blurb that says I should discuss the case with the clinical virologist at Auckland Hospital, a harrassed-sounding woman who seemed quite upset about being phoned, and directed me to public health. Public health was very helpful and instructed us to send the patient home immediately. They were going to send someone to the patient’s home; a far more sensible arrangement.
I seems to me that there is a distinct lack of co-ordination at all levels of the health service on this matter. I am particularly appalled that Health Line – whose number is given out routinely by the Herald for those seeking advice on swine flu – tell patients to leave the house, travel to a busy A&E, A&M or GP and cough their viruses all over the waiting room. That would have to rank as one of the most spectacularly bad pieces of advice I have ever heard.
I also note that, by 4 o’clock this afternoon, the public health department had not even rung my patient, let alone visited her. So when John Key says that “New Zealand’s response to the threat of swine flu has been swift, thorough and appropriate“, he clearly meant “slow, spotty and disorganised”.
I am sure my patient will be fine. Hopefully by now some nice person from the public health department will have given her some antivirals, although one Christchurch man had not been contacted by the health department, despite going to an A&M clinic today. At any rate, that noted medical expert, Bill Ralston has told us that this is not Ebola, which I am sure will be comforting to the relatives of the 100 mexicans who have died so far.
Anyway, in the interests of public health MacDoctor provides you with the 0800 number that the nice public health person gave to me (at 20:45 tonight) for people who are concerned that they may have contracted or been in close contact with swine flu.
0800 358 5463
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Apr 28 09 1:33 am
LOL – sorry it is not funny – but how typical!
So I take it you won’t be at next week’s blogger drinks due to being in quarantine?
Apr 28 09 1:41 am
No, I’ll be fine because, as soon as I learnt that she was a potential Swine Flu, I didn’t approach her. My triage nurse will probably need prophylaxis though. And possibly the patients in the waiting room. Assuming anyone bothers to check contacts.
Apr 28 09 9:57 am
Well done MacDoc – an excellent post. Scary and worrying, but very informative.
Apr 28 09 2:18 pm
Did your patient have swine flu?
Won’t know for 3-4 days. I suspect not.
Apr 29 09 9:34 am
My experience of Healthline is that they grossly over react to trivial matters. What is your impression of their advice?
How seriously do you take the possibility of swine flu becoming a pandemic?
If that does happen I assume that the government will be utterly useless and it’ll be every man for himself.
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Apr 29 09 10:40 am
KP: Healthline is highly risk averse. They have been instructed to assume the worst case scenario for all presentation – meaning you are highly likely to be referred on to an urgent or emergency service even for an ostensibly trivial matter. Their chief function is not actually to help you per se but to keep you out of crowded big-city emergency departments.
I think it is likely that Swine Flu will go pandemic. I also think that it is likely to be less deadly than our first impressions but still quite nasty.
If you are relying on government and/or the health service, you are likely to be disappointed. Health services usually barely cope with the normal winter problems and governments the world over have a very poor track record with any epidemic. Witness the meningococcal epidemic where the government response was to immunise every child with an untested vaccine after the epidemic was over…
Apr 29 09 3:19 pm
I’ve been puzzled as to why Mexico is so much worse than elsewhere, but your update #5 has a plausible explanation, i.e. a good number of known cases have been fatal but the mortality rate over all cases may well be not too bad. I understand that a lot happens in rural Mexico that the state knows nothing about.
Do you think that this might be a pandemic of a worse-than-average virus rather than a rerun of 1918? People aren’t dying in a day as they were in 1918.
Do you think that those of marginal and poor health should get some Tamiflu just in case?
I was reading about plague some years ago and it talked about the significance of the speed of travel possible at the time of an epidemic, i.e. the more people that a person can come in contact with during the infectious phase then the faster the epidemic will spread.
I see that USA today erroneously says that NZ has 11 “confirmed cases”. You can’t trust the WHO, governments, or the media (who feed off the former), so we’re pretty much in the dark. Hopefully you have a torch of the Common Sense brand.
http://www.usatoday.com/news/health/2009-04-27-swine-flu-mexico_N.htm
I know someone who called Healthline about a migraine and was told to call an ambulance because they had tingling down one side. This person went to bed instead and didn’t suffer a CVA or anything else apart from the migraine.
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