Swine Flu Update 4

Tony Ryall has confirmed tonight that Swine Flu is in New Zealand. Three of the 10 Students from Rangitoto college have tested positive for the virus. 

“Mr Ryall said the initial response had been rapid, thorough and appropriate for the level of risk at the time.

“* On Saturday morning, flight NZ1 arrived in Auckland from Los Angeles at 5am. On board were the Rangitoto College group which had visited Mexico.

“* Their teacher insisted those with flu symptoms contact their doctor and at 12.30pm one of the doctors contacted Auckland Regional Public Health Service.

“* The Auckland public health response centre was activated by 3pm and by 6pm a team of nurses was assessing the Rangitoto group. All were treated with Tamiflu and isolated with their families by 10pm.

“* On Sunday night testing revealed the Rangitoto 10 had influenza A. Ministry officials decided they should be treated as probably cases of swine flu.

“Mr Ryall said nearly all the passengers on NZ1 had been traced, assessed and offered Tamiflu as a precaution.”

Did you notice the weasel-words? “appropriate for the level of risk at the time“. Not quite. The US confirmed its first cases of Swine Flu on the 21st April, four days before NZ1 landed. They upgraded that to 9 confirmed cases the day before. WHO declared this a public health emergency on the day that NZ1 arrived. Yet the public health response was fixated only on ten of the passengers on a 400-seat aircraft. All ten of the students were clearly infected with some form of respiratory infection very likely to be Swine Flu. Did the public health department not think it was worth immediately tracing the other passengers.

As I blogged yesterday, I saw a patient with respiratory symptoms at 4pm who had yet to be contacted nearly 60 hours after the arrival of NZ1. 

While the speed of reaction over the Rangitoto students was commendable, there seemed to be a very blinkered response to the rest of the passengers. Surely it should have been quite obvious, given the extent of the problem in Mexico, that many others on the flight would also actually be infected, rather than simply exposed to the students?

The mixed response of our public health department may now be a moot point. WHO has declared that containment of the virus is no longer possible. The Deputy Chief of the WHO, Keiji Fukuda, stresses that “a pandemic should not be considered inevitable”, but gives no clear indication of how the problem might be tackled except by vaccination.

“The first batches of a swine flu vaccine could be ready in four to six months’ time but it will take several more months to produce large quantities of it, Mr Fukuda said.”

Splendid. The vaccine should be available just in time for the end of the pandemic, judging by the speed of spread. The number of new cases is already dropping in Mexico and the first cases were reported in mid-march, so this sounds like the standard 3 month peak of a flu virus. Without border restrictions, I can’t see this bug taking more than a couple of months to get around the world.

Oh, and those of you who are astute will realise that the US and the UK are moving out of flu season, reducing the potential spread of the disease. New Zealand is moving in to flu season, making spread more likely.

Additional:

Interesting speculation in USA Today as to why the outbreak seems to be hitting Mexico so much harder than other nations. One official speculates that there may be many thousands of Mexicans with much milder symptoms who have not presented to doctors or health officials (i.e, the death rate is actually much lower than 6%, although it is probably higher than the standard 0.2-0.5%).

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