H1n1_09-43

Jeff Green | Oct 29, 2009

By Jeff Green

When the “Swine Flu Outbreak” hit the world media back in April it started a race against time.

Would the search for a vaccine and the planning by the health-care system be in place by the time the winter flu season hit?

Last week, the vaccine and the public health messaging was hastily being put into place, just as an early wave of what we now call the H1N1 flu hit Eastern Ontario, at least 6 weeks earlier than the normal start of flu season.

“What we believe about this illness is that for the most part it acts like a moderate influenza. With reasonable treatment at home, it resolves,” said Doctor Laurel Dempsey in a telephone interview from the Verona Medical Clinic on Friday, October 23. “It generally comes on rather quickly, with a high fever and profound fatigue. Within hours people are feeling like death warmed over. It has a rate of spread that is similar to Spanish flu [which killed millions of people worldwide in 1918] but it is a much less clinically severe infection.”

The basic message being delivered from all health care providers and the KFL&A Public Health Unit is for people to stay home if they are sick.

If symptoms are more severe, causing breathing problems or chest pains, or if fever persists, medical clinics are encouraging their patients to phone rather than show up.

“We have a protocol in place when people phone the clinic,” said Gail Knowles of the Sharbot Lake Family Health Team, “which will result in a range of advice. In many cases we will advise people to stay at home and not come in, and in extreme cases we will ask them to call an ambulance or go themselves to the emergency department of the nearest hospital, but we want to send as few people as possible to the hospital.”

Some patients will be asked to come into the local clinics for further assessment, and they will be asked to use a side door and will be escorted into a particular examination room to protect the other patients and the clinic staff from the virus.

Although there has been talk about the efficacy of the antiviral drug Tamiflu if administered within a short time of the onset of symptoms, Dr. Dempsey said she has not prescribed it to patients with flu-like symptoms this fall.

“Tamiflu may shorten the course of the illness by a day or two,” said Dr. Dempsey, “but it does not necessarily alter the illness. It is unclear if it can prevent any of the severe cases from occurring.”

Although the incidence of respiratory illness is up at the clinics within the Rural Family Health Organization, only some of the cases can be attributed to the H1N1 virus, and patients are not being routinely tested for it.

As of last Friday, local schools were not reporting an increase in absenteeism due to illness.

However, by Monday, the KFL&A Public Health Unit was reporting that the rates of respiratory illness were “high” (which is the top of the scale that has been created to track the illness) throughout Eastern Ontario, and the rates for gastrointestinal illness were elevated although not yet “high”.

In this region, the Municipality of Napanee and outlying areas such as Tamworth are seeing the highest level of activity.

Vaccination Schedules  

KFL&A Public Health has already started their vaccination program, with clinics in Kingston at the Frontenac Mall on Bath Road (click to see KFL&A Public Health schedule).

In the rural areas, the members of the Rural Family Health Organization (the medical centres in Sydenham, Verona, Tamworth, Newburgh and Northbrook, as well as the Family Health Team in Sharbot Lake) will be starting clinics on Thursday, October 29  (click to see Rural Family Health schedule).

People in the most vulnerable groups and healthcare workers are encouraged to come first to the clinics, with the rest of the population being asked to wait until the second or third clinic before coming in for the shot.

Vulnerable groups include children between 6 months and 5 years old, healthcare workers, adults under 65 with underlying medical conditions such as respiratory illness, and pregnant women.

Regardless of age or medical condition, no one will be turned away from the clinics.

Among the targets for the vaccination are children under 9 years of age, who will require two shots, with a gap of as close to 21 days as possible between the shots, so families should consider going to a clinic as soon as possible.

There are no plans for a vaccination program in local schools, however, partly because nurses are in high demand and the system is already stretched by the community clinics that are hastily being set up.

The vaccine will not likely provide much protection for the wave of illness that is currently hitting Eastern Ontario, because the vaccine takes 3 or 4 weeks to reach maximum efficacy.

“The peak flu season is normally in late February,” said Doctor Dempsey, “so we are hoping that as many people as possible will take the vaccine before the end of November.”