Thousands will have had flu

| 27/07/2009

(CNS): In the wake of Cayman’s first confirmed death as a result of swine flu, health officials were seeking to reassure the community today that the handling of the pandemic is in line with all WHO guidelines and that people in Cayman are at no greater risk from the virus than anyone anywhere else in the world. Medical Officer of Health Dr Kiran Kumar confirmed that, while there are 60 officially tested and documented cases of swine flu here, there are likely to have been at least 2000 cases as there is no longer a policy of testing everyone.

Dr Kumar explained that hundreds of people will have visited private GPs and others would simply have recovered at home without medical intervention. The primary concern now, health officials said, is that those who are in high risk categories ensure they get medical care and that the country continues to monitor the flu for possible mutations. Only those who are sick enough to be in hospital are tested as a matter of course, and the hospital is taking 6 random samples per week, as well, to send to CAREC for surveillance purposes.

Mark Scotland, the Minister for Health, said that while the ministry has been criticised for not doing enough, he reassured the public that staff were in daily contact with the hospital and reacting to advice as quickly as possible as the situation changed.

“We hoped that we would not see any deaths from this virus but sadly, like many countries, we know we now face the same challenges as are occurring all over the world,” he said, adding that any resources required to manage the pandemic would be given to the HSA, but people  everywhere were grappling with this flu outbreak.

The minister said the main message remained the same, that people who had flu like symptoms should stay home unless they were from a high risk group, in which case they should seek medical attention. Those include women who are pregnant, the elderly and the very young, those who are obese, people with compromised immune systems, and anyone who has an existing medical condition. Dr Kumar noted that every person who has been hospitalized for H1N1 in Cayman was in a high risk group with a pre-existing medical condition.

Dr Greg Hoeksema said that the problem for health officials now, both locally and globally, was managing the use of Tamiflu and the problems of virus mutation and resistance. The health officials could not say exactly how many people here had been treated with Tamiflu or if the virus was showing any signs of real resistance or mutation, though some tests have been sent to CAREC for that specific purpose. Dr Hoeksema did say there have been a few spontaneous mutations, which he said were different from a whole scale mutation of the virus as it spreads around the world.

With only two drugs that are proving to work on the novel H1N1 strain of flu, the concern of over-use of the Tamiflu is a very real one if the virus does mutate and become more virulent, Hoeksema stated. He said striking the balance between treating those in high risk groups (who had not yet contracted the virus but who had contact with someone who has) with Tamiflu as a preventative measure had to be weighed against the risk of resistance.

Dr Hoeksema said that here in Cayman when the virus first showed itself, the HSA officials had begun by treating the flu aggressively in all those that presented in an attempt to prevent the spread completely. He said that now, however, only patients at high risk of becoming severely ill were being treated. “We have to be judicious with who we choose to treat because of the risk of resistance, especially as we have seen some spontaneous mutating in certain parts of world,” Dr Hoeksema added, noting the difficulty was in the definition of a "high-risk" patient as some young healthy people have become very sick as well.

The message that people who contract the flu, even if they are not feeling too bad, is they should still stay home, not least because they could pass the virus to someone who would be at a higher risk of getting seriously sick if they were to catch the flu.

While no decisions have been made yet about whether schools should re-open as scheduled in September, a consideration in some countries, the health minister said the stay home message was preferable to closing things down. He asked employers to be understanding and allow parents to stay home with sick children, as well sending home anyone who came to work unwell. This, he said, applied to day care centres, summer camps, church services and other public gatherings.

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  1. Anonymous says:

    There are a number of practical steps that could be taken which do not appear to even be under consideration in Cayman. The main point of these steps which are being considered in other countries would be to separate people with H1N1 or a higher probability of having H1N1, from the rest of the population, and to limit the rate of spread by limiting the congregation ofgroups of susceptible people in small poorly ventilated and difficult to sterilise spaces. This is most important with those most vulnerable, including the young and the elderly. Hospital patients with other medical problems should not be exposed to a constant stream of people with H1N1.

    A specialist H1N1 "triage" unit in each district, away from physician’s offices and the hospitals as suggested by an earlier post is a good idea in this regard.

    Closing day care and summer camps should be considered despite the inconvenience for some parents. Parents should perhaps reconsider taking their children to the cinema or other locations at times when there are likely to be lots of people in attendance.

    The government should also be considering whether to delay the opening of schools until it is determined whether the vaccination systems that will be available in a few weeks work. If they do work they should be used. Without such precautions there is likely to be a significant increase in cases once the schools start up again.

    I am sure that the government does not any more deaths but they need to start thinking about new and admittedly inconvenient measures. Either that of the Minister will have to get used to automating his sending of condolences. 

  2. Anonymous says:

    What is being done to deal with the situation once schools reopen? Why is there not a 24/7 make shift clinc set up for people to go to when they suspect they have "a" flue, rather than coming to the general health facilities exposing other people?

  3. Anonymous says:

    About 30% of those who have died so far in the Europe did not fall within any of the high risk groups.  It appears this policy is going to leave some people at home to die.