Scenario 3

Pandemic

400 UK cases, nearly 20k internationally
Please remember that this is an exercise and while based on events in 2009 it is not happening now.

Newsnight Scotland discusses the pandemic

First pandemic of the 21st century

The UK response has moved from treatment to escalation, which means that contact tracing and closing schools can generally stop. (BBC coverage)

Within weeks there are over 1,000 confirmed cases in the UK.

By the time a pandemic (Phase 6) is declared, the majority of UK cases have so far been mild, and associated with school outbreaks, consequently most cases have been children aged under 5 or aged 5-14. However, healthcare workers are beginning to be affected.
Increasing numbers of patients are requiring critical care, however these have so far had underlying conditions associated with seasonal influenza such as chronic respiratory or heart conditions.

Antivirals
The Department of Health has released national guidance (which is also followed in Scotland) which describes the process of antiviral assessment, authorisation and collection that will be enacted if required. This is intended to reduce the pressure on primary care and ensure everyone who needs antivirals can get them as quickly as possible – there is still no vaccine.
A telephone line is set up enabling patients to gain access to anti-viral drugs without a confirmatory test.

Worsening situation
Within a few weeks, larger than normal numbers of patients with influenza are requiring an additionally high level of intensive care. This is due to the impact of the virus on their lungs which is reducing their ability to adequately oxygenate the patients’ blood.

Patients with known influenza risk conditions (such as heart or respiratory conditions) as well as those who have recently been identified as being at greater risk from this virus (e.g. the morbidly obese or pregnant women) and those with no known or recognised risk factors are requiring an extra level of care.

The specific treatment is termed ECMO (extra corporeal membrane oxygenation) and is a process whereby the patient’s blood is pumped out of the body and oxygenated using a machine, before being returned to the patient’s circulation. This is a highly skilled process and there are limited numbers of hospital beds in the UK where this treatment can be provided. The UK has a long-standing agreement with Sweden for extra capacity, and a UK patient has recently been flown there because all UK beds are currently full.

Patient confidentiality is stopping any detailed look (in the media) at whether or not the decision not to request ECMO treatment was merited or not. Medical experts have explained to the media that ECMO machines will not save everyone from swine flu and that as ECMO machines are a limited resource clinicians choose those patients that are most likely to respond to treatment. However, these messages are failing to hit home.

Links of interest:
What it was like – patient perspective and long recovery
What it was like – sudden death
What it was like – the mild asthmatic
What it was like – the pregnant woman
The doctor’s perspective

More information about pregnancy and swine flu, and
here

Questions to build into your discussion
Are you surprised that schools can stay open now when they were being closed before?
Planning figures suggested up to 50% of the population might get ill, and a large number might need Intensive Care. How will the system cope?
If pregnant women are more at risk, what effect might that have?
Imagine now that numbers just grow and grow and grow. Services start to be overwhelmed. How are prioritisation decisions made, about who gets intensive care? ECMO?
How do hospitals provide all that extra intensive care at short notice?
Can you remember what projected deaths might have been? How would your home town have coped if 1.5% of the population had died within 2 weeks?
What happens to public services if 50% of the population is ill?
What do the people coordinating these services normally do? What’s happening to those tasks?
Do the case histories in the BBC links affect you? Do you think people might be more likely to get vaccinated (or take other measures) if they read these stories?

REMEMBER TO SUMMARISE YOUR LEARNING POINTS AT THE END OF THE WEEK

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One Response to “Scenario 3”

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  1. Scenario 3 is now live | Public Health Teaching in Dundee - November 18, 2013

    […] Scenario 3 […]

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