http://www.digitaljournal.com/article/274827
What is the best way to limit the upcoming H1N1 pandemic?
By Michael Cosgrove.
Published 29 min ago by ■ Michael Cosgrove
That is the question being asked by French authorities charged with the preparations for a pandemic, expected to occur in the Autumn. Between public fears and practical considerations, something will have to give according to analysts.
Anything between 25 and 50 percent of the French population could be hit by H1N1 in Autumn, according to French medical experts and analysts. “The most plausible hypothesis is the arrival of a second wave of infections in the Autumn, with quite a high number of cases due to the highly contagious nature of this H1N1 strain” asserts Professor Patrick Berche, Head of the Microbiology Service at Paris’s prestigious Necker Hospital.
In a press conference reported by Le Figaro he goes on to say “In that event, the epidemic would be difficult to contain for 8 to 10 weeks during which time it will probably be necessary to envisage measures of collective isolation.”
Most opinion here agrees that although anything could happen, from the near-extinction of the virus to a continuing mutation of the virus leading to a more serious world pandemic, the most probable scenario remains that of an outbreak around September.
More than 200 cases have so far been diagnosed in France. Even though the current virus has proved to be less dangerous than predicted on a worldwide level, with two or three deaths for every thousand cases, (against one death for every thousand annual ‘flu infections) certain characteristics of H1N1 are worrying.
The potential for mass infections is real because this is a relatively new virus against which the population at large has little or no immunitary protection.
Moreover, even if the mortality rate is low, applied to the French population as a whole that could mean a substantial number of deaths. The population of France is 60 million. If 20 million people – a third of the population – were infected, the number of victims would be around 40 thousand, according to current mortality rates.
The other side of the debate is centred upon practical issues.
Should schools be closed as soon as a case of H1N1 is confirmed? Should people telephone the hospital or go there if they suspect they have caught the virus? Should those diagnosed as being infected all be hospitalised?
French doctors have not yet seemed to have clear answers to these questions. And nor have local health authorities.
Up until today the possibility of a pandemic had not elicited a clear response strategy.
That strategy is beginning to be outlined in a communiqué sent from the DGS, the Direction Générale de Santé – the French national health authority – to the hundreds of chiefs of the various local health authorities in France.
The DGS stipulates that from now on no-one displaying signs of H1N1 infection should automatically be hospitalised unless they are considered to be showing signs of being seriously ill. This decision is being justified on the grounds that admitting all those infected would swamp hospital resources, and that not all infected individuals would necessarily want to be hospitalised. Those displaying signs of serious illness would be accepted for testing initially.
The measures also include the demand that other health-related premises, such as ambulance stations, install consultation services that would examine possible patients for signs of infection, including nasopharyngital testing if deemed necessary, and the handing out of antiviral treatment, surgical masks and hygiene measure recommendations, before sending people back home.
The idea here is to separate the reception of those suspected of being ill into many different groups in order to reduce the risk of mass infections that the recommendations say would be inevitable if everyone went to the hospitals.
At the Necker Hospital, for example, suspect cases were still being treated in areas in which people ill with altogether different pathologies were present. The new measures are designed to limit those situations.
Antoine Flahault, an Epidemiologist and Influenza specialist, recommends that “Treatment should be more oriented towards general practitioners and and analysis laboratories as is done in the United States, a country which has many more cases than France.” In his opinion “General Practitioners do not consider themselves to be well enough prepared, whereas they should be the key to the answer during htis epidemic.”
In Professor Berche’s opinion, measures should go even further. “The patient should be able to stay at home, including for testing, which should be done by paramedical staff. But that won’t be possible unless General Practitioners know exactly which isolation strategies to put in place in order to train house visitors to be able to avoid the whole family being contaminated.”
It will be interesting to see the reaction of General Practitioners who, up until now, have insisted that hospitals should deal with those infected.
More measures are expected to be announced shortly.
What is the best way to limit the upcoming H1N1 pandemic?
By Michael Cosgrove.
Published 29 min ago by ■ Michael Cosgrove
That is the question being asked by French authorities charged with the preparations for a pandemic, expected to occur in the Autumn. Between public fears and practical considerations, something will have to give according to analysts.
Anything between 25 and 50 percent of the French population could be hit by H1N1 in Autumn, according to French medical experts and analysts. “The most plausible hypothesis is the arrival of a second wave of infections in the Autumn, with quite a high number of cases due to the highly contagious nature of this H1N1 strain” asserts Professor Patrick Berche, Head of the Microbiology Service at Paris’s prestigious Necker Hospital.
In a press conference reported by Le Figaro he goes on to say “In that event, the epidemic would be difficult to contain for 8 to 10 weeks during which time it will probably be necessary to envisage measures of collective isolation.”
Most opinion here agrees that although anything could happen, from the near-extinction of the virus to a continuing mutation of the virus leading to a more serious world pandemic, the most probable scenario remains that of an outbreak around September.
More than 200 cases have so far been diagnosed in France. Even though the current virus has proved to be less dangerous than predicted on a worldwide level, with two or three deaths for every thousand cases, (against one death for every thousand annual ‘flu infections) certain characteristics of H1N1 are worrying.
The potential for mass infections is real because this is a relatively new virus against which the population at large has little or no immunitary protection.
Moreover, even if the mortality rate is low, applied to the French population as a whole that could mean a substantial number of deaths. The population of France is 60 million. If 20 million people – a third of the population – were infected, the number of victims would be around 40 thousand, according to current mortality rates.
The other side of the debate is centred upon practical issues.
Should schools be closed as soon as a case of H1N1 is confirmed? Should people telephone the hospital or go there if they suspect they have caught the virus? Should those diagnosed as being infected all be hospitalised?
French doctors have not yet seemed to have clear answers to these questions. And nor have local health authorities.
Up until today the possibility of a pandemic had not elicited a clear response strategy.
That strategy is beginning to be outlined in a communiqué sent from the DGS, the Direction Générale de Santé – the French national health authority – to the hundreds of chiefs of the various local health authorities in France.
The DGS stipulates that from now on no-one displaying signs of H1N1 infection should automatically be hospitalised unless they are considered to be showing signs of being seriously ill. This decision is being justified on the grounds that admitting all those infected would swamp hospital resources, and that not all infected individuals would necessarily want to be hospitalised. Those displaying signs of serious illness would be accepted for testing initially.
The measures also include the demand that other health-related premises, such as ambulance stations, install consultation services that would examine possible patients for signs of infection, including nasopharyngital testing if deemed necessary, and the handing out of antiviral treatment, surgical masks and hygiene measure recommendations, before sending people back home.
The idea here is to separate the reception of those suspected of being ill into many different groups in order to reduce the risk of mass infections that the recommendations say would be inevitable if everyone went to the hospitals.
At the Necker Hospital, for example, suspect cases were still being treated in areas in which people ill with altogether different pathologies were present. The new measures are designed to limit those situations.
Antoine Flahault, an Epidemiologist and Influenza specialist, recommends that “Treatment should be more oriented towards general practitioners and and analysis laboratories as is done in the United States, a country which has many more cases than France.” In his opinion “General Practitioners do not consider themselves to be well enough prepared, whereas they should be the key to the answer during htis epidemic.”
In Professor Berche’s opinion, measures should go even further. “The patient should be able to stay at home, including for testing, which should be done by paramedical staff. But that won’t be possible unless General Practitioners know exactly which isolation strategies to put in place in order to train house visitors to be able to avoid the whole family being contaminated.”
It will be interesting to see the reaction of General Practitioners who, up until now, have insisted that hospitals should deal with those infected.
More measures are expected to be announced shortly.