Flu Pandemic & How Should Pharmacists Respond? |
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Going back in time, the most severe flu pandemic in our history was the Spanish flu pandemic (H1N1) in 1918 which infected about 500 million people and killed between 50 – 100 million; the Hong Kong flu (H3N2) in 1968 which claimed 1 million lives. In 1997, bird flu virus (H5N1) killed it’s first human victim in Hong Kong. From then on, the world has been making serious preparation to deal with another possible global flu pandemic.
Influenza A viruses are all RNA viruses from the orthomyxoviridae family. They are differentiated by the surface antigens, viz. hemagglutinin (H) and neuraminidase (N). Up till now, the most common antigenic variants of influenza A viruses are H1N1 and H3N2 subtypes. But the H5N1 variant proved to be a potentially dreadful one based on its past record. Of the 421 confirmed human cases infected in 14 countries, 257 succumbed to the bird flu in the process, ie. 61% fatality, making it one of the most lethal flu viruses known to mankind based on WHO confirmed cases between 2003 to Apr 2009. By contrast, SARS which devastated the world killed only 9.6% of its victims between Nov 2002 and Jul 2003, shattering the lives of 8,437 victims and killed 813 across 32 counties [http://www.who.int/csr/en/].
The biggest news in the past 2 weeks that gripped the nerves of the world was the rapid spread of a subtype of influenza A called swine flu. This time, the culprit was the subtype of H1N1 virus. As of 30 April 2009, there were 99 confirmed cases of swine flu in Mexico (with 8 deaths), 91 in the US (with 1 death), 19 in Canada, 10 in Spain, 5 in UK, 3 in Germany, 3 in New Zealand, 2 in Israel, 2 in Costa Rica, 1 in Austria, 1 in Switzerland and 1 in Peru. There has not been any reported case in Singapore, but given Singapore’s location as the cosmopolitan regional air hub, it’s plausible to expect some cases to emerge with time if the spread of the disease does not abate anytime soon. The world in 21st century has learned a lot from the SARS lesson and the ubiquity of air travel added a challenging dimension to the spread and transmission of diseases across the globe. Since it’s unlikely to use border control as a strategy to curtail any form of disease transmission due to trade and other business activities; the real challenge is to implement some effective international Alert and Response system. To this end, WHO has been playing a pivotal role in the fight against such international outbreaks of diseases and epidemics. At national level, healthcare infrastructure must be on full alert and emergency response strategies be activated and phased in to commensurate with the response needed. This sounds easy, but we all know that healthcare resources are finite and they can easily be overwhelmed in any major crisis. As such, every available resource is vital to ensure that they are deployed in a coordinated manner to cope with a potential flu pandemic like one that we now face.
As pharmacists, we have been playing a vital support role to ensure supplies and distribution of essential health products reach the necessary sites of demand, including the hotspots or “war zones” in hospitals, retail pharmacies, schools, offices, communities and homes. As most essentials health products in Singapore are imported, practically all such items need to be ordered urgently in times like this. Unless we have had prior stockpile, which is highly unlikely during peaceful time due to the financial implications of inventory holding, most overseas suppliers may not cope with surge in demands and even ration deliveries to Singapore. That said, a different kind of strategy and management concept are needed. People will rush to buy PPE, disinfectants, vitamin C even prescription drugs for flu & vaccines. Pharmacies and pharmacists are in the middle of such fix. There is a balance between meeting professional responsibilities vs. fulfilling commercial duties; but the most important thing is to ensure that the public is properly informed and accurately educated about the situation. To this end, pharmacies and pharmacists can really fill in as the role of public health experts to educate and impart knowledge to public about personal hygiene; social responsibility & etiquette; proper use of PPE, disinfectants, supplements, drugs, health promotion; temperature monitoring etc. PSS has produced a number of guidance and leaflets during the 2003 SARS and these have been uploaded to our website. Since this H1N1 response strategies may differ somewhat compared to SARS, we are now working on a number of communiqué to update and better guide our colleagues and customers alike in the preparedness plan. We would like to encourage members who have experience and interest in this area to contact us to work on this initiative.
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