Chief medical officer defends national response to swine flu

Australia’s Chief Medical Officer, Professor Jim Bishop, has described the national response to combating H1N1 Influenza (Human Swine Flu) as appropriate, proportionate and successful, following criticisms by a Victorian General Practitioner (GP) in the latest on-line edition of the Medical Journal of Australia (MJA).

Professor Bishop said he was sorry the author of the paper felt that GPs were unprepared or ill equipped to cope with H1N1 Influenza because many GP divisions have put considerable time and effort into their own pandemic planning and he would give much more credit to the medical profession for their awareness and appropriate actions in dealing with the infection.

“I personally have had continual contact with doctors and medical associations since the outbreak began,” Professor Bishop said.

“I have sent letters to GPs, held roundtables with peak GP organisations, there is a special health professionals page on the heatlh emergency website and we share information with medical associations and colleges on a regular basis.

“In addition, from very early on, state and territory health departments have been working closely with their GP organisations to ensure primary care providers are prepared and equipped to manage H1N1 Influenza in the community.

As well as these measures the Australian Government has provided $4 million to the Australian General Practice Network to work in partnership with the Royal Australian College of Practitioners (RACGP) and these organisations are involved in programs specifically tailored to GP needs and training.

“I recognise that doctors, especially GPs, are bearing the brunt of this disease with a huge influx of patients who are worried about having H1N1, and as the pandemic phases have changed, doctors have had to keep up with the new testing and antivirals policies that have changed from CONTAIN phase to PROTECT phase.

“As well, while all GPs would have had their own supplies of personal protective equipment we have responded to their need for more masks and gloves and these have been released from the National Medical Stockpile as quickly as possible for distribution to general practices through state and territory health departments,” said Professor Bishop.

“GPs have been doing a phenomenal job and to suggest they would not cope if the H1N1 Influenza infection had been more virulent ignores the professionalism we have seen from GPs and their organisations”.

Professor Bishop said that the suggestion in the MJA paper that antivirals were overused and that GPs had missed many positive H1N1 cases in the early stages of the outbreak because they were only looking at people with an overseas travel history, also undervalues the professionalism and clinical judgment of doctors.

“During the DELAY phase it was important to identify travellers as a likely source of infection, but doctors faced with a patient with influenza-like-illness would be expected to use, as always, their clinical judgment and treat and test as required.

“When border measures were put in place it was widely discussed that these were only meant to try to delay the entry of the virus into the country and that doctors would have known to look out for the infection, regardless of a patient’s travel history.

“The antiviral policy has changed in different phases of the outbreak and, on expert advice, it was agreed that in CONTAIN phase antivirals would be appropriate for treatment of in the identified cases and for the contacts of cases to reduce population spread and to dampen down the number of people who could be affected, whereas later in the course of the outbreak it is more appropriate to target those with severe disease and those most at risk of poor outcomes,” he continued.

“Extensive use of antivirals helped keep the infection contained for much longer than would otherwise be. The rationale for dampening down such spread is that the volume of cases requiring care at health services can be reduced as can be the numbers of people ultimately experiencing poor outcomes.

“Had the disease been more virulent we would have recommended different actions. Clearly the new pandemic phase PROTECT, developed with GPs and others, was proportionate and appropriate with an unprecedented level of national coordination and cooperation,” Professor Bishop said.

“There will be a lot to learn from the national response to this disease and improvements to put in place for any future exercise of this magnitude, but I am confident that health professionals in our hospitals and general practices will act appropriately and in the best interests of their patients”.