As widely predicted, swine flu appears to be plateauing and slipping from the headlines – for a while at any rate, helped largely by the school holidays. Time for some well-earned R&R all round.
What have we learned so far? What lessons to help us face a possible second, more virulent wave in the autumn?
I think perhaps the main lesson is that despite about five years of preparation, scenario planning and multi-agency live exercises, we didn’t expect the unexpected.
Whilst flu experts were anxiously monitoring poultry farmers in south east Asia and bird migration patterns across the globe, the pandemic surprised everybody by popping up in Mexico, from pigs.
For reasons still unclear the UK rapidly became the most affected country outside the Americas, with outbreaks centring largely on schools, fuelled by the number of young people returning from trips to America.
When WHO raised the level to 6, despite repeated reassurances that for most people the resulting illness is mild and recovery fairly rapid, a few high-profile deaths and a news-hungry press combined to whip up a huge surge of demand for diagnosis and antivirals that threatened to overwhelm the system. Primary care was swamped and the national flu line was not yet ready to take the load. It became more a pandemic of worried well than swine flu.
Then, with the policy of giving antivirals to anyone whether they were in a priority group or not, we had concerns about wasting them on people who didn’t need them or wouldn’t benefit from them, and worries about developing resistence or unnecessarily risking side-effects.
This gave the press another opportunity, this time highlighting the ‘confusion’ over the official advice for pregnant women – actually caused more by statements from various professional bodies rather than the Department of Health. Nonetheless, the government got the blame.
And most recently the focus has shifted to whether the vaccine will be deployed in time and whether there are enough intensive care beds and ventilators to see us through a potential double whammy of swine flu plus seasonal flu this coming winter.
So, as we enter a strange lull, there’s lots to reflect on and learn, not just about managing the pandemic, but perhaps mostly about managing public expectations and the media. Thank goodness the virus was relatively mild.
And another lesson, for those who decide these things. Local public health teams and health protection units have been at the forefront of the fight against the pandemic and have thoroughly proved their worth. All the more reason therefore to beef up the public health workforce nationally, increase its capacity and capability, and develop its leadership.
As with the Stanley Royd salmonella outbreak 25 years ago which ushered in a new era for public health, it’s an ill wind that blows nobody any good.
Better Health For All 
Hi!
I really enjoyed the article but I am not sure if the main lesson was that “we didn’t expect the unexpected.” I think there is a strange case for that maybe expecting the wrong thing? As after all, the main bulk of post 2006 pandemic planning has been mainly geared towards a new, novel and virulent virus. It was meant to spread quickly around the world causing death and creating chaos in its wake, leaving few staff and disrupted services.
So then when the first H1N1 cases were announced everyone put in place for what had been planned for, except it didn’t fit.
Maybe it is the planning logic is wrong as at the minute plans policy and designed to respond to the worst-case scenario. The theory being that then they can respond to anything. But is this right, and is the worst case the best to plan for? Arguably the worst case is the easiest to identify (especially for the doom watchers!) but it being the main assumption could/does lead to problem when trying to scale it down.
I think its safe to say that it’s what falls between nothing new and all out chaos, that trips planners up. Especially the smaller slow burning emergencies that are ambiguous and harder to reconise. They seem to present problems and uncertainty like: what’s the necessary level of response or how, when and even whether to even implement a response.
Not that I know any of the answers but current practice does seem to add an extra layer of uncertainty to an already highly uncertain situation. I also will point out that I could be completely wrong as I am still only a student doom watcher.
I also have a question for you – can people in Emergency Management get on the training for Public Health? I have been looking into it and Public Health Protection and found out it covers an area that interests me. Would three years as a health emergency planner give me eligibility to apply for the five year training course?
Sorry to ask here you don’t seem to have a contact email I can see.
Thank you.
Thanks for your thoughts Chelle. I think you’re absolutely right – the government did plan for the worst-case scenario and found itself locked into a full-scale response even though the illness, for most people, was comparatively mild. No doubt the planners are now working on a more sophisticated algorithm that allows for different levels of threat, need and demand.
Still, the second wave is now building up, and who knows how hard it will hit over the winter?
Regarding your question about public health training…
As an emergency manager, you (and anyone working in a field related to public health) are welcome to apply for accredited training providing you fulfill the entry criteria. Details here:
http://www.publichealthconferences.org.uk/careers/apply.php
Regards
Alan