Right now our little town is in the grip of the swine flue pandemic. Its officially an epidemic. The reported rate of influenza presentations in the last two weeks in the 6 practices has sky-rocketed, being about 5 times the normal seasonal rate of influenza presentation. (Its winter here)
There are many lessons that we have already learnt, with clearly significant success from the “stay at home” message for at least in our practice we are only seeing the reasonably sick patients and alas those who can't read or hear the public health messages. We haven't been overrun with patients yet....Clearly good practice and public health organisation has allowed the development of systems to cope with the high number of sick fortunately only about 1% of whom require intervention. A great practice for a more virulent epidemic.
Talking with other medical centres, it seems that good practice management is key to handling the problem, particularly focusing on barrier hygiene and isolation techniques. You have to combine this with skilled reception staff and excellent phone nurse triage but it works.
Funny thing is that a little over a couple of months ago the idea of barrier techniques was being laughed at by most docs including the author. That was until my practice manager and I visited a couple of practices in Toronto where the SARS epidemic had such an impact on primary care. To see practices where curtains were not used for patient privacy was a little surprising until our good host from McMaster Uni pointed out the reservoir of viruses and bacteria that such niceties provided.
This evening, at a public health meeting for all primary care, the hygiene strategy was emphasised. However the idea that we should removed curtains was laughed down as being “over the top” although I note that we were discouraged from having seats with “furry” seat covers. Now I admit that there is a significant difference between seat cover material and curtains, but I have a faint suspicion that we will come to change our views on this. History does not repeat itself, just that doctors make the same old mistakes.
Another interesting observation from the epidemic to date has been the fact that the “hard to reach” have become the most likely to suffer. The non European population, especially itinerant workers here to prune the 1000s of hectares of grapes in the valleys suffer more because of both language and also cultural problems. The former issue is blindingly obvious, but some of the social behaviour, especially “sickness behaviour” such as whole families visiting when someone becomes sick, clearly facilitates infection spread. Interestingly one important cultural group has already altered the practice of kissing greeting at meetings in response to the epidemic.
There must be other models of this type of social change out there.
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