Peter Curson: We're not ready for the flu

It is the season of influenza pandemic plans. Every country worth its salt has now produced one. Now it's New Zealand's turn.

Importantly, the New Zealand Plan is seen as a working document which will continue to be updated over the next few months - presumably as the threat of a possible pandemic edges closer.

So, how does the plan rate? Should we all feel comfortable and secure? Is there anything new in it?

For a start, it models the potential scale of a pandemic in New Zealand based on the 1918-19 pandemic experience, when New Zealand experienced much higher mortality and morbidity rates than many developed countries.

Such an exercise presumes that 40 per cent of all New Zealanders would catch flu and about 33,000 would die from it. Probably, these figures are much too high, but at least it alerts the community to the possible effects of such a disaster.

For the rest, the plan largely follows the WHO model with the delineation of a set of pandemic stages, each with an appropriate set of official reactions.

One important variation, also part of the recently released New South Wales Plan, is the recognition of the critical links between animal disease and human disease and the need to increase surveillance of animal infections.

The plan also follows the established pattern of suggesting increased surveillance, the use of anti-virals and a possible vaccine, closure of public institutions, increased border controls and possible quarantine of arriving passengers.

So what's missing from the plan?

Well, in the first instance, while it recognises the crucial importance of infectious disease surveillance as a first line of defence, it says nothing about the need to consider a better surveillance system than what currently exists.

In New Zealand, influenza surveillance relies on 90 GP Sentinel Practices plus hospitals and laboratories, and animal infections are surveyed independently from human infections. Surely we need a better defence.

What about a national infectious disease surveillance system that connects all the country's GPs, vets and laboratories via a protected computer link that can provide immediate real-time data on animal and human infections?

Second, while the plan talks about communicating with the public and providing accurate information so as to facilitate home care, there is absolutely no mention of how the psychological distress and fear that a pandemic would undoubtedly engender might be addressed or managed.

Are these things not important? Previous epidemics in New Zealand stand testimony to the extraordinary scenes of human emotion, fear and hysteria accompanying the passage of infectious disease.

Third, there is only a passing comment in the plan about how a pandemic might impact on the economy and the business sector.

Businesses would be confronted with 30 per cent absenteeism, people would avoid shops, restaurants, hotels, places of recreation and public transport. Movement around New Zealand and overseas would grind to a halt and consumer confidence would plummet.

Are these not serious issues worthy of comment?

Fourth, the New Zealand plan places much emphasis on anti-virals and a possible vaccine, but says nothing about how such drugs might be delivered to everyone in New Zealand.

The logistical difficulty of delivering two doses of a vaccine (if indeed it was available in sufficient amounts before the pandemic was over), to four million people in a timely fashion at the outset of a pandemic, should certainly be addressed.

The delivery of anti-virals raises other problems not addressed by the plan.

Tamiflu, for example, if not delivered within 48 hours of the onset of flu symptoms, does not work very well. In addition, the drug's life expectancy is short, and people would probably require a new dose every five or six days.

If a pandemic continued for say eight to 12 weeks, New Zealand would require to deliver at least six to eight doses to every key health and emergency worker and their families and the severely ill.

Would there be enough? Possibly a better solution would be for every New Zealander to go out and get a flu shot.

The plan also says little about the potential impact of a pandemic on the healthcare system.

Currently there is little surge capacity in the New Zealand hospital system. A pandemic which might see 30,000 people requiring hospitalisation over two to three months would place enormous demands on the existing system.

Presumably we would see a return to 1918 when halls, churches, tearooms, kindergartens and racecourse grandstands were all converted into temporary influenza hospitals?

And what about those living alone or too frail to look after themselves? The plan recognises the problem but simply suggests that local communities would need to provide support networks.

Interestingly, the New South Wales plan suggests the setting up of what is delicately termed "staging facilities" for those who could not care for themselves at home.

And could the local GP cope with say an additional 50 to 80 patients a day, every day for say eight weeks, given that some of their staff would be ill or at home caring for family members?

Finally, if people who are ill are told to go home and stay there, who is going to support them in terms of food and medicines, given that many shops and businesses would be closed and, presumably, delivery people might be somewhat reluctant to deliver to "infected" suburbs?

The New Zealand plan is a step in the right direction, but there are still many questions that require answers.

* Professor Peter Curson is director of the health studies division of environmental and life sciences at Macquarie University in New South Wales.