The situation of Avian Flu becomes more imminent as we learn from everyday headlines in the news on areas of new occurrence. As reported, the spread of H5N1 to poultry in new areas is of concern as it increases opportunities for further human cases to occur. However, all evidence to date indicates that the H5N1 virus does not spread easily from birds to infect humans. The WHO level of pandemic alert remains unchanged at phase 3: a virus new to humans is causing infections, but does not spread easily from one person to another.
Direct contact with infected poultry, or surfaces and objects contaminated by their droppings, is considered the main route of human infection. Exposure risk is considered highest during slaughter, defeathering, butchering, and preparation of poultry for cooking.
Until July, outbreaks of the H5N1 virus were restricted to East Asia. Since then, the infection has been reported in Inner Mongolia, parts of Russia, Kazakhstan and now Turkey, Romania, Greece and Macedonia etc. There is increasing evidence that bird flu is carried by wild waterbirds as they migrate from their spring-summer breeding grounds in Russia, to Europe and Africa. Migratory birds travel along various overlapping routes known as flyways. These aerial highways stretch from the far north of the Euro-Asian landmass to Africa, India, Australia and New Zealand. So the threat is indeed worldwide and imminent especially for China and Hong Kong since autumn and winter is the peak season for bird flu in China. That is the reason why WHO ordered stepped-up vigilance against the spread of bird flu.
Highlighted in the discussion paper on Health Care Reform from the Health Medical Development Advisory Committee is the advocacy of strong Family Doctor Concept by the Government. As gate keepers of the health care system, we are the front line Health Warriors in this virus war if it happens eventually. Unlike SARS, the infectivity of H5N1 is enormous if it comes to human to human transmission. And the death rate among people who catch it directly from birds has been as high as 50 per cent. If the H5N1 strain that is currently ravaging wild bird flocks learns to pass between human beings easily, while retaining even a tenth of its current lethality, the world would face an influenza pandemic as grave as the one in 1918-1919. Known as the Spanish flu, it killed between 50 and 100 million people at a time when the world's population was only a third of what it is now. As medical practitioners, it would be our duty as front line warriors to stay in the battle field with protection when the pandemic comes
We saw plentiful measures being planned or taken by the Government this time for staying vigilance for the pandemic. In health promotion, we have witnessed the launching of Exercise Prescription for patients with chronic diseases in Kwun Tong, Sai Kung and Tseung Kwan O with the support from many professional and voluntary bodies; the banning of smoking by proposed legislation; and the promotion of balanced and healthy diet through campaign on 2 plus 3 everyday regime of fruits and vegetables by the Department of Health.
In disease prevention, we have witnessed the launching of implementation of WHO Hand Hygiene guidelines in Hong Kong together with 10 countries around the world on 13th October 2005 in the Centre for Health Protection (please refer to P. 6 of this Bulletin); the impending launching of the Government¡¦s Influenza Vaccination Programme for 2005/06 on 7th November 2005 to boost up the community immunity against flu in Hong Kong. The Centre for Health Protection even requested our Union for a time slot on 16th October 2005 Princess Margaret Hospital Sunday Afternoon Symposium to explain more details on the importance of such measures not only in the public sector but in the private (please refer to P. 5 of this Bulletin). The Director of Health, not only commenting on the preparedness of the medical profession and the Government to stockpile antiviral agents, begins to call on the business sector to stockpile as well.
In preparation for crisis management, after numerous meetings with our Union (Please refer to page 7 of this Bulletin), the Government did agree to push out again the Visiting Medical Officer scheme for the old aged homes and the voluntary recruitment plans for the private doctors to help the public sector in case of emergency so as to increase the upsurge capacity of public health services during pandemic. During such meetings, I have particularly requested the Government to clarify on the Honorarium for voluntary health care workers and Professional Indemnity Insurance for voluntary workers and VMOs. They promised to clarify on these important issues soon.
As leader in the health care professions, there is no doubt that we would try out best to serve our citizens and fight against the virus in times of need as what happens in those days of SARS. However, for your clinic logistics, may I remind you again the simple formula PDF.3R which I have quoted to you in a previous message where P stands for protection; D stands for detection, F stands for Follow up action; while 3R stands for Refer, Report and Retreat if necessary. (Please refer to February 2005 issue of HKDU Bulletin for details).
I remember that early this year, we have stockpiled the antiviral agents to get prepared for the pending pandemic. According to the drug firms, the orders from the private sector was low in the beginning but rose sharply recently to such a huge amount that the demand cannot be met. In our meeting on 6th October 2005 (please refer to Page 7 of this Bulletin) with the Vaccine Director of an International Drug firm which produced the First Avian Flu Vaccine in the world, she informed us that the total time taken for the vaccine to develop following the emergence of new strain of Avian flu up to the time persons get inoculated and get protected would be at least 12 weeks. So one can calculate the minimum number of antiviral agents required for one¡¦s own protection. Another useful information from our secretariat is that the price of PPE supplied by the companies to our members presently (including disposable masks, caps, eye shields, gowns in the attached circular No. 0536) is indeed low and is the same as that for the Hospital Authority. You are most welcome to order such from the Union. Remember, the Union does not take a cent out of such transactions. So do phone us up when you are stockpiling PPE.
Finally, dissemination of truthful information is of utmost importance particularly in times of emergency. Please stay tune to the Rapid Communication System (RCS) of your union. In case you may wish to register with the secretariat, you may either download the Registration form from HKDU web site at download session of http://hkdu.org or you can simply phone up our secretariat for a copy.
Dr. Yeung Chiu Fat Henry