Are we prepared?

With each new case of Avian Influenza reported in the media, the idea that the virus responsible, H5N1, could be the cause of the next global pandemic seems more grounded in reality.

According to figures from the World Health Organization, as of April 19, H5N1 has been responsible for 196 confirmed cases of Avian Influenza among people since 2003 and, out of those, 110 patients infected with the virus have died. All the confirmed cases of human infection have occurred in countries in Asia-Cambodia, China, Indonesia, Iraq, Thailand, Turkey and Vietnam-but the virus has been found in birds across Asia and in areas of Europe and Africa, and experts believe the virus may begin to show up in birds in North America within six to 12 months, perhaps even earlier.

But whether or not this virus, also known as Bird Flu, proves to be the cause, pandemics occur in cycles, and the next one is already overdue.

"All the experts agree that a pandemic will occur. It's just a question of when, not a question of if," said Michael Tansey, who handles media relations for the Public Health Agency of Canada, created in 2004 by the federal government in the wake of the SARS outbreak in Toronto. The agency's role is to provide a co-ordinated, national approach to dealing with infectious diseases, emergency preparedness and chronic diseases across the country.

"According to worst-case scenarios, up to 53,000 people could perish in a pandemic across Canada. Now we don't anticipate that a worst-case scenario will play out, but those are the numbers. And we could have hundreds of thousands of people seeking hospital admissions. We could have a significant number of people who experience symptoms of some kind, whether it's feeling ill or missing work for a few days, all the way to requiring hospital admission, or they could even perish from a pandemic."

We've already seen what a pandemic can mean in terms of loss of human life through experiences with the three major global influenza pandemics that occurred during the 20th century. In 1918 to 1919, a strain commonly called the Spanish Flu killed an estimated 40 million people worldwide. Estimates put the total number of people who died from the Asian Flu in 1957 to 1958 at somewhere between one million and four million. It's estimated the death toll from the Hong Kong Flu in 1968 to 1969 was about one million worldwide.

In order to be prepared when an influenza pandemic does occur, the federal government has drafted the Canadian Pandemic Influenza Plan. It was developed in collaboration with provincial and territorial governments.

The plan outlines how Canada would prepare for and respond to an influenza pandemic. The plan was released in February 2004 and replaces Canada's first pandemic influenza plan, created in 1988. It is designed to assist all jurisdictions involved with all aspects of planning, including surveillance, health services, emergency services, public health measures, communications and antiviral and vaccine programs, and to help co-ordinate responses by all levels of government.
"The overall goal of pandemic influenza preparedness and response is first to minimize serious illness and overall deaths," the preface to the report states. "And second is to minimize societal disruption among Canadians as a result of an influenza pandemic.

Included in the plan is a specific section dealing with pandemic influenza planning on federal reserves across Canada.

"What we're trying to ensure is that First Nation communities, like other communities in Canada, are prepared in the event of a pandemic," said Shelagh Jane Woods, director general of Primary Health Care and Public Health with Health Canada's First Nations and Inuit Health Branch (FNIHB). "And I think it's really because many First Nation communities are small and remote, they may not be able to rely on others in case of a pandemic. And what [FNIHB] has been doing has been trying to assist them to have well thought out, well developed plans. And we're really working with them on a number of planning fronts and the overall is the sort of emergency preparedness and response writ large, what we call all hazards plans. And what we're trying to do is link a strong pandemic component into them."

Under the plan, a number of partners are named who must be involved in the process for on-reserve influenza preparation, including the FNIHB headquarters and regions, provincial public health authorities, the Centre for Emergency Preparedness and Response and the First Nation communities themselves. While having this many fingers in the pie may seem unwieldy, Woods says it's just part of the way FNIHB does business.

"The branch is always looking for ways to integrate First Nation health issues with those of the provinces and that sort of thing. And so what we're really looking at is making sure that the First Nation communities are making the right links to the right organizations. That involves doing a lot of this multi-layer, multi-party planning. So we know that in a pandemic, a First Nation community in Saskatchewan isn't going to call me. Probably the first person they're going to call upon is people within their community who have some training and experience to help out, to lend a hand, particularly if it were the case that some of their medical personnel fell ill. But then they'd start going, 'What's the next nearest locus of possible assistance?' And that might be, in some cases, a local health authority, a local hospital and that sort of thing. So really, a big focus of the planning is to get the communities communicating with one another and collaborating, but also communicating and collaborating with those other entities who are there to give services to citizens in emergencies and non-emergencies."

According to a fact sheet dealing with on-reserve pandemic planning issued by Health Canada in February, work is still underway to clearly define the roles and responsibilities of the various partners in order to pave the way for a co-ordinated approach to dealing with a pandemic situation.
While in the end, final responsibility for having a plan in place to deal with an influenza pandemic falls to each individual First Nation, that doesn't mean on-reserve communities will be left to their own devices, Woods explained.

"We're going to provide as much help as we can. Our different regions have taken different approaches. Sometimes that's because they have different relationships with, say, a province, or different relationships with the First Nations. So in one case, in the case of the Manitoba region, they've gone to the Manitoba Native Firefighters Association because they have lots of experience in emergency preparedness and response. And so they've gone to them and said 'Could you help the First Nations do some of their emergency planning with us?'"

The FNIHB regional offices also keep track of where each individual First Nation is in the process of creating their pandemic plans.

"So as you can imagine, given the diversity of the communities, some of them are way ahead in terms of their planning and some of them are not very far ahead. And so it's a matter of keeping on, working with the one's who are slower to get started," she said. "We've just got to keep making this a big priority because we can't afford to say, 'Well, there were a few that just didn't get started.' That's not acceptable. And we know that everybody has been engaged to some degree or another and now it's a matter of pushing, keeping on, making sure that there's progress and that the work continues."

Specific information about the Canadian Pandemic Influenza Plan, pandemic influenza and what role individuals can play in preventing the spread of infection can be found at www.phac.gc.ca.
"I'd also encourage people to look at the Web site of the health department in the province in which they live because the front line response will come from the province or the local health agency."

"From our perspective, the main messages that we want to have people absorb are that when a pandemic does occur, if they are sick they should stay home. The best way to avoid getting sick is by getting a vaccination when the vaccines are ready. And frequent hand washing is one of the biggest tips that we can provide in terms of reducing the likelihood of getting infected."