It is declared as pandemic!

"The world is now at the start of the 2009 influenza pandemic," said the WHO director-general Dr. Margaret Chan on 11 June 2009.

So, when is a disease called as pandemic?

Phase 1-3 correlate with preparedness, including capacity development and response planning activities.
Phase 4-6 clearly signal the need for response and mitigation efforts.
Periods after the 1st pandemic wave are elaborated to facilitate post-pandemic recovery activities.

Criteria of each phase:

Phase 1: no viruses circulating among animals have been reported to cause infections in humans.

Phase 2: An animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans. It is considered as a potential pandemic threat.

Phase 3: There are sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community level outbreaks.

Phase 4: Community level outbreaks by human-to-human or human-animal transmission. It indicates a significant increase in the risk of a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO.

Phase 5: Human-to-human spread of the virus into at least two countries in one WHO region. It is a strong signal that a pandemic is imminent. The time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6: Pandemic phase, characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in phase 5.

Post peak period: Pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed level.

Post pandemic period: Influenza disease activity will have returned to normal level. The pandemic virus is expected to behave as a seasonal influenza A virus.

Our main concern: What is a GP's role in a pandemic preparedness?

First, we have to know what "pandemic preparedness" is. The pandemic preparedness is categorized as:

1) non-pharmaceutical (public health): It is aimed to reduce the social impacts, such as social distancing by prompt case isolation, household quarantine, and closure of school and workplaces. In addition, it includes data collection and surveillance and basic respiratory hygience practices as well.

2) pharmaceutical: It includes vaccination, anti-viral medications, stockpilling of vaccines and drugs and  co-ordinated effort in distribution. This would involve pre-pandemic vaccination and treatment of cases for secondary prevention.

Secondly, what role do we play? (scenario: H1N1 influenza pandemic)

1)  Teacher and psychologist: GPs should educate the patients about what the disease is, and the transmission mode. We must disseminate the information to the community on how to prevent the disease, from whom they can get health service and medication when they are ill, and the reinforcement of personal hygiene as well as the other precautious measures. Then, we have to get the feedback from the community and need to ensure that they can understand what we say and we solve all their puzzles regarding to the H1N1 influenza. Other than that, GP should also provide psycho-social support to the community. Therefore, GP should establish a good relationship with the community by having a great communication with them.

2) Detective, gate keeper, coordinator and reporter: The GPs are the gatekeepers. We play the frontier role in management of patients with influenza without complications to allow unexpectedly large numbers of ill patients to be managed in the community. So, we should be able to detect the epidemics and mini epidemics of viral illness in accordance to national guidelines to avoid missing cases. We can coordinate triage system for suspected cases. Then, we identify the vulnerable and at risk groups for necessary health protection. Specimens will be collected from the suspected cases for rapid diagnosis. Besides that, we have to coordinate the care for the close contacts or the family members of the suspected targets. If we have detected the patients with H1N1 influenza (cluster of people or large group of community with same sign and symptoms and tested H1N1 positive) we should report to the district health officer. The epidemiological data obtained in primary care represents the best proxy measurements of the day-by-day prevalence of ailments in the community. Since we play a role as detector and gatekeeper, self-protection is essential, so that we will not be infected with the virus.

3) Pharmaceutical measure: It includes the provision of vaccines, esp during the pre-pandemic period, anti-viral drugs, etc.

4) Monitoring and assessment: We have to monitor the suspected targets as well as their close contacts. We then assess their condition. For the follow up, it is preferred to implement home-visit-approach or setting a special review clinic to avoid cross infection. Moreover, we are responsible to monitor the resources in primary health care to ensure that we always have enough supply for our demands. We also need to assess the capacity to manage large number of ill patients.

5) Have a great communication with public health authorities: To get the epidemiological update and results of investigations, so that we can provide better, comprehensive and continuing care in this pandemic setting. Therefore, there will be no misdiagnosis and unnecessary referral to secondary care.

Wow, a lot of roles, right? Yea, being a doctor isn't an easy job, esp. when there is an outbreak of disease or a disaster happens.... This is absolutely a challenging job! ;)

Reference:
1) http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html
2) http://www.medicinenet.com/script/main/art.asp?articlekey=101133
3) http://www.who.int/csr/disease/swineflu/phase/en/index.html
4) http://www.biomedcentral.com/1471-2458/10/661