Swine flu - a new wall of silence

  • Joanne McCarthy

The dramatic acceleration in swine flu cases in the past week has coincided with what appear to be signs of chaos and lack of transparency in the Department of Health and the HSE.

Irishhealth.com’s experience in recent days has been that queries for information on the swine flu outbreak in Ireland have gone unanswered or passed between the Department, the HSE and the Health Protection Surveillance Centre (HPSC) with no definitive answer being given.

This week’s press conference given by the health authorities as the swine flu pandemic intensified saw officials reluctant to give specific information on some areas of concern; in particular what emergency plans were being put in place regarding services as a result of the flu upsurge.

This lack of transparency is preventing the public from learning essential information about the escalation of the virus, and more importantly, how it is being handled by those in charge.
Yesterday, the Department of Health said that 500 people in Ireland were diagnosed with swine flu in the last week. This morning on RTE’s Morning Ireland, the Director of the HPSC said that 1,500 people have in fact been diagnosed with swine flu in the last week, three times the amount the Department said yesterday.

This led to some public confusion about the figures. With the authorities now relying on GP reporting of suspected cases, it appears that the latest figure accounts for people who have presented to GPs with suspected swine flu symptoms. The public is getting very confused and the lack of clarity does not help.

Why were such dramatically different figures put out in such a short space of time?

The HPSC later today refused to confirm to us the number of people with swine flu in the country or clarify the statement made by its director, and the Department of Health also refused to comment on the issue, merely saying “a press release is being drawn up”.

Lack of transparency in the midst of the world’s first pandemic in over 40 years will inevitably lead to panic and confusion in the community, and raises serious questions as to how the health system is handling the outbreak in Ireland.

According to Dr Tony Holohan, chief medical officer at the Department of Health, hospitalisation is required in about one in every 50 swine flu cases. This means that 20,000 of the one million people predicted to get swine flu would need hospitalisation, and it is predicted that 20% of them will require treatment in intensive care units (ICU).

With many intensive care units around the country already at full occupancy, and critical care in Ireland under-resourced as it is, a large increase in admissions could prove a major challenge.

In spite of the concerns this raises, the HSE is declining to answer simple questions on how hospitals will cope with the upsurge, saying only that it was looking at the capacity of ICUs and working with hospitals and specialists.

Moreover, when irishhealth.com recently asked the HSE whether Ireland has a functioning national unit which could provide Extracorporeal Membrane Oxygenation (ECMO) treatment to seriously ill swine flu patients as it is required, the HSE took five days to reply before eventually stating in a vague response that “a number of people have had this treatment in Ireland in the last year.”

The HSE refused to say what in which hospital the ECMO unit was located. It appears that the only unit providing ECMO in the country is in Our Lady’s Children’s Hospital in Crumlin, which caters only for children.

Furthermore, according to Dr Brian Marsh of the Intensive Care Society of Ireland, to date, ECMO therapy has been sourced outside of Ireland for patients who needed it. There is a unit planned for the Mater Hospital, but it is not up and running yet.

In response to a request for confirmation of this, the Mater hospital refused to comment on its ECMO unit or to say when it would be available.

ECMO is used for patients with severe lung problems. The UK’s unit in Leicester, which has five beds, is now completely full, meaning that one pregnant Scottish woman with swine flu had to be flown to Sweden for ECMO treatment.

If the use of an ECMO unit was required here, it appears a similar strategy of sending patients abroad would have to be adopted. However, as Dr Marsh stressed, it is unrealistic for centres in other countries to cater for extra demand from Ireland while already reacting to their own national demand.

While initially it appeared that the HSE and Department of Health were dealing with the swine flu outbreak in Ireland in a calm and measured manner, their recent reluctance to respond to very simple and straightforward questions would lead many to believe that those in charge of our healthcare system are starting to panic, and that the more familiar policy or spin and secrecy has returned.

It's not too late for the health authorities to put things right and tell it like it is.

The HSE's swine flu information line is freephone 1800 94 11 00

View swine flu advice on the HSE's website here

See also our swine flu Q&A here

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