Coffee with... -
With vaccinations well underway in central Newfoundland, H1N1 is the talk of every town from Glenwood through the Eastport Peninsula.
Dealing with the challenge of immunizing a large portion of the province's public is an immense challenge, as evidenced by the number of changes made to the schedule leading up to opening of the Gander clinic on Oct. 30 - two weeks before the initially announced start date of Nov. 12.
Dr. Ann Roberts, the medical officer for health with Central Health, oversees these challenges for the health authority. Health emergency management includes pandemic planning, of which there's been much of late for Dr. Roberts.
Aside from planning beforehand, Dr. Roberts is also involved in tracking the H1N1 influenza, which had claimed one life in the province as of The Beacon's Monday deadline.
Having served as the medical officer for health with Central Health, Dr. Roberts has worked in similar roles in other parts of the country. In Labrador and Nunavut, she was closely involved in planning to deal with a tuberculosis outbreak, and was also involved in handling a meningitis scare in Alberta during the 1980s.
Q: How much of a challenge does H1N1 represent to you as far as your job goes?
A: I've been working on pandemic planning for over 10 years, and I'm almost relieved it has come to this, because I was beginning to wonder if a great part of my life's work was just spent in planning for things I didn't get to see. It's a challenge in that I have to balance lots of different elements.
Everything else doesn't stop for me because a pandemic appears to be here now in it's second wave - it's the ability to be flexible with my time. A broader swath of people are stopping me in the hallway and asking me questions they think only I could give, because nobody else would know anything about influenza.
I also work with everybody across the region who has the pandemic plan to try and help them decide when it is time to take out their plan and (implement) it - because the flu doesn't affect every community at once. It just jumps around.
Q: Are there any unknown factors at play with H1N1?
A: We know roughly when we expect the flu to come and go. We know influenza outbreaks in summer are rare, but that there can be, as there was last summer, a loss of individual cases and a small cluster of other cases that never (became serious).
Q: Are you surprised by the amount of attention that H1N1 has been receiving from the public and from the media?
A: Not at all in the last couple of weeks, but I have to say that two or three weeks ago, when we were the only ones interested in this topic, I felt the community wasn't really engaged in what we were trying to scope out for them, and what we though the fall would bring with regard to influenza. But in the last couple of weeks, we seem to have gotten people's attention to some degree.
Q: What sort of things are you going to be watching for in the early stages of the second wave?
A: What I like to do is look at markers of influenza in any community or group of communities. Basically, everyday I get a report of how many people go to emergency rooms in our 11 facilities, and the total number of people with influenza-like illness.
Up until a couple of weeks ago, it was three or four per cent of patients coming in with an influenza-illness - a cough, aches and pains, and a fever. But the rate rises over time, and I like to start my day by understanding what every health service district has in terms of influenza-like illness.
Q: In some of the worst-case scenarios, you'd have to make decisions regarding the closing of schools and businesses. How would you proceed in making those kinds of decisions?
A: Very carefully, because when you close anything, say schools, when you send those children home, you've created a problem for the parents - at least one of them is likely to be working. If you close the school in a community that has a health facility, you're probably sending home your staff.
I have to think about what I'll achieve by closing schools or businesses. Most of the businesses would be like daycares. That's usually a mutual decision where everybody's ill and they don't have enough staff.
Q: In Gander, word has been spreading that some parents have kept there children away from school. This may in part be due to some fears raised about that boy in Toronto (Evan Frustaglio, a 13-year-old who succumbed last week to H1N1 influenza). What would you say to parents with these sorts of anxieties about H1N1 and having their children attend school?
A: I would tell them that Ontario is a large jurisdiction. We are a population of thousands. While we will have our sick people, and we will have our admissions (to hospitals), and we may have some deaths - but they are rare. It would be very difficult for any one parent to believe me it wouldn't be their child in a bad situation, but that's human nature.
I have a fair amount of sympathy for their stance, but keeping them out of school for several days is not as useful as it might seem. You have to live in your community, and you can't lock your child in the house for days on end. For any one community, it may take a month or two before the flu rises to its peak and eventually tails off, but you've got a lot of time to put in if you're trying to avoid influenza.
Q: What do you think is the most important thing the public has to realize with regards to H1N1 influenza?
A: They should stay home if they're sick. They should take themselves out of commission when they think they have the flu. And furthermore, within the home they should as best as possible to avoid affecting other members of their family. If it's available, they should avail of it.
