Experts say let swine flu run its course

With the number of influenza A H1N1 (swine flu) cases in Australia now over 300 federal Health Minister Nicola Roxon says the government is considering whether to elevate the nation's response to the disease from the ‘contain’ to ‘sustain’ phase, as it may become impossible to keep quarantining people.

People who come down with ‘flu-like’ symptoms may soon be advised to stay at home and recover rather than visit their GP.

Swine flu has hit every state and territory in Australia, the state of Victoria has been hit the hardest with 212 positive tests and 11 schools forced to close to curb the spread of the virus - more than 3,000 Victorians are in voluntary home quarantine and there are apparently 459 further tests awaiting laboratory results.

The ‘contain’ phase involves healthy people who have had contact with a swine flu patient being quarantined voluntarily and given antiviral drugs for a week – the ‘sustain’ phase, involves quarantining which is limited to those who share a home with a confirmed swine flu patient. Ms Roxon says it is appropriate that Victoria is now getting ready to move to the ‘sustain’ phase.

The health minister says issues can be expected when a highly contagious virus becomes a community-wide disease and there will be challenges ahead.

Chief medical officer Professor Jim Bishop says as the swine flu situation evolves the advice to people with flu-like symptoms may change and in future fit and healthy people may be told to stay at home, and only those in ‘at-risk’ groups, including those with respiratory problems and asthma will be advised to visit their GP.

Currently there are 212 people infected with swine flu in Victoria, 64 in NSW, 17 in Queensland, six in South Australia, four in the ACT, and one case each in Tasmania, the Northern Territory and Western Australia.

Professor Bishop says swine flu differs from seasonal flu because it is highly contagious among children, the community has no immunity to it and it is sensitive to Tamiflu (which seasonal flu is not) and it also has the ability to change which is an added worry.

Ms Roxon says health officials will review the Victorian situation if the disease numbers rise dramatically as is expected over the coming week and if the disease becomes a community disease a new phase would be entered where efforts would go into treatment and identification of people who are at risk.

Ms Roxon is considering advice on whether the nation's pandemic plan should be modified to allow alerts to be tailored to suit each state's and territory's public health situation.

However some infectious disease experts are suggesting that swine flu should be allowed to run its course and be treated like any other seasonal flu.

Professor Peter Collignon from ANU's School of Clinical Medicine says initial reports from Mexico suggested that swine flu was much more aggressive but other regions such as Los Angeles and Canada are now treating the virus as normal seasonal influenza.

Many are thought to agree with him - Professor Collignon says the public health system is at its limit as to what it can do to contain swine flu and it may be time to step up Australia's pandemic alert level from ‘contain’ to ‘sustain’.

While most cases of swine flu have been mild, a few people have been hospitalised and most experts expect the infection to remain mild but they say future deaths cannot be ruled out - 10 to 30% of the population can be expected to catch this flu variant over the coming flu season.

To date more than 15,000 people in 53 countries have tested positive to swine flu, this figure includes 99 swine flu-related deaths.