A total of 25 cases have now been confirmed, including two young boys from the cruise ship, the Pacific Dawn, in Sydney overnight.
"We are moving into a different phase here in Australia; the disease will be spreading quickly," Ms Roxon said.
"We know with the increased number of cases that there will be increased contact, that there will be more people who will be confirmed with having swine flu.
"We need to put all our effort into making sure that is a small number, as small as we can keep it."
Victoria has 14 confirmed swine flu cases, NSW five, South Australia and Queensland two, ACT and Western Australia one.
What a different story, only 8 days later, and these are only the confirmed cases. The real number must be ten times this:
There are now 521 cases of swine flu in Victoria, an increase of 126 overnight.
NSW has 70, Queensland's swine flu tally has risen to 26, Tasmania has two cases, South Australia eight, ACT four, Western Australia two and the Northern Territory one.
Around the rest of Australia, Victoria now sits in the same category as countries such as Mexico, Panama and Japan.
NSW, Queensland and South Australia all announced the move on Wednesday, with Queensland authorities saying Victoria's status warranted further containment measures.
The announcement will affect hundreds of Queensland and NSW families who have flown to Melbourne for the State of Origin rugby league match on Wednesday night.
On Wednesday, Victoria changed its pandemic status from contain to a modified sustain level.
How did it happen? Here is one way, the Pacific Dawn, a cruise ship affectionately now called the "Plague Ship" by some.
The Pacific Dawn is currently cruising up the Queensland coast with a new load of passengers after docking in Sydney on Monday when it was the centre of a swine flu alert.
On the cruise into Sydney, flu-like symptoms were reported by 172 passengers - five of whom were Queenslanders who subsequently tested positive for the disease.
GENERAL practice has a confusing relationship with the government. It, the government, knows we are out there in the community and knows that people come to see us. It also knows the taxpayer picks up the bill.
We, the GPs in GP-land, know we work hard to ensure the ongoing health and wellbeing of all Australians, taxpayers and otherwise. There is an ambivalent tension between us. We know the limitations of our resources but we feel the government distrusts what we say, regarding us an expensive pain that requires treatment.
For example, next month the government will increase the number of GP audits by a whopping 500 per cent. Medicare apparently thinks we spend too much time with patients and are over-charging. Meanwhile, federal Health Minister Nicola Roxon is asking GPs to focus on preventative health.
That is good but time consuming.
Given this mixed message, it's little wonder GPs believe the government does not hear us when we say that we do not have the resources to see acute patients, manage chronic patients and implement preventative health strategies for those who are well but leading unhealthy lifestyles.
We can see only one patient at a time.
I work 50 to 60 hours a week. Yet the message is that GPs may be penalised for the time we spend with patients. This is absurd.
Another illustration of this confusion and mistrust occurred when I presented, uninvited, to one of the first pandemic planning meetings in Queensland when avian influenza (bird flu) was in the news a while back. Everyone else at the table was welcomed by name. I was merely acknowledged by name.
I attempted to explain that in the event of a pandemic, GPs would be at the coalface in the community and would require infrastructure support, such as a guaranteed supply of protective masks and reliable supplies of Tamiflu. Obviously, I don't want my receptionists or myself to be put at risk.
Yet I was advised bluntly that they were not there to plan for general practice or engage the wider community. The meeting was about the needs of government employees and hospital staff.
They then proceeded to ignore me.
It's happening again with H1N1, swine flu. GPs are up in arms over the failure of government support. Classic example: The Australian on June 13 ran a front-page story about a GP in South Australia who was unable to source Tamiflu for a 17-year-old for eight days, whereas professional football players can have it within 30 minutes.
Roxon responded by promising another $4million to support general practice, although no one knows how she will spend it. Although the dulcet ker-ching of the cash register is soothing, it's not enough. We need consideration, competent leadership and consultation. Australia is lucky that H1N1 is a benign illness -- at least so far -- as it's running its own course, spreading 10 times faster here than in New Zealand and Japan.
The government has quietly capitulated after failing to make the case for home quarantine. Delaying the likelihood of a more lethal mutation and development of Tamiflu resistance gives vaccine manufacturers more time to develop an effective vaccine.
There was a point early on that things could have been handled differently at the local level. Flu clinics should, and could, have been run at local levels. Even a caravan parked in a car park near a shopping centre can be a makeshift flu clinic. Better-resourced labs could have been set up to run the tests quickly, so GPs could property treat football and non-football players alike.
The sense we get here in GP-land is that when a government is in election mode it's happy to spend money to run focus groups and hire expensive advertising gurus to make sure that the political message hits home.
In contrast, when it comes to managing a biological emergency that affects us all, but not the results of an election, politicians rely on middle-level health bureaucrats who fail miserably to explain anything to the public.
The result is all too often a confused mish-mash about not panicking. Panic about what? No one knows what is going on. If the government were capable of listening and willing to trust GPs, this swine flu pandemic would have been managed more effectively and more easily. Unfortunately, pigs haven't learned to fly ... yet.
Thomas Lyons is a general practitioner on the Queensland Gold Coast.
NEW Zealand's capital Wellington is threatening to surpass Melbourne as the swine flu capital of Australasia, an infectious diseases expert says. Tim Blackmore, a specialist at Wellington Hospital, says while case numbers are higher in Australia, a snapshot in time shows New Zealand is struggling with relatively higher severe cases of H1N1 influenza.
"Melbourne is the swine flu capital of Australia but if you compare hospitalisations for the whole state of Victoria, we're ahead in our comparatively tiny city," Dr Blackmore said.
Victoria, a state of five million, had 18 inpatients last Friday, the same as the Wellington region with just 400,000 residents, but the Kiwi figures have been climbing fast.
Australia's statistics are still more grim, with 4320 cases and nine deaths reported compared to just 700 cases and no deaths in New Zealand. But Dr Blackmore says New Zealand is at an earlier stage in the epidemic's cycle, and the situation is heating up fast.
About 30 people are now in hospital in the Wellington region, one in critical condition, and the hospital is diagnosing 15 cases a day.
Dr Blackmore has predicted at least four in every 10 New Zealanders will get the illness.
"What we're seeing is the tip of the iceberg and it's looking moderately severe to us," he said.
"The hospital services are starting to struggle. We've never seen admission rates like this before and unfortunately it's only going to get worse."
Dr Blackmore said the virus was mild to moderate for most people, but those most at risk, including children and those with respiratory diseases, may need help breathing.
The flu was most prevalent in Maori and Pacific Island communities in Wellington, and appears to have begun in suburbs with damp homes and poorer living conditions.
The Government is to announce soon that it will buy early supplies of a vaccine against swine flu, for use by front-line health workers.
Health authorities have an arrangement to buy an egg-based vaccine when it's available in coming months, but are also thought likely to purchase an alternative, cell-culture vaccine in the meantime.
Health Minister Tony Ryall would not go into detail on Thursday, but said an announcement is imminent in the next few days.
SCHOOLS are being emptied by the swine flu scare as more than a quarter of students stay home with flu-like symptoms. School numbers are being savaged, with reports of just four to seven students attending on some days. A Lower North Shore public school yesterday lost up to 40 per cent of its students. Last Tuesday the Oakhill Catholic College lost about 400 students in one day - a quarter of its enrolment.
"I've been teaching for 40 years and I've never experienced what we have this year," principal Brother Ken Ormerod said. "These are phenomenal numbers I would never have expected."
As the Health Department acknowledged yesterday that the spread of swine flu could not be stopped the Education Department was criticised for its decision to no longer keep parents informed of swine flu cases in their schools. A department spokesman said while ill children were still being asked to stay at home, schools were no longer required to send letters to other parents when a swine flu case was confirmed.
University of NSW professor of infectious diseases Dr Raina MacIntyre said, with children the most susceptible, parents needed to know if another child or teacher in their school had contracted swine flu. "The schools should have an obligation to tell parents," she said. "It is people under 18 who are the most susceptible to this virus. This is now the dominant flu we are seeing but the epidemic hasn't peaked. It is only going to get worse."
Castle Hill Medical Centre Dr Peter Hay said it was the worst epidemic he had seen in 20 years of medicine. "Once it has started spreading like this you can't stop it," he said. "We have 20 doctors and every doctor was booked out by 11am. I have been seeing about 15 to 20 patients a day over the past three weeks who have the flu."
However he and NSW Health cautioned it remains a mild virus. Dr MacIntyre predicted the peak would come by the end of this month or early August and that people should expect more to fall ill.
The number of confirmed swine flu cases in NSW has reached 1446, with western Sydney being particularly hard hit. Two people with swine flu have died in NSW this year.
The hospital system has seen a 17-fold increase in people with flu symptoms compared with last year's flu season.
HEALTH authorities have lost the battle against swine flu, conceding it now makes up about 60 per cent of all influenza cases.
And it is only going to get worse as businesses already feeling the impact brace for bigger numbers in staff absenteeism.
Just this week 1000 people have already been diagnosed with the flu in NSW, The Daily Telegraph reports.
It is expected to be the worst flu season on record with numbers expected to skyrocket in coming weeks.
Health experts yesterday warned workplaces will be hard hit with every worker off at least twice this winter with flu symptoms.
Currently 100 out of every 1000 workers are off sick - an increase of 20 per cent from last year with predictions the number could spike to as much as 60 per cent.
Swine flu is now the dominant virus, accounting for two thirds of all flu cases in NSW. However, it is feared the state could follow Victoria, where 90 per cent of all flu cases are swine flu.
"If you are sick, and you have the flu, then it's almost certainly swine flu," NSW Chief Health Officer Kerry Chant said.
"This year's flu is swine flu.
"If you had asked me a few months ago if swine flu would become the dominant strain compared to normal season influenza I would have said 'no'."
The usual seasonal viruses such as influenza A and influenza B have disappeared as the ferociousness of swine flu spreads through the community.
NSW Health figures show that in the past week there has been a 17-fold increase in influenza patients at hospitals compared with the same period last year.
From July 1, about 175 people a day began arriving at hospital emergency departments with the flu. In May, it was just 25 a day.
Businesses are bracing for record absenteeism, with some workers given influenza kits containing hand sanitisers, masks and tissues to control the spread of the disease.
The Daily Telegraph yesterday reported the virus is expected to infect companies with a $1 billion sick bill.
Direct Health Solutions director Paul Dundon manages an absenteeism call-in service for companies such as NAB.
He said projections showed absenteeism could reach more than 40 per cent.
"Even people who aren't sick but have been exposed to swine flu are being ordered to stay away," he said.
"Workers are taking three days off rather than just one. Absenteeism is already sitting at levels 20 per cent higher than last year."
The surge in the number of people with swine flu needing life-saving treatment has forced NSW Health to consider closing elective surgery at some big hospitals to allow staff to redirect resources.
More than 350 people have been admitted to hospital with swine flu since the pandemic began. Fifty have been treated in intensive care, but doctors say the surge in patients needing cardiac bypass treatment is putting a huge strain on intensive care units and on staff and resources across the state.
All six of the victims on cardiac bypass are at Royal Prince Alfred Hospital, where staff have been forced to borrow three machines to treat 10 patients in the past two weeks. The hospital usually treated about five patients a year using the machines, the head of intensive care services, Robert Herkes, said yesterday.
"This is not an ordinary winter. Swine flu is hitting young, otherwise healthy people ... they start with a sore throat, develop shortness of breath and within 12 to 24 hours have rapidly developed respiratory failure and are being ventilated."
Dr Herkes said extracorporeal membrane oxygenation, or ECMO, was considered a last resort treatment, but staff were "throwing everything" at the patients because they were young and relatively healthy.
Patients in respiratory distress are administered anticoagulants by machine, and their blood is drained through tubing in their femoral or jugular veins. It is oxygenated outside the body, allowing the lungs to recover.
Brad Frankum, a general physician and immunologist at Campbelltown Hospital, said he had heard anecdotal reports that "more people than ever before" were being treated with ECMO this winter. "This is of great concern because it would suggest that the number of serious cases [of acute respiratory distress] are threatening the capacity of the system," he said.
The deputy director-general of NSW Health, Tim Smyth said yesterday five big hospitals in Sydney had now been designated to treat swine flu victims with ECMO, up from two a fortnight ago. He said about a third of swine flu patients in intensive care were needing this treatment, but there was still capacity to deal with the pandemic.
He said the department had stockpiled 130 new standard ventilators two years ago as part of the state's disaster plan and would open more intensive care beds on high dependency units if the number of patients continued to surge.
But Peter Collignon, a professor in infectious diseases at the Australian National University, played down the use of the machines, saying "this happens every winter - it just doesn't get publicity".
A spokesman for the State Government said elective surgery could be cancelled at Royal North Shore, Royal Prince Alfred and St Vincent's hospitals, and patients due for surgery would be moved to less affected hospitals.
"There's no move at this stage to move to a different [status] in our pandemic plan," a spokesman for the Health Minister, John Della Bosca, said.
There are many hundreds of flu deaths every year, but a senior health source said swine flu was likely to hit harder as there was no vaccine and no immunity.
Christchurch Hospital's intensive care unit (ICU) is overflowing after an influx of people with swine flu.
ICU staff are working extra shifts to cover the overflow, and new patients requiring intensive care may have to be sent to other South Island hospitals.
Surgeons have been told that any elective-surgery patients needing to recover in the unit, including all elective cardiac surgery patients, could have their surgery postponed.
Influenza experts say the presence of previously healthy people in the unit with swine flu could indicate the virus is mutating and becoming deadlier.
Christchurch Hospital acting general manager Ruth Barclay said yesterday there were eight people in the unit with swine flu or flu-like illnesses who needed ventilation.
The unit usually had no more than 12 patients but had been expanded to accommodate 15.
"The ICU is the area where influenza H1N1 is having the biggest impact," Barclay said.
"We've got young people, from two years to 50, with H1N1, and some have no underlying medical conditions."
The heads of surgical departments had been sent a memo telling them to consult on any surgery requiring ICU recovery time, she said. It had always been anticipated that the spread of swine flu might mean elective surgery had to be postponed.
ICU staff were working longer hours to cope with extra patients, but in the event of a multiple-victim accident or too many new patients being admitted to the unit with influenza, some might have to be transferred to Dunedin, Invercargill or Nelson, Barclay said.
Canterbury hospitals were coping well with the winter influx of patients, she said. There were 59 people in Canterbury hospitals with flu-like symptoms yesterday.
Did you see what that professor Peter Colligion said in the post before the one above, he played down the vent problem, said, "this happens every winter". I bet those poor ICU nurses would like to ***** slap him about now. The rough thing is that it is doesn't appear to be near peak.
And the sad part is, in winter, we're usually full of COPD/CHFers with an assortment of "grandma will never die, keep her on the vent until she wakes up" folks....wonder where they're all going to go when the flu hits?
a nine-year-old sydney boy has died from swine flu as it emerged 94 children aged under five were admitted to hospital in the past week.
the state's death toll from the deadly h1n1 virus doubled from five to 10 yesterday.
a staggering number of children are falling ill, making up the bulk of hospitalisations.
while the majority of children do not need intensive care treatment, health authorities are concerned by the increasing number being struck down by swine flu.
"the group most likely needing intensive care is between 39 and 50 years old," dr chant said.
a third of all patients in icus are swine flu patients, including 32 adults and four children. at least six new mothers are also listed as critical after contracting the virus.
hospitals are feeling the strain of the virus, with westmead and blacktown hospitals cancelling non-urgent elective surgery.
more alarming is that doctors and nurses are now being hit by swine flu, causing hospitals to suffer shortages.
at westmead, staff absenteeism last week was more than double the number at the same time last year.
"it is one of the significant factors that we have had in allocating our resources," westmead hospital's dr peter klineberg said.
"it varies day by day but last week we had double than expected. the bottom line is it's affecting us."
in an embarrassing case for health authorities, a once healthy grandfather remains in an intensive care unit after he was placed in the same room as a man with swine flu at singleton hospital.
the gravely ill 68-year-old, identified only as ivan, was admitted for a minor procedure.
his family is appalled and said he should never have been placed in the room with a swine flu patient.
but when contacted by the daily telegraph, hunter new england health service said it might have wrongly diagnosed him with swine flu, despite his being treated in john hunter hospital's intensive care unit this week for the disease.
"we falsely told the man he has (swine) influenza," a hospital spokeswoman said.[?????]
GOLD Coast nurse Rebecca Casey thought swine flu was just a mild bug. Yesterday, as she prepared for the funeral of her son Cameron Todd, she demanded to know why more had not been done to warn the community about just how deadly the disease could be.
indigo girl
5,173 Posts
GP's Cut Out of the Swine Flu Loop
http://www.theaustralian.news.com.au/story/0,25197,25690820-23289,00.html
Thomas Lyons is a general practitioner on the Queensland Gold Coast.
(hat tip flutrackers/shiloh)