Sunday, 8 November 2009

Pandemic politics

The Halloween health scare continues to haunt the nation well into November as people are dying from flu and other respiratory diseases, as politicians play the blame game. If the nation’s top officials had done a better job preparing for this year’s flu epidemic, Andriy Stakhiv might still be alive today. Instead, the 31-year old Lviv native – described as “young, healthy and strong” – died of flu-related complications, only two weeks after complaining of a temperature, aches and pains.Friends and family wonder if medical negligence also contributed to his death. “He called a doctor, who came the next day, prescribed some pills and left,” his friend, Oleksandr Parshkov, said. Four days later, suffering from a fever and shortness of breath, Stakhiv was taken to a hospital emergency room in Lviv.“Prepare for the worst. His lungs are almost gone. We do not know how to treat him,” doctors at the hospital told Stakhiv’s family, according to Parshkov. He died on Oct. 30, the same day that the government took dramatic steps to stop the spread of the flu. That day, Prime Minister Yulia Tymoshenko ordered the nation’s schools and universities closed and banned large public gatherings for at least three weeks.Initially, the government’s justification for taking such drastic steps was hotly criticized. But the debate has subsided as the death toll keeps rising. Still, the nation is seen as having missed prevention opportunities since at least this spring, when the swine flu struck Mexico. Many, including President Victor Yushchenko, believe Tymoshenko’s government could have curbed the epidemic sooner by vaccinating and educating people. Meanwhile, speculation remains about whether the fast-moving virus will mutate to a more deadly form.The victimsAs of Nov. 5, the Health Ministry reported that 95 people had died in Ukraine from flu and respiratory infections in the last month. The World Health Organization says most could be victims of the A/H1N1 vrus, also known as swine flu, or Californian flu. The WHO is also working on the assumption that most of the more than 633, 000 respiratory illnesses recently registered in Ukraine are probably caused by the virus as well.The Health Ministry said almost 30, 000 people have been hospitalized, nearly 5, 000 more than a day earlier.While the total number of flu-related and acute respiratory illnesses is on par with previous years, the number of cases registered daily has since mid-October exceeded the epidemic threshold, leading flu specialists in Ukraine and abroad to sound the alarm bells.Several thousand people die from flu-related illnesses each year in Ukraine. For the first nine months of 2009, for instance, 3, 822 people died from flu and its complications. But the spike in deaths in the last month has raised fears that the number of victims during this flu season could grow much higher.What is it?Early warning signs of the epidemic came between Oct. 12-18 from health workers in Ternopil Oblast, who reported a dramatic rise in flu-like illnesses and deaths after more than 45, 000 people fell ill with “an unknown respiratory illness.”That’s what Deputy Health Minister Oleksandr Bilovol, the country’s chief sanitary doctor in charge of the government’s flu prevention program, called it. During a press conference in Kyiv on Oct. 23, Bilovol played down fears of a flu epidemic. He said all the necessary measures, including school closings, were being taken to contain the outbreak and restrict it to Ternopil Oblast.“We expect the start of the flu season in mid or late November, depending on the weather conditions,” Bilovol said. “And we are prepared to handle any flu epidemic that might arise.”Slow-footed responsePublic officials have known for many months that it was a matter of when, not if, the swine flu would arrive in Ukraine. Nevertheless, they provided little advance notice and took few precautionary measures. The Cabinet of Ministers in April 2009 provided the Health Ministry with only $6 million (Hr 50 million) to prepare for a swine flu epidemic. But not even that modest amount was well-spent, it appears.“The money was allocated for . . . drugs, laboratories, artificial respirators, test systems . . . everything necessary to get the patient out of the critical condition,” Prime Minister Yulia Tymoshenko told lawmakers on Nov. 3. A day earlier, the General Prosecutor’s Office opened a criminal investigation into how the funds were allegedly misallocated.Time and money— half a year and Hr 50 million— were not used wisely to prepare the nation for the approaching epidemics.“There are no test systems or antibiotics. Hospitals are not equipped with artificial respirators. All the drugs and equipment are either in transit or storage,” Tetyana Bakhteeva, chairwoman of parliament’s health committee, said on Nov. 3.Victor Ovrachuk, deputy head of the Ternopil Oblast administration health directorate, agreed.“We have not received laboratories, artificial respirators or antibiotics. We have received a two-day supply of the antiviral medication Tamiflu. That’s about it,” Ovrachuk told the Kyiv Post on Nov. 4.It was the same story in Luhansk. “We paid for test systems from our regular budget. We did not get the equipment we needed the most,” Anatoly Dokashenko, Luhansk’s chief sanitary doctor said.He criticized the centralized state purchases, insisting regional government is more aware of their needs. “We know locally what exactly we lack and what exactly we need,” Dokashenko addedPiet Spijkers of Dutch Humanitarian Aid described the situation at Lviv Oblast hospitals his organization supports as “appalling.” He said on Nov. 4 that there is a lack of basic medical supplies, barely any flu tests, vaccines or antiviral drugs, such as Tamiflu.“If children get ill, we can’t even establish whether they have the swine flu virus. We just have to go by the symptoms,” Spijkers told Radio Netherlands.Panic Media-driven flu fears, meanwhile, hit panic level in Kyiv, as people flocked to drugstores to buy Tamiflu and Relenza – the only antiviral medications known to be effective against the swine flu virus. People also tried to stock up on anti-bacterial gels, thermometers, and vitamins. By Halloween, most of the capital’s apothecaries had already sold all their stock of paracetamol (acetaminophen) ibuprofen, and flu-related medications. Vendors at outdoor markets also cashed in on the hysteria, hiking prices for garlic and fresh fruits.Surgical masks have remained the most desired flu-related item, but they too have been in short supply. After searching for them in vain at a dozen drugstores in Kyiv’s Shevchenkivskiy district, the Kyiv Post eventually located several at a sex shop.WHO to rescue?Ukraine’s Health Ministry on Oct. 30 confirmed Ukraine’s first swine flu-related death, and the government ordered Ukraine’s schools closed and banned public gatherings – including election campaign rallies – for at least three weeks.Yushchenko the next day focused world attention on the country’s flu problem in a letter calling on the European Union, the World Health Organization, NATO and other nations to come to Ukraine’s assistance. The dramatic appeal came amid media reports that helicopters were dropping chemical agents to prevent the spread of the plague.A team of nine flu experts from the WHO arrived in Kyiv three days later on a two-week fact-finding mission to evaluate the clinical and epidemiological situation in the country and help the government cope.“This is a serious matter,” said Glenn Thomas, WHO media officer. Earlier this year, the WHO provided Ukraine’s health ministry with comprehensive information on prevention and management of the swine flu virus, also donating 61, 000 packs of Tamiflu, 4, 000 flu test-kits and diagnostic equipment.The Verkhovna Rada, Ukraine’s parliament, on Nov. 3 enacted legislation allocating an additional $131 million (Hr 1 billion) for flu response measures, in addition to another $12 million for funding other unspecified flu prevention measures.The armed forces and Emergency Ministry, meanwhile, have been instructed to prepare portable military hospitals, and the government has promised to provide all of the country’s regions with enough gauze to sew their own face masks.Though the country has imposed several social-distancing measures, such as a three-week school closure set to expire on Nov. 23, no general quarantine is in effect. Officially, 10 western regions are under quarantine, but it is loosely enforced.Americans in Ukraine looking to get better prepared than Ukrainian nationals are out of luck. A message posted on the U.S. Embassy’s website says officials are aware of the swine flu outbreak and are monitoring the situation, but “because of legal restrictions and lack of resources, we are not able to provide private citizens with pandemic supplies, medication, medical treatment, or medical advice.”Symptoms, prevention and treatmentDeputy Health Minister Bilovol on Nov. 4 predicted almost a quarter of Ukraine’s 46 million inhabitants could come down with the flu or other acute respiratory viral infections over the next year.“Taking into account the susceptibility to the pandemic virus, about 12 million people could be infected,” Bilovol said during a conference call with the heads of the country’s regional administrations. The estimate, he said, is based on “a tried-and-true” epidemiological forecast taking into account WHO recommendations and general information about how the swine flu pandemic developed in other countries.The symptoms of the H1N1 flu are similar to any other seasonal flu and involve pain in muscles and joints, sore throat, elevated body temperature, cough and runny nose, and, in some cases, vomiting and diarrhea.Swine flu spreads from person to person through droplets that are released when a person coughs or sneezes. Someone sick with A/H1N1 is usually contagious for 7 days, starting from the onset of the illness until the flu-like symptoms disappear.“The virus spreads just like any other seasonal flu. The only difference is that people don’t have any immunity to it. Therefore, when exposed, they usually get sick,” Myles Druckman, vice president of International SOS, told the Kyiv Post on Nov. 3.Druckman said educational measures are “critical” in tackling the epidemic because they make people less anxious.“One of the best ways to protect oneself is frequent hand-washing, coughing in the elbow and cleaning the workplace,” Druckman said. “You don’t need any fancy cleaners, just soap and water will do the job.”According to the guidelines released by Ukraine’s Health Ministry, anyone sick with flu should be immediately put into bed and isolated from family members and public places, including transportation or educational institutions. They must call a doctor, take an antipyretic such as paracetamol to control high fever and drink plenty of fluids. Patient who experience trouble breathing, very high fever, nosebleed, seizures, cyanosis, diarrhea and vomiting should seek emergency medical help.Panic subsidesThe highest waves of panic came during the last week of October. On Oct. 30, people lined up at pharmacies, but had difficulties getting medicine and masks. Kyrylo Katyshev tried to get home to Rivne Oblast that day, but learned from a police offer that “no one is allowed to leave the oblast” because of the flu. WHO guidelines, however, say that travel restrictions are generally ineffective at stopping the flu’s spread.From Lviv, near the Ukrainian center of the epidemic, Kyiv Post columnist George Woloshyn wrote on Nov. 2: “People are going about their business and taking precautions but, otherwise, accepting this as simply another difficulty that will go away in time. The only critical comments heard are complaints that the authorities had not provided for an adequate supply of masks. They contrasted the government’s handling with that of Mexico, where medical assistants were handing out masks in public squares and transit areas. Such items as masks should have been stockpiled for this or any other emergency, rather than rushed from neighboring countries.”Ihor Pokanevych, head of the WHO office in Kyiv, told Deutsche Welle on Nov. 5 that health authorities are watching to see if the seasonal strains of the flu and the swine flu will mutate into more virulent form of virus. Ukraine has become a test case of sorts.“The outbreak in Ukraine may be indicative of how the virus can behave in the northern hemisphere during the winter season, particularly in health care settings typically found in Eastern Europe,” Pokanevych added.

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