Health Secretary Nicola Sturgeon
Statement to the Scottish Parliament
Thursday, June 11, 2009
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I am grateful for this further opportunity to update Parliament on the current situation in relation to the Influenza A (H1N1) flu virus.
As of this morning the World Health Organisation reports that 27,737 cases of A/H1N1 have been officially reported across 74 countries. 2500 of these cases have been reported in the last two days. There have been 141 reported deaths in 5 countries.
A total of 797 cases have been confirmed across the UK, with a third of these in Scotland. As of yesterday, there were 311 confirmed cases across 7 health boards in Scotland and 522 possible cases. We have no probable cases.
The WHO's pandemic alert remains at level 5. However, it is likely in light of sustained community transmission in countries outside of North America - most notably in Australia - that level 6 will be declared later this morning following the WHO's Emergency Committee meeting at 10am in Geneva.
Members should be aware that a move to level 6 is not a verdict on the severity of the virus; it does not mean that the WHO thinks the virus has become more serious. It simply means that the extent of global spread now fulfils the definition of a pandemic.
A move to level 6 means that countries need to be ready to implement pandemic plans immediately.
However, it is important to stress that as we are already operating at a heightened state of readiness, a move to level 6 will not trigger any material change in our response.
As I made clear in my statement of 14 May, a move to Phase 6 may mean a change in the schedule for delivery of the H1N1 vaccine we are now procuring. Phase 6 would activate pre-existing contractual arrangements for securing pandemic vaccine and would cause adjustments to worldwide vaccine production timetables which would mean that the UK receives supplies over a longer timeframe, a change which we have of course factored into our contingency planning.
Presiding Officer.
As the numbers show, we have seen a rapid increase in the number of confirmed cases in Scotland over the past 10 days. Based on this experience, Health Protection Scotland has expressed the view that sustained community transmission appears to be taking place. This data is being shared with the Health Protection Agency for analysis on a UK basis.
The highest numbers of cases confirmed so far are within the 15-24 year age range. There has only been 1 reported case over the age of 65 years.
Of the 311 confirmed cases in Scotland, 18 have been admitted to hospital for clinical reasons, giving us a hospitalisation rate broadly in line with that in the US. 5 have required management in an intensive care or high dependency unit. 2 of them are critical but stable and the other 3 are stable.
I want to emphasise that while we are seeing a small number of people develop complications - most of whom have underlying health conditions - it is still the case that the vast majority of people contracting the virus are experiencing relatively mild symptoms.
We are still working hard to disrupt and slow the spread of the virus. This policy has been successful in limiting the transmission of the virus over the last 6 weeks and in areas where there are only a small number of isolated cases the current level of containment will continue to be appropriate.
However, where more sizeable clusters arise and where there is evidence of community transmission - such as we have seen in Dunoon, Glasgow and Paisley - our current approach of tracing and offering prophylaxis to all close contacts becomes less effective. In addition, because it involves giving antivirals to very large numbers of people, many of whom will not be ill, the risk of the virus developing resistance to Tamiflu increases.
Yesterday's meeting of COBR therefore agreed a number of refinements to build more flexibility into our approach and better target the measures for containing the virus towards those who are at greatest risk.
These refinements will now be applied in those areas of the country where they are deemed appropriate by public health assessments. They include:
· the use of clinical diagnosis rather than laboratory testing where there is a high probability due to close contact with confirmed cases that symptomatic people are positive;
· continued antiviral treatment of all those who have the virus but more targeted use of antiviral prophylaxis, based on local risk assessment and limited to contacts considered most at risk of contracting the virus - in practice that will be mainly household or household-like contacts, or in a school context, those at surrounding desks; and
· the restriction of contact follow up to those most at risk.
Decisions to close schools will continue to be taken on a case by case basis, following robust risk assessments and advice from Public Health officials.
As of today there are 15 schools and nurseries across the country either closed or partially closed, of these 7 are full closures. May I take this opportunity to extend both my and Fiona Hyslop's appreciation to education departments and staff for their hard work in managing the situation at affected schools and nurseries and to parents for their understanding and co-operation.
The refinements to our containment strategy are based on expert advice and are appropriate to the reality of what we are dealing with now. However, there will come a point when even this more flexible approach to containment will no longer be effective and the focus will shift from containing the spread of the virus to mitigating its impact.
This mitigation phase has always been anticipated in our pandemic plans and very significant preparation and further planning for this has been carried out in recent weeks involving Health Boards and NHS24.
Presiding officer
I want to touch now on a number of issues relating to NHS preparedness.
Health Boards across the country have dealt exceptionally well with the outbreak so far. NHS Boards have built on their winter, pandemic flu and business continuity plans and next week, as part of this routine planning, NHS Board Chief Executives and Chief Operating Officers will be meeting with officials to discuss planning for the coming winter. In particular, they will consider what lessons have been learned from the outbreak of A/H1N1 so far and how we can best plan for potential escalation if that is required.
In addition to the work of territorial Health Boards, it is important to remember that, since the first cases of swine flu were confirmed in Scotland, NHS 24 has dealt with a significant increase in the number of calls to its core out of hours service. This includes the dedicated flu line. Last week, when further cases were announced, NHS 24 saw, on average, an increase of around 30% in the number of calls coming in.
I am pleased to report that NHS 24 has coped extremely well with the rise in call demand, with more than 98% of calls being answered within 30 seconds and an average time to answer of around four seconds.
The most recent development has been the setting up of the Scottish Flu Response Centre, based at NHS 24's Cardonald contact centre and working in conjunction with Health Protection Scotland and Health Boards across Scotland. This has been established to help deal with any developments in the spread of flu. It will provide vital information, advice and reassurance to the public and to health professionals concerned about the virus and how it may affect them.
Finally, let me touch on wider preparedness. The effects of a pandemic have the potential to have a wide-ranging impact, even if the symptoms continue to be no more serious than seasonal flu. Many agencies are already well prepared to deal with these effects. But we are continuing to work with our partner organisations to enhance their levels of resilience.
We are working closely with Scotland's 8 Strategic Co-ordinating Groups to ensure the emergency services and other members of these groups are working well together to refine their arrangements. Although we are in regular contact with these groups we will be hosting a specific meeting on 24th June to take stock of progress and address any specific issues.
Colleagues will be aware that a pandemic has the potential to put some sectors under very considerable strain. Under some scenarios, maintaining "business exactly as normal" will not be possible or practical. In order to anticipate such challenges, we are - in partnership with other administrations across the UK - continuing to ensure that our planning takes account of any eventuality.
The recent rapid increase in the number of cases in Scotland has undoubtedly put increased pressure on health and local authority services. I would like to take this opportunity to thank all staff working in front line services - including GPs, nurses, doctors, teachers, social workers and social care staff - for all of their efforts in tracing, treating and caring for those affected by this outbreak.
I would also like to assure members that I will keep parliament updated on any developments.