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How Good is the BC Pandemic Plan?

If swine flu hits hard here, what the province can and will do is sketchy. Read for yourself.

By Crawford Kilian, 5 Oct 2009, TheTyee.ca

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The first thing we need to understand about the provincial pandemic plan is that it's over four years old.

That speaks well for our health system's foresight, but you'd think they would have updated it a bit since H1N1 broke out last spring.

Even so, it's a pretty grim document. This is how it foresees the impact of a pandemic on four million British Columbians:

BC's Official Pandemic Plan

The document posted on the web hasn't been changed in four years. You can read it here.

Over 3 million of us infected. Up to 1.8 million of us clinically ill. Up to 610,000 visiting a healthcare provider. About 18,500 needing hospital care. As many as 6,800 of us dying from flu or its complications.

And these forecasts assume that H1N1 will be like the pandemics of 1957 and 1968, which were far milder than the 50-million toll of the Spanish flu. (A recent article draws some close parallels with 1957.) However, 3 million infections would imply a 75 per cent attack rate, which sounds like a catastrophe -- and 6,800 deaths implies that over a third of all those hospitalized would die.

The plan itself is relatively brief, only about 30 pages, with over 150 pages of detailed "annexes." Its assumptions have so far been largely vindicated, like the appearance of a second wave of cases within three to nine months of the first one. But it remains to be seen if the second wave will be more serious than the first.

The plan defines the Ministry of Health and the provincial health officer as the "lead authority" at all stages of a pandemic, but it recognizes the roles of other organizations like the B.C. Centre for Disease Control and the Health Authorities.

Significantly, it says: "every B.C. government ministry, crown corporation and local government is also responsible for developing its own plan to ensure that key public services continue to be available during a pandemic."

But I am aware of very few such plans. School districts seem simply to be following the guidance of their local Health Authority, and a search of the city and district of North Vancouver websites found no mention of a pandemic at all. Vancouver itself mentions an Emergency Plan for Public Health but offers only a bullet-point list of its elements, not the plan itself.

The provincial plan says municipal governments, school boards and health authorities may be eligible for emergency financial aid if a pandemic forces them to extra expense. Whether this part of the plan is still operative remains to be seen. Given recent provincial cuts to just such agencies, it seems unlikely.

No surge capacity?

The provincial plan offers detailed estimates of the numbers likely to fall ill, to seek medical attention, and to require hospitalization. But it is surprisingly silent on whether our hospitals could actually handle such numbers. Instead it offers a link to a spreadsheet program, FluSurge, an American program last updated in 2007. This presumably gives health authorities and individual hospitals a sense of what they could face.

But the health authorities' own plans are surprisingly out of date. Vancouver Coastal Health, for example, has a plan dated Sept. 2007 focused on bird flu. It says nothing about anticipated hospitalizations or need for extra healthcare workers. Even the "acute plan," written in 2006, is largely in the future tense, detailing what will need to be done, but saying nothing about whether the resources will be available.

Equally disturbingly, plans say little or nothing about logistics. Hospitals in the U.S. are already ordering more tents, turning their parking lots into flu wards. Do our hospitals have similar plans, and will enough tents be available if needed? We simply don't know. Nor do the plans tell us about availability of ventilators, ambulances and paramedics, and cleaning staff.

Building networks

The pre-pandemic plan calls for "capacity, cooperation, and communication networks" to be in place before the pandemic hits. So far, these essentials seem to be working reasonably well. The same is true of vaccination planning, but we don't yet know what the Health Authority organizations are doing to "develop strategies for situations where people refuse vaccine or cannot be vaccinated because of medical contraindications." Many of these people are employees of the Health Authorities who will refuse the vaccine when it arrives.

In the pandemic itself, the plan allocates various responsibilities to the province and the Health Authorities under six categories: emergency response, vaccine, antivirals, clinical health services, surveillance and communication. The tasks are straightforward, but those of us outside the government and healthcare professions may have no idea how well they're being done. Both the province and the Health Authorities seem to be carrying out their communication tasks, at least on the web, through sites like the B.C. CDC and the B.C. Ministry of Health.

Vaccines and questions

While the plan also calls for internal communication within the healthcare system, this may have worked too well. Recently, a report co-authored by the B.C. CDC's Dr. Danuta Skowronski caused nationwide confusion about vaccination schedules for both seasonal and pandemic flu strains.

Evidently still under peer review for an unnamed scientific journal, the report is said to have found that persons who get the seasonal flu shot are more likely to then come down with pandemic flu. As a result of this, only B.C. seniors will receive seasonal flu shots this fall. The assumption is that they already have some immunity to H1N1 thanks to having lived through the 1957 and 1968 pandemics. Everyone else will get the pandemic vaccine first, and the seasonal vaccine next year.

We will have to wait to see if this decision was a wise one or not.

Lessons learned

After the pandemic, the plan calls for documenting "lessons learned" in each of the six categories. Only then will we be able to judge the pandemic's severity, although it seems likely that we will never know exactly how many British Columbians fell ill and how many died due to H1N1.

One lesson that seems obvious is include present and anticipated inventories and personnel in future pandemic plans. Otherwise, the plan amounts to putting ham and eggs on the menu without ensuring that ham, eggs, and a cook will be available.

The current plan expects a resumption of "regular surveillance activities," but does not mention long-term follow-up on the impact of the pandemic. For example, in the 1918-19 pandemic, many babies born to infected mothers in that period appear to have suffered lifelong health and intellectual impairment. Adult survivors of the Spanish flu may have suffered higher rates of Parkinson's disease later in life, as well as the mysterious sleeping sickness encephalitis lethargica.

If H1N1 survivors suffer such ailments, careful surveillance over decades may be needed to identify them and develop effective responses.

Ironically, one of the "lessons learned" from earlier pandemics -- and even from recent outbreaks of bird flu in humans -- is that most people prefer to forget about the experience as soon as possible. So it will take far-sighted politicians to ensure that long-term study of this pandemic will continue long after the politicians themselves have left office. [Tyee]

Tyee contributing editor Crawford Kilian blogs about pandemic flu at H5N1.

21 Comments:

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  • Camero409

    2 years ago

    H1N1 Farce

    This so called pandemic is really nothing other than a regular, natural occurrence every year. Obviously big pharma wants government to "scare" us into accepting the injection. I'll bet dollars to donuts that more people get ill from the cure than the real thing. Me? I not falling for it and I never have. By the way, I'm 65. I have never taken a injection for flu and never will.

  • alive

    2 years ago

    There is a reason it gets press

    Guess who profits from Tamiflu vaccine?
    10% goes to Donald Rumsfled former US Secretaty of defence !
    Need I say more?

  • Ed Seedhouse

    2 years ago

    Er, Tamiflu is not a

    Er, Tamiflu is not a vaccine. It is an antiviral.

    Like any vaccine or any drug, there are risks involved with taking them. The question is, do the risks outweigh the benefits?

    In the case of the vaccine, the risk of getting vaccinated are real, but far, far lower than the risk of getting the flu and dying from it.

  • lynn

    2 years ago

    Tamiflu

    Rex Murphy had a phone-in on the flu on CBC radio yesterday....very revealing in regard to both widespread public confusion and fear... and also that many doctors themselves are unsure of protocol to be followed.

    One doctor phoned in, concerned about his patients, and asked what the protocol was concerning Tamiflu if he thought one of his patients had H1N1. Does he wait until the lab results come back giving proof positive before prescribing Tamiflu to his patient? The answer by the infectious disease expert was that the Tamiflu anti-viral should be started immediately.... that if you wait for lab results ( usually about 2 days) that it will not be effective. Must be taken right away.

    Just something to consider.

    If I have this wrong, please correct me.

  • silvervalley

    2 years ago

    Dr. Chris Shaw at an Anti-Forced Vaccination Rally in Vancouver

    He talks about the adjuvants and evidence of damage to cells
    http://www.youtube.com/watch?v=4-Y1Guvqrro

  • Intention Pure

    2 years ago

    CBC Radio just had Shelly

    CBC Radio just had Shelly Ross, head spokesperson for the BCMA, stating that telephone diagnosis is preparation for a pandemic. I am writing to state that I do comprehend the necessity of preparing for a pandemic, however, considering the implementation of telephone diagnosis of H1N1 for the "whole idea" of getting a Tamiflu prescription as any sort of "preparation" is preposterous.
    This is just another way that the BCMA (and other groups of professionals) are being used, under false pretenses, to market illness aka "selling sickness". Taking the oral anti-viral Tamiflu to combat the symptoms of this mild flu is dangerous and does prolong illness because taking it has been shown to INCREASE the chances of developing a secondary BACTERIAL infections, and it is these secondary bacterial infections that cause deaths, more so than the plain old flu virus itself.
    People contract a virus, with all its symptoms, but the death arises out of severe secondary bacterial infections usually in the lungs but also seen in nasal cavity, blood (septicemia),and other systems. It is also very dangerous, to the entire population, as it may increase the chance of the virus mutating to a more virulent form, through the development of tolerance to the anti-viral pill.

    Tamiflu stock is largely owned by Rumsfeld (US war criminal in my opinion) and Tamiflu can and does make people ill, and even prolong illness, and it can prevent fever which is an important step in fighting off the virus. These are important things to know, and so far, the large amount of fear and anxiety being created for an apparently mild flu virus seems to be aimed at influencing people's choices to use anti-virals and vaccines, and we have many "alphabet agencies" that are promoting this from a conflict of interest standpoint.

  • David Huntley

    2 years ago

    What is the vaccine effectiveness?

    Can someone please tell me what the effectiveness of any influenza vaccine is?

    The reason I ask is that I have been trying to find this information for about 3 years and have found very little information of any use.

    One small double-blind placebo-controlled experiment was done on people aged 60 or more in Belgium about 15 years ago; the results were published in the Journal of the American Medical Association v.272, 1661-1665, 1994. This showed that vaccination reduced the incidence of clinical influenza from about 3% to about 2%. There is more information in the paper but that gives one a general idea of the effectiveness in this case.

    That's all. If someone can find another double-blind placebo controlled study I would love to know about it. I have read twice from medical professionals that another study would be unethical. I cannot understand why this should be so.

    Now, there are more papers on the topic. A good example is a retrospective study of a large number of elderly people (New England Journal of Medicine Oct 4, and Dec 27, 2007). Retrospective means taking existing information. No double-blind. No placebo. The authors come to the unwarranted conclusion that vaccine has some beneficial effect. I say unwarranted because all the results can be explained by people interested in their health both being vaccinated and washing their hands regularly (and/or avoiding crowds). In fact there is an unplanned control in these data; in two of the years the vaccine administered turned out to be the wrong one for the prevalent influenza strain - and the results were no different!

    So, can someone please provide us with some good reliable data on the effectiveness of any influenza vaccine. As far as I can tell it doesn't exist. We need it.

  • Waldmeister

    2 years ago

    How Good is the BC Pandemic Plan?

    “There is no evidence that any vaccine thus far developed is effective in preventing or mitigating any attack of influenza. The producers of these vaccines know that they are worthless, but they go on selling them, anyway.” – J. Anthony Morris (Formerly Chief Vaccine Control Officer at the US Federal Drug Administration)

    And just why is Dr. Morris now (Former) Chief Vaccine Control Officer at the US Federal Drug Administration? How many recall the swine flu fiasco that was promoted by the United States Center for Disease Control (CDC) and other branches of the U.S. Public Health Service in 1976? Because of this government sponsored health fraud, 40 million Americans were vaccinated against a disease which never existed – with a vaccine that would not have worked even if the disease had existed. Dr. Morris sounded a warning of the hazards and uselessness of the swine flu vaccine program before it was instituted and was fired as a result of his warning.

    Even before the vaccine was administered, the public health service realized the vaccine would produce fevers in about 10% of those injected. This comes to a figure of 4 million people who suffered the needless pain and discomfort of a fever. A conservative estimate of 10,000 deaths may be attributed to this program. The swine flu vaccine has also been linked to approximately 1000 known victims of the Guillan-Barre syndrome, a disease in which the body’s own immune system is stimulated to attack nerves, resulting in paralysis .

  • Waldmeister

    2 years ago

    Tamiflu - an approved treatment for swine flu?

    Tamiflu has some potentially very serious side effects and public health is NOT adequately warning British Columbians of the risks involved using this "flu" remedy.

    43 cases of serious skin reactions in the United States FDA’s Vaccine Adverse Event Reporting System (VAERS), including 3 fatalities (all adults) have been reported. This includes 24 cases of Stevens-Johnson Syndrom (SJS is a deadly skin condition resembling acute full blown small pox covering the entire body), 14 cases of erythema multiforme, 4 cases of toxic epidermal necrolysis, and 1 case of pemphigus. In addition to these serious skin reactions, 75 other hypersensitivity reactions were identified from AERS and the literature. This includes 6-anaphylactic reactions, 6-anaphylactoid reactions and 17-anaphylactic shock reports.

  • mopled

    2 years ago

    Pandemics are not what they used to be

    WHO changed its definition of a "pandemic"...now it just means there are cases world wide, but means nothing in terms of how severe it is. Not only is it a scarier word, its use by WHO allows them to call for mandatory immunizations.

    Every year from now on there will be a flu "pandemic" under the new definition. It is VERY fishy.

    Alan Cassels, a drug-policy researcher with the University of Victoria and Jim Wright, professor in the departments of pharmacology, therapeutics and medicine at the University of British Columbia wrote this in 2005
    "A recent systematic review of more than 25 studies The internationally recognized Cochrane
    Collaboration (which accepts no money from the pharmaceutical industry)
    did a systematic review of all randomized trials studying the effectiveness of influenza vaccination and concluded that the evidence does not support universal immunization of healthy adults.

    This study found that the flu shot reduced the incidence of clinical influenza on average by 6 per cent, but there was high variability in effectiveness. There were not enough hospitalizations or deaths in the
    data to come to any conclusions as to what kind of payback the vaccines are delivering."
    http://www.policyalternatives.ca/monitorissues/2005/02/monitorissue1050/?pa=a60a3ae6

  • matken

    2 years ago

    Pneumococcal Vaccine (Pneumovax)

    Most of the serious consequences linked to swine flu virus are the result of pneumonia and an underused vaccine called Pneumovax can prevent or at least limit such complications in many people. It is estimated Pneumovax has the potential to prevent an estimated 1/3 of pneumonia deaths linked to swine flu. It's especially recommended when one becomes a senior (since they are most prone to die from pneumonia) but anyone over age 2 years can take it. This is not a new drug. It has been around for years. I personally had it when I turned 65. I wonder why this drug is never mentioned when the swine flu pandemic is discussed?
    However, there are several articles on the internet where doctors and health officials suggest talking to your doctor about getting this vaccine. It provides protection against certain types of pneumonia for 8-10 years. Check it out.

  • Intention Pure

    2 years ago

    Independent review of efficacy of flu vaccines

    The link to the Cochrane Collaboration at the end of this comment speaks to the efficacy of flu vaccines in general and states the best interventions and preparedness for H1N1 are NONPHARMACOLOGICAL. Incidentally, I am very, very, very, very, very happy with the stance the BCNurses Union has taken on H1N1 as they are ensuring that every nurse will have access to personal protective gear (N95 mask, gloves, gowns, etc) and we will be relying on this "tried and true" protection rather than insisting on vaccinating health care personel with the H1N1 vaccine. The chance that the virus will mutate is real, thus rendering the H1N1 vaccine useless in terms of protecting health care personel. We need to comprehend and prepare for this possible "pandemic" in ways that are not based on pharmacology (anti-virals and vaccines) but based on thorough comprehension and application of public health knowledge developed over decades of hard work by professionals. This evidence and knowledge can not be thrown to the wind in favor of pharmacology that treats symptoms. We need to address the root causes and modes of transmission, not spread false security (and possibly increased injury and fatality) through pharmacological interventions. http://cochrane.org/news/articles/influenza_2009.html

  • SicPreFix

    2 years ago

    Woowoo Festival In This Thread

    The simple, willful ignorance and belief in utter nonsense being expressed in this thread is nothing short of staggering, and truly frightening. Next thing we know one of you sages will be advising crystal therapy to fight cancer. Yikes!

    Anyway, I digress....

    For True Believers there is no evidence on earth, beyond their uninformed faith, that will convince. Nonetheless, as you are all (presumabley) adults, I post two links to highly credible, well researched founts of legitimate, soundly-based information regarding H1N1 flu, vaccines, and much other very important and highly relevant medical information:

    1. Science-Bzsed Medicine: http://www.sciencebasedmedicine.org/

    2. Effect Measure: http://scienceblogs.com/effectmeasure/

    If any of you would like to deplane from your Venusian orbit and rejoin planet earth, the vast volumes of real information at those sites might just save your life one day.

  • rockbysea

    2 years ago

    SicPreFix says:"vast volumes of real information at those sites

    ...more like vast volumes of establishment propaganda. I do not need to go to the links you posted to get this rubbish... all I have to do is turn on my TV and listen to the so-called "experts" in white coats.

    Enjoy your flu shots and please take an extra shot for me.

  • SicPreFix

    2 years ago

    rockbysea: head-in-sand

    Clearly you haven't gone to those sites and determined for yourself that in fact they are not what you call establishment propoganda whatsoever.

    It is specifically your kind of willful ignorance ("I don't want to see it so I won't look -- fingers in ears can't hear you, nya nya nya"), and presumably belief in woo, nonesense, and magical thinking that helps charlatans cause the damage they do.

  • rockbysea

    2 years ago

    many aint fallin for it sicfix. Only one sentence required

    "A quarter of a century after the Great Influenza pandemic, effective vaccines against influenza were in production."

    Effective? That is a load of crap.

    Like I said, "take an extra shot for me." And make sure to tell your doctor that you want your shots to contain an extra dose of aluminum hydroxide, thimerosal (mercury), phenoxyethanol (antifreeze), human diploid cells (originating from human aborted fetal tissue), squalene (linked to Guillain-Barré syndrome) and a little monkey kidney cell culture for good measure.

  • dunstergirl

    2 years ago

    what's happened here?

    I go away for a few months and come back to a Tyee unrecognizable, could be Fox News for all I can see. New editorial board or what?

  • SicPreFix

    2 years ago

    mopled: dictionaries are your friend

    The defintion of pandemic has not changed. It has always meant "world-wide". It is your misunderstanding that has falsely assumed it to mean something fishy.

  • urbansurfer

    2 years ago

    Don't trust them

    I have to laugh at the recent coverage regarding the H1N1 virus landing here in the Province. The government has tried to reassure the public that we are prepared for a significant increase in hospitalizations with the flu season just around the corner. As a Paramedic who works in the Lower Mainland I have an opinion which can be no further from the truth. The ambulance service is the front line of health care in this Province and we can barely handle the call volume as it stands right now. This has nothing to do with the current labour dispute, but with the current service levels and procedures imposed by the government.
    I can point to recent historical examples of senior care facilities developing an outbreak of gastrointestinal illness. The ambulance service will respond to numerous requests for service over a short time frame. These patients will be transported to a local hospital where paramedics will sit for extended periods of time with these patients. A single senior facility with a GI outbreak can utilize significant percentages of ambulance resources.
    Every shift paramedics climb into the back of an ambulance with sick & unhealthy patients. Therefore, if the pandemic hits BC with any strength I believe you would see a greater percentage of Paramedics sick than in the general population. Now our government states that they are going to transfer patients from hospital to hospital to deal with capacity issue? It doesn’t seem reasonable that a service already stretched beyond and capacity dealing with a pandemic would be able to handle what the governments plan purports to be.
    Over the phone triage? Seriously, to escape legal liability the first thing the doctor is going to say is call and ambulance and go to a hospital. That is already the process when dealing with the same aforementioned senior health care facilities. Let’s not kid ourselves here, this plan they are developing only deals with specific components of the health care system which will potentially fall apart when the forgotten front line is overwhelmed. Or did I miss the part where they were going to expand ER beds throughout the Province?
    From where I sit the government just patted us on the head and told us there are no monsters under the bed...to bad they have given us good cause not to trust them recently.

  • Crawford

    2 years ago

    Thanks for that

    Urbansurfer: Drop me a note at

    . I'd like to post your comment on my H5N1 blog, but I'll wait until you give me permission.

    Anti-vaxers: Thanks for letting us know how you're feeling, but you still haven't made your case. Strange though it may sound, others may be wiser, smarter, and better-informed than you.

  • rockbysea

    2 years ago

    Crawford and Sicfix: "Get Your Damn Vaccine"

    http://www.youtube.com/watch?v=CMqYlnAiIUU&feature=player_embedded

    For others:

    Vaccines’ Dark Inferno
    What is not on insert labels?
    September 29, 2009

    http://www.globalresearch.ca/index.php?context=va&aid=15452

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