‘A lot of work has been done to make sure we are prepared’
Director of public health Dr Nicola Brink gives an update on the measures Health & Social Care has in place to prepare for the possibility of a coronavirus pandemic.
When asked if the island had faced a pandemic like this before, Dr Brink pointed to swine flu in 2009, but said the island was already prepared with a pandemic influenza preparedness plan.
‘We have developed and reviewed that plan further and it’s directly applicable to any emerging respiratory disease, so we are using the pandemic flu plan as we manage the evolving events.’
She said a lot of work had been done to look at the island’s preparedness, including primary care, secondary care, the emergency department and diagnostic capabilities.
‘What we have to realise is that we are at the tail-end of flu season and not only do we have some seasonal cases of influenza, there is another virus circulating called respiratory syncytial virus (RSV) which we see commonly in winter months as well.
‘So we have to balance between making a diagnosis between a possible novel coronavirus infection by the more likely outcome of a respiratory viral infection such as flu or RSV.’
Islanders who suspect they have a respiratory virus are encouraged not to just turn up at hospital or a doctor’s surgery but to isolate themselves and call their GP.
If the novel virus is suspected, a nose and throat swab sample is taken from the person and tested locally in a lab to look for flu A, flu B and RSV, but to provide people with the best possible care, a second nose and throat swab sample is taken. That second sample – for those who fit the possible diagnosis for the novel coronavirus infection – is sent to a laboratory in the UK for specific coronavirus testing.
People who have travelled to the relevant areas [mainland China, Hong Kong, Japan, Singapore etc] in the previous 14 days or have had contact with a diagnosed case of coronavirus would fit the criteria for the second swab.
Clinical symptoms including coughs, shortness of breath and fever also help doctors determine who needs specific coronavirus testing as opposed to regular flu A, flu B and RSV testing.
‘We have protocols in place as to where we would receive someone, where we would carry out diagnostics [the testing is currently all done within the PEH but it is likely that it will be rolled out to other places in the community in the future], and we have identified where in the hospital we can manage people safely in the negative pressure rooms.’
The PEH has six negative pressure rooms, which are used for managing people with infectious diseases. These have a special ventilation system that lets air into the room but not back out into the rest of the hospital. Should those six rooms be full, patients could be concentrated in a particular ward.
Transfers to the UK have also been looked at and how that might be managed safely, but it would depend on the clinical situation and availability of resources in the UK.
‘This all forms part of our pandemic flu plan, but we are nowhere near that – we haven’t even had a positive case in the Bailiwick yet, so it is all about being appropriately and proportionately prepared. As of today [11 Feb 2020] we have gone to the Health & Social Care committee about making the coronavirus a notifiable disease, which would enable us to enforce quarantine.
‘We have a group of doctors, nurses, pharmacists, primary and secondary carers, clinicians and ambulance servers who work together to provide scientific and technical advice to the pre-assessment team and we have briefed our civil contingency team as well.
‘We have also checked stockpiles to ensure we are prepared and have been updating staff training on the use of personal protective equipment.’
Dr Brink said an awful lot of work has gone on to ensure the island was as prepared as it could be to receive a diagnosed case.
Advice is being issued for people to phone GPs with information about their clinical symptoms and travel history, not to just attend surgeries or hospitals.
‘If someone did attend, we would assess every situation on a case-by-case basis and look at the individual circumstances and we would then either arrange transport to the hospital or they would take themselves.
‘Based on those circumstances we would make a judgement if this is a suspected case of the novel coronavirus and secondly, if it is a suspected case, what is the appropriate transport to hospital where all testing is taking place.’
Public Health England has released guidelines on infection control which Guernsey’s health officials are following to the letter.
‘One of the things I think we must not be scared to say at this time is that this is an evolving situation and we are literally getting new information and advice on a daily basis.
‘Some of the useful information that has come out is from the World Health Organization, which gave us a summary of the first 1,000 cases.
‘What was interesting from that was that 81% of those cases were ‘‘mild’’ with only the remainder being ‘‘severe’’ and 3% ‘‘critical’’.’
Should an incident occur in a doctor’s surgery, a school or another facility, health professionals would go in and assess whether it fit the coronavirus case definition, testing would be done on how sick the person was, whether they were coughing etc, and then an overall assessment would be done and based on that, appropriate decontamination would be advised.
‘We very much stick to the Public Health England guidelines on this and they are very, very robust,’ Dr Brink said.
‘It is not possible to have a one size fits all approach as it would very much depend on the person and the circumstances – our advice will be tailored to those particular circumstances.’
Results from the UK lab take about two to three days to get back [see story in facing page], but as testing is being rolled out to other labs in England it is likely that the diagnostic time will reduce. ‘To put it into perspective, we’ve tested seven people locally in Guernsey, however, the UK tested hundreds before they got a positive result.’
She said people who were at the most risk were those over the age of 65 and people with underlying medical conditions.
This pandemic is being treated and prioritised differently to seasonal flu because it is a new virus that has emerged into the human population. It is a virus that the world’s population had no exposure to before around November/December 2019. As a new virus it has the capability to be spread more widely because there is no inherent population-based immunity to this viral infection.
Also, with the emergence of any new virus into the human population, there is a degree of uncertainty about exactly what the impact on the population will be.
‘We are now getting a better feel for the clinical symptoms and the mortality/severity but it is something that is evolving fairly rapidly,’ she said.
Fewer than 10 people have been asked to self-isolate so far. There are different groups of people who could be asked to do so; anyone who is awaiting novel coronavirus infection test results, anyone who has returned from mainland China in the past two weeks or anyone who has returned from any countries with known cases and is showing symptoms of the virus.
As a small island, Guernsey has just one hospital, one emergency department and a finite group of doctors and nurses.
Dr Brink explained: ‘We saw this with swine flu; if one area was particularly badly affected you could perhaps get help from another area. We have a single hospital and a smaller group of health professionals, so from a resilience point of view our smallness allows us to look at very effective control measures.
‘But equally we do not have a second hospital to rely on, we have one set of operating theatres, one intensive care unit, one emergency department so from that point of view it’s a greater threat to us.’
However, she noted that Guernsey has a very willing society that is keen to work together to minimise the risk of any infection to our island.
Important infection control measures are always being enforced, such as washing hands thoroughly and using an alcohol rub when possible, as well as the ‘catch it, bin it, kill it’ campaign.
‘Around 60% of secondary transmissions can be prevented by good infection control,’ she said.
There are so many unknowns about the virus and how it would spread would depend on individual cases of exposure.
R-zero is a formula to work out how many secondary cases there are for a single primary case.
‘The R-zero is currently estimated at R-2.2, which means that we are expecting around about two secondary cases for every primary case. What we don’t know is what the impact of good infection control around a primary case would be. What we are looking at now is the indication of any cases and then trying to prevent secondary transmission from those cases.’
She said it was possible that a vaccine would be available by the end of the year, so they will then look at trying to immunise people once that becomes available.
Dr Brink was particularly impressed with the degree of community support and the co-operation from the public in self-isolating when told and working to keep the Bailiwick as safe as it can.
‘If someone is self-isolating, they are actually doing that for the good of the community and we need to value and appreciate that.
‘Obviously if someone is self-isolation you cannot pop round for a chat but you can call them up, keep in contact with them remotely, ask them if there’s anything they need and drop it off on their doorstep. ‘It’s really important and from our perspective, one of the things we really appreciate is the amount of support that we are getting.’
Dr Brink emphasised how long had been spent on being prepared for pandemics such as this and being able to cope locally.
‘What I like to do is be well prepared so that if or when we get a case, we have thought what we are going to do, how and where we are going to manage someone, what our thresholds for providing transfer would be etc.
‘Is it being treated as an urgency? It is certainly being treated as a priority.’
Advice for Guernsey people looking to travel to countries with known coronavirus cases is the same as the Foreign & Commonwealth Office advice.
Some areas are not recommended to travel to, but Dr Brink said from Guernsey’s point of view is to stick to the Commonwealth Office advice.
‘People of course decide that they want to do their own risk assessment, particularly because it is a rapidly changing situation,’ she said.
The FCO is currently advising against all travel to Hubei Province [where the first case of novel coronavirus was reported], and against all but essential travel to the rest of mainland China. If you’re in China and able to leave, you should do so.
The FCO is not advising against travel to any other country/territory as a result of coronavirus risks, but travel advice remains under constant review.
Some airlines, including British Airways and Virgin Atlantic, have suspended flights to and from China, or revised their schedules. Other flights in the region may also be affected.
If you’re due to travel on an affected route, keep up to date with the latest information from your travel company or airline.
As of Wednesday afternoon [12.02.2020], there were more than 42,700 confirmed cases and a further 23,500 suspected cases.
Deaths from the virus had reached over the 1,000 mark with more than 100 in just one day.
25 countries had been affected with confirmed cases.