Emerging infectious diseases: Asian SARS experience useful for strengthening New Zealand's preparedness, says MOH nursing advisor.

Ministry of Health Chief Nursing Advisor Dr Francis Hughes has recently been attending both the Asian/Pacific forum on SARS in Sydney and the Emerging Infectious Disease forum in Wellington. Here she describes the state of play with what is now recognised as the first serious and readily transmissible infectious disease of the 21st Century.

Emerging infectious diseases (EIDs) present a particular threat to all health services and are expected to continue to present challenges at unpredictable times and intervals. While it is always possible that an EID will be a novel or previously unknown disease, this may not always be the case. in many parts of the world old diseases are re-emerging as an active threat to populations.

Severe acute respiratory syndrome (SARS) is commonly recognised as the first serious and readily transmissible EID of the 21st century, but it is certain it will not be the last. Health service impacts and disruption in countries that experienced SARS outbreaks were severe, though worldwide fewer than 9000 people developed the condition, with about 900 deaths. Despite the relatively small number of infected patients, direct health service delivery was severely impacted, both at the affected sites and beyond, often as a result of successful measures to stop the spread of the disease.

While traditional public and primary health measures played a key role in eventually halting the spread of SARS, and will be central in combating other emerging infectious diseases, clinical response in primary and secondary/tertiary care an important lesson played a central role in preventing or halting the spread of infection.

New Zealand was fortunate enough to avoid importation and local transmission of the SARS virus during the 2003 international crisis. New Zealand health agencies and personnel worked intensively and largely successfully on response planning. Lessons learned during the preparation for SARS and in review of the New Zealand response were many, including the need for consist, effective and timely communication lines and information; and clarity around responsibility and accountability.

THE INTERNATIONAL SCENE

In April this year, the World Health Organization and AusAid funded a CNO (Chief Nursing Officer) forum in Sydney, Australia, which brought together senior Government nurses from 21 countries from throughout the Pacific and Asian regions to share learnings and experiences of SARS.

It was learnt at the forum that SARS proved to be a disease that mainly spread within hospitals, with the most sophisticated hospitals being the worst affected, infecting many health care workers as well as patients. Its effects therefore were not limited to actual mortality and morbidity (though these were significant) but also included catastrophic indirect consequences for the health systems concerned. Hospitals were forced to shut their doors as clinical staff became sick or were quarantined, and patients needing isolation were unable to be managed, Primary nursing practice ceased, and in Hong Kong health workers were restricted to 11 contacts per day to manage the exposure to the virus.

Additional issues began to emerge, such as the fact that the protective masks did not fit Asian faces. Health professionals 'nurses and doctors' were shunned in their local communities. Taxis and buses refused to pick up health professionals in uniform, tearing they would transmit the disease. Landlords refused to rent property to health workers. Families asked health workers to quit their jobs, Insurance companies would not insure health workers.

Health services that were able to quickly implement effective infection control processes lessened these impacts and contributed significantly to the eventual eradication of EARS from their region.

THE EMERGING INFECTIOUS DISEASE FORUM, WELLINGTON

As a result of the discussion held at the CNO forum, it became apparent there were lessons for New Zealand nurses. Greater levels of education and ongoing training in infection control amongst health professions in New Zealand were necessary to ensure the safety of patients and health professionals.

To engage professional organisations and to better understand the nursing and medical workforce capacity and capability to respond in the event of an emerging infectious disease, the Ministry held an EID forum in Wellington on 7 May. The forum provided the opportunity for the Ministry and health professionals to:

* share what had been learnt from international and New Zealand SARS experiences

* identify the known and potential gaps in the nursing and medical workforce capacity, flexibility, skills and resources

* identify the impact on nursing and medical training, education and ongoing competencies

* learn and discuss ways of managing professional ethical issues relating to care

* dentify related regulatory issues that impact on professional registration.

Dr Judith Shamian, the Executive Director, Office of Nursing Policy, Health Policy and Communications Branch, Health Canada shared learnings from Canada's experience. Or Frances Hughes and Dr Jill White provided a summary of learnings from Asian and Pacific regions

DISCUSSED AT THE CNO FORUM IN SYDNEY

Feedback from the forum was very positive, and clarified the importance of acting on the SARS experience to improve New Zealand's ability to respond to emerging diseases. Information gained from the forum will inform and contribute to curriculum planning and ongoing competencies.

A NATIONAL PLAN FOR HEALTH SERVICE RESPONSE TO AN EID-RELATED EMERGENCY

As part of improving New Zealand health services' ability to respond to an EIB-related emergency, the Ministry of Health has been developing a national plan. Previously, much planning work had already been done around the New Zealand health service response to a large influenza epidemic or pandemic, but this new plan broadens that to include what was learnt from the SARS experience.

The resulting plan provides a framework for a structured local, regional or national sector-wide response to an EID-related emergency for primary, secondary and tertiary services in the event of the treat of any EID. The preparation of this document has involved extensive consultation with DHBs and health professionals. Robust systems to assist in the management of an emerging infectious disease within the Ministry of Health are also being identified and developed.

THE PRINCIPLES UNDERPINNING THE PLANNING IN THIS DOCUMENT ARE TO:

1. provide the greatest possible protection for the population at large, all health service workers and health service patients

2. protect and maintain business as usual at local, regional and national levels for as much of the health service as possible

3. provide the best available clinical care.

The plan will be completed by 30 June 2004.