Preparedness against SARS in Norway

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Preparedness against SARSin Norway

• Preben Aavitsland
• Department of Infectious Disease
  EpidemiologyDivision of Infectious Disease
  Control
• Norwegian Institute of Public Health
• (May 22, 2003)

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Current strategy against SARS

• Detect cases
• Isolate cases
• Trace contacts
• Follow up contacts
• Based on available knowledge
• May be adjusted
• Lowest effective level

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The roles of NIPH(Communicable Diseases Control
Act 7-9)

• Surveillance
• In Norway
• Internationally
• Guidance and services
• General guidance on infectious disease control
• Reference laboratories
• Vaccination programme
• Research

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Surveillance for SARS

• Starting March 16
• mandatory reportable to NIPH
• phone [phone] plus fax/letter
• According to WHO definitions
• Reporting to EU, WHO

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Guidance and services for SARS

• Guidance to public, health services and
  authorities
• www.fhi.no
• MSIS-rapport
• Epidemiologist on call 22 04 23 48
• Telephone, e-mail
• Public hotline [phone]
• Conferences
• Mass media
• Reference lab
• appointed by MoH

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Research

• Virology
• Specific immunoglobulin (with Affitech)
• Vaccine (with Bionor)
• Scenarios

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Are we prepared?
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Positive features of Norwegian society

• Well organised
• Knowledgeable population
• Wealthy people and government
• Sparsely populated
• Good health system
• Advanced science

• Democracy
• Free press
• Trust in Government
• Strong state
• Modern communicable disease law
• Not dependent on tourism

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Negative features of Norwegian society

• Complacency?
• Never had a problem like this
• Never tested our preparedness
• Not mentally prepared for extreme measures

• Egoistic?
• Xenophobic?
• Infectious disease epidemiology not very well
  developed
• Used to 100 security accept no less

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Scenario

• Municipality of 5000
• Man 45, fever, malaise and diarrhoea after trip
  business trip to Singapore
• Patients delay two days
• Been to cafeteria, cinema, work place, friends
  homes etc. while mildly sick

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Scenario continued

• Admitted to hospital for diarrhoea
• 300 beds, 1000 employees
• Misdiagnosed as enteritis for two days in
  hospital
• Waited in emergency room
• Been in single room and X-ray department
• Episodes of diarrhoea in bed

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Do we have the municipal capacities?

• Personell
• for contact tracing and follow up
• for dealing with mass media
• for dealing with the worried well
• Gloves, masks, gowns
• Thermometers
• Ambulance for bringing the next patients to
  hospital

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Do we have the hospital capacities?

• Personnel
• for caring for many patients
• for replacing sick staff and contact staff
• for contact tracing and follow up
• for dealing with mass media
• for dealing with the worried well
• for supporting health care personnel
• Gloves, masks, gowns
• Isolation rooms
• ICU beds, respirators

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Do we have the national capacities?

• Personnel
• for supporting the health services
• for informing the public
• for dealing with mass media
• for dealing with the worried well
• for conducting surveillance

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Conclusion

• Strategy is clear
• Detect and isolate cases
• Trace and follow up contacts
• Information level is high
• Norway is seemingly well prepared
• SARS is an extreme threat
• Extreme capacities may be needed
• Are we prepared for the big one?